Extralaryngeal manifestations of laryngopharyngeal reflux are widely recognised, although evidence to support mechanistic pathways is still lacking. Evidence to support reflux contribution to the following disorders is accumulating: otitis media, sinusitis, obstructive sleep apnea, dental erosions, subglottic and tracheal stenosis, inflammatory lung disease and lung transplant rejection. Acid likely only plays a small part in symptom generation and therefore proton pump inhibitor therapy will not provide sustained relief for many, and should no longer be considered as a diagnostic trial. Multifaceted management including behavioural modifications, barrier protection, antiinflammatory approaches and occasionally surgery are more effective.