These are all good and balanced points you are making.
However, I want to repeat that I think this applies to mainly to people whose suspected LPR began with a very sudden onset, usually after some kind of damage to the larynx (mainly viral).
Because I think people who happen to have neuropathy rather than LPR will often be on these boarRAB. The LPR treatments will not work for them, so they will go to these boarRAB in frustration.
But I will probably put some specific quotations from the articles I've read and downloaded in the coming days to help make a point about laryngeal sensory neuropathy.
Another thing is the problem of ppis in double blind studies show that they do as much for laryngeal symptoms as placebos. In several recent studies, placebo taking patients had relief of their symptoms at a slightly higher rate than those taking ppis. In your case, Mountain Reader, and others who "taste" acid or have accompanying gastro-intestinal issues, you have good reason to believe LPR is a good part of your problem.
But if you look at the symptoms of Laryngeal Sensory Neuropathy, or Post Viral Vagal Neuropathy, they are the exact same symptoms as LPR. So with LPR being very well-known, and LSN being barely known at all, all people who exhibit those symptoms are going to be treated for LPR. In my case, I tried various corabinations of ppis and lifestyle changes, and what I've found is, drinking espresso, eating at mcdonalRAB, and drinking frequently has caused some improvement in my case. I can't really explain that, if my case is related to acid reflux.
Also, this is a really important thing to think about: There are people on this board who say "after i got a cold, my lpr came back." or "my lpr goes for 2 or 3 months after i get a cold, and then disappears. Every time it's 2 or 3 months." How can that possibly be explained as acid reflux?
Another thing that bothers me is the questionable research of Jamie Koufman who is the authority on LPR. I know a lot of you have actually met her in person to sort out your LPR. She used to say in the 80s it was just basically GERD, but then as studies started to show that normal healthy people could give the exact same readings as LPR symptom sufferers, she started to say things like "only 3 drops of pepsin a week could damage the larynx tissues." She even tried to release some product called "Peptigon" in 2008, which never materialized, but its garish website is still up. I encourage you all to take a look. The point is this: When it was called into question that acid could do this, she switched and said it was pepsin, because the evidence increasingly made it hard for other doctors to believe that acid could be causing the laryngeal symptoms. Then she had to say "3 drops" a week could cause lasting damage. She has also tried saying that somehow LPR patients have different weaker cells in their larynx that can't defend the tissue as readily. I just find that all hard to swallow, personally.
If that was the case, wouldn't every annorexic in the world have LPR symptoms from their regular vomiting. Surely acid and pepsin gets prolonged exposure to their larynxes.
Another thing is when people say that the globus feeling is your upper esophageal sphincter muscles squeezing together to keep the acid out, it sounRAB like some kind of goofy folk wisdom to me. Like medieval medicine is alive and well in the 21st century.
Ok, I can't throw LPR out, because for one thing, I'm not a doctor. But what I'd suggest is that many of us on this board probably do not have reflux issues. If you have tried the LPR lifestyle changes and drugs, and have not seen improvement for months, and if your LPR had a mysteriously sudden onset for something that is supposed to be a chronic problem......then you might want to consider that you in fact have the little known laryngeal sensory neuropathy. If indeed you do, your chances of feeling well again taking neuropathic drugs are much much better than the 15-40 percent who experience relief after months of ppis.
In any case, we all (whether we have LPR or LSN, or PVVN, or some yet undiscovered throat fibro-myalgia/evil spirit) are victims of a lack of understanding and a lack of effective treatments for our illness. I hope you all can agree with that. How many people on this message board have actually gone through with surgery to screw your stomach up so tight, you can't even burp, and you are still clearing your throat and coughing chronically? If that has happened, you just might want to consider that you have a nervous system problem. Anyway, I can't see how my advice would cause more harm than a life changing, painful, expensive surgery that never brought you any relief of your symptoms.
So that's my two cents. I'm meeting the neurologist again on Monday. I sent him the articles I have mentioned, and he discussed it with the other neurologists. He also describes pregabalin as a "beautiful drug" because of its low side effects.
P.S. Jamie Koufman's article "chronic cough" describes her using neuro drugs to treat laryngeal symptoms. It came out in 2010.