Proton pump inhibitors (PPIs) continue to be among the top 10 most common prescribed drugs nationally. The past decade as seen a flurry of reports on the potential association of PPIs with various short and long-term adverse effects. Emerging high quality randomized controlled trials now suggest that many of these observed associations are not causal relationships. Despite this level one evidence supporting their safety, otolaryngologists often find themselves during patient discussions regarding the risk, benefits, and alternatives of PPIs. Further the years of concern regarding the use of PPIs and innovate approaches to laryngopharyngeal reflux (LPR) management has led many otolaryngologists to critically consider the role of PPIs in management of diagnoses potentially related to LPR. This panel will start with a short didactic from each panelist. After reviewing the most up to date publications, the panel will discuss appropriate work up for clinical entities associated with gastroesophageal reflux and evidence-based PPI use for the management thereof. Finally, the short didactic session will end with a discussion about the approach patient conversation regarding PPIs and in general how to make decisions in the face of conflicting data. Most of the panel will focus on cases and expert panel discussion. A variety of cases will be reviewed and issues around patient counseling, ordering and interpreting pertinent testing, and long-term management of laryngeal and pharyngeal clinical entities where LPR plays a pathologic role, will be discussed.