Diagnosis and treatment of presumed laryngopharyngeal reflux (LPR) remains controversial. Empiric medication trials remain widespread for suspected LPR, despite emerging evidence that questions both efficacy and safety of this approach – many patients with presumed LPR are non-responders to PPI trials, and these medications have significant cost and potential side effect profiles with prolonged use. Interestingly, because of different available tests and therapeutics, LPR treatment patterns are somewhat different between North American and Europe. By exploring differences and similarities between these regions, with focus on both cost and effectiveness of both reflux diagnosis and subsequent treatment, this panel hopes to see what Otolaryngologists from across the world can learn from one another in LPR care. Discussion will focus on both diagnostics and therapeutics and will emphasize a “personal medicine” approach where evaluation focuses on particular patient complaints rather than grouping all cough, throat clear, hoarseness, post-nasal drip, and globus pharyngeus patients under the overly broad umbrella of “LPR”. Treatment discussions will similarly emphasize this “personal medicine” approach and encourage participants to think beyond PPI alone as we consider alginate therapy, lifestyle modifications, and other treatments for what might be acid reflux, non-acid reflux, or mixed reflux. Finally, there will be discussion of testing (pH-impedance, oropharyngeal pH probe, and pepsin assays) as they differ between North America and Europe.