Gastroesophageal reflux disease (GERD) is a prevalent condition associated with significant extra-esophageal manifestations, particularly affecting the upper aerodigestive tract. Laryngopharyngeal reflux (LPR) presents diagnostic and therapeutic challenges due to non-specific symptoms and delayed symptom resolution following standard therapy. This study integrates data from two prospective interventional trials evaluating severity-guided, individualized treatment strategies for managing ENT symptoms in patients with GERD. Both studies emphasize a structured approach combining clinical evaluation, objective diagnostics (pH-impedance, endoscopy), and biomarkers (salivary pepsin), followed by tailored interventions ranging from lifestyle modification to surgical fundoplication.