--sadewitz, edith dob 9/21/20

--93yo women, former smoker, well known to me since 2008 for chronic dysphonia. First thought to be multifactorial, including age-related, possible silent acid reflux (not much change with emperic pre-dinner omeprazole in 2011 or so), and irritant effect of asthma inhalers. Never any evidence of tumor or paresis. Now with c/o frequent throat clearing. No heartburn, cough, sob or fever. ENT exam, Voice quality seems a little better than in past. No stridor, dysarthria. Ear, Nose, Neck are benign. Laryngoscopy (see video) reveals health cord mucosa, normal mobility. No mass lesions. Mild posterior mucosal thickening, prob. c/w silent reflux. Treatment includes reassurance, liberal hydration, avoidance of throat clearing, anti-reflux diet (no tomatoes or chocolate after 5pm). PPI therapy is a consideration if symptoms progress. RTC PRN. Thanks, Steve Sloan, MD