Prevalence of laryngopharyngeal reflux symptoms in divers

Introduction: Laryngopharyngeal symptoms (LPS) refer to aerodigestive complaints that may result from the retrograde flow of gastric contents into the upper aerodigestive tract. These symptoms may be under-recognised in populations exposed to mechanical or environmental stressors. Divers may be at increased risk due to factors such as pressure changes and body positioning. This study characterised the prevalence and severity of LPS among divers and identified associated risk factors. Methods: A cross-sectional, anonymous survey was distributed to members of the Divers Alert Network (DAN). Collected data included demographics, diving-related behaviours, medical history, and LPS burden measured using the Reflux Symptom Index (RSI). Results: Of the 309 survey responses analysed, 47.2% were male with a median age of 50.0 years (IQR: 40.0-60.0). Among 291 divers with complete RSI data, 26.1% (95% CI, 21.4-31.5%) had abnormal RSI scores, representing a +16.0 percentage-point increase (95% CI, 11.3%-21.4%) over non-diving population estimates (P < 0.001). In multivariable analysis, female sex (adjusted prevalence rate [aPR] 1.59, 95% CI 1.07-2.37) and gastroesophageal reflux disease (GERD) history (aPR 1.75, 95% CI 1.16-2.65) were independent predictors. Recreational divers had a lower risk (aPR 0.59, 95% CI 0.39-0.90). Approximately 5% of respondents described their symptoms as life-threatening. Conclusions: Divers may represent an under-recognised population at elevated risk for LPS. Female sex and GERD history were associated with greater symptom burden, while recreational diving appeared less provocative compared to technical diving. These findings may have implications for risk stratification and symptom management in the diving community.