Gastroesophageal reflux disease has been increasingly associated with ear, nose and throat signs and symptoms; however, the cause and effect relationship between these two clinical entities is far from established. Many patients initially diagnosed with gastroesophageal reflux disease as the cause of laryngeal signs do not respond either symptomatically or laryngoscopically to aggressive acid suppression, and do not have abnormal esophageal acid exposure as measured by pH monitoring. This has resulted in frustration on the part of both gastroenterologists and ear, nose and throat physicians, and confusion on the part of patients. This review discusses the reasons for this controversy and highlights data that attempt to clarify this complex area.