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March 13, 2015

New Non-Invasive, Non-Medication Treatment for Laryngopharyngeal Reflux(LPR)

REZA Band is a new non-invasive device that may be able to treat LPR reflux without the need for medications. Furthermore, it may be able to address all the different forms of reflux regardless of whether it is acidic or non-acidic.

The device is worn around the neck like a necktie and tightened snugly over the cricoid cartilage. By exerting pressure on the cricoid cartilage (see pic below), any reflux that occurs up into the throat region will not be able to pass up into the voicebox area.

Why would cricoid pressure (also called Sellick Maneuver) help? It's because the swallowing tube (aka esophagus) is located between this cartilage and the bone protecting the spine. By putting pressure on the cricoid cartilage, the esophagus is compressed closed against the bone. With such physical closure, reflux will not be able to pass. Watch video below to better understand this concept.

The actual fitting of this device is accomplished by using a "pressure gauge" to ensure the device is exerting 20-30 mmHg of pressure on the cricoid cartilage. Further detailed instructions on its use can be downloaded here.

According to the manufacturer, using the Reza band feels like wearing a shirt collar buttoned. Breathing and swallowing are unaffected.

At this time, the only way to purchase it is online here with a prescription from your doctor. Insurance coverage is still unclear for this new device even though it is FDA approved.

However, keep in mind that although LPR symptoms may improve symptoms of globus, hoarseness, dysphagia, throat-clearing, cough, etc, reflux is not technically cured. This device just prevents what reflux that does occur from getting up around the voicebox.

Also, given this device is only worn at night while sleeping, it would not resolve LPR symptoms in those individuals where reflux occurs even when upright during the day, a not uncommon phenomenon. A 24 hour multichannel impedance study would be able to determine whether upright (daytime) reflux occurs and if so, Reza band may not be beneficial.


References:
Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier. Laryngoscope. 2014 Oct; 124(10):2268-74. doi: 10.1002/lary.24735. Epub 2014 Jun 27.

Correlation of externally applied cricoid pressure with luminal upper esophageal sphincter pressure augmentation; Effect of posture and technique. Gastroenterology (146:5) Supp 1, S-856, May 2014.

A Multi-Center, non-Randomized, Prospective Study of the Reza Band® Upper Esophageal Sphincter (UES) Assist Device for the Treatment of Esophagopharyngeal Reflux.

Efficacy of a novel UES assist device in management of supraesophageal complications of reflux disease: The results of a limited clinical trial. Gastroenterology (142:5), Supp 1, S-102, May 2012.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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VIDEO: How Does the Human Voicebox Work?