The Relationship Between Eosinophilic Esophagitis and Laryngeal Manifestations: Pathophysiology, Clinical Overlap, and Diagnostic Challenges

Background: Eosinophilic esophagitis (EoE) is a chronic type 2 immune-mediated esophageal disease defined by esophageal dysfunction and eosinophil-predominant inflammation. Beyond classic gastrointestinal symptoms, patients may present with aerodigestive complaints such as chronic cough, hoarseness, recurrent croup, stridor, vocal fold abnormalities, and subglottic stenosis, creating diagnostic overlap with laryngopharyngeal reflux, vocal fold dysfunction, asthma, allergic rhinitis, and other airway disorders. Methods: This scoping review mapped evidence on the relationship between EoE and laryngeal manifestations. PubMed/MEDLINE was searched using terms related to EoE, laryngeal disease, reflux, vocal fold pathology, and subglottic stenosis. Human English-language case reports, case series, observational studies, clinical trials, and reviews were narratively charted by study design, population, diagnostic criteria, laryngeal findings, reflux evaluation, treatment, and outcomes. Results: Laryngeal involvement in EoE appears clinically relevant but remains incompletely characterized. Direct eosinophilic infiltration of laryngeal or hypopharyngeal tissue is rare, whereas indirect mechanisms—including shared type 2 inflammation, epithelial barrier dysfunction, eosinophil and mast-cell mediators, reflux or microaspiration, and comorbid atopic airway disease—may contribute to symptoms and lesions. Pediatric patients may be especially likely to show airway-predominant presentations, including recurrent croup, chronic cough, and subglottic stenosis. Evidence is limited by heterogeneous definitions, inconsistent laryngoscopy or biopsy, variable reflux testing, and small observational reports. Conclusions: EoE should be considered in persistent or recurrent laryngeal symptoms, particularly when refractory to reflux or airway-directed therapy or associated with atopy. Multidisciplinary evaluation may improve recognition and management. Future studies should use standardized laryngeal assessment, pediatric case–control designs, and biomarker approaches linking EoE activity with objective laryngeal findings.