I'm sorry to hear you're struggling with your GERD. I have also been to an ENT due to hoarseness. He will most likely want to take a look at it. At that point he will likely have an opinion regarding what you need to do. Surprisingly, ENTs seem to be quite knowledgeable on the subject of GERD, as many of the symptoms they see result from reflux. Many times I think the ENT is the first one to inform patients that they have GERD.
I had a Nissen for atypical symptoms--especially asthma--and it did make a huge difference. I was able to reduce my medication significantly. I have severe allergies, which complicates things, but because of the surgery my steroid intake was very significantly reduced. I also have hoarseness, but it's not the reason for the surgery. It is likely a combination of coughing (due to allergy) and my inhaled medications that are quite irritating. It was hoarse for so long that I think I would need complete voice rest to even give it a chance to improve. I wish I could say that my hoarseness improved instantly, but unfortunately in my case it didn't.
That said, I am thrilled with the outcome of the surgery. I was so sick before the Nissen that I was even hospitalized for GERD-caused asthma. My doctor told me that my condition was life-threatening, and pushed me hard to go forward with it.
Atypical LPR symptoms are much more difficult to treat with the Nissen surgery, as it is possible that only a tiny amount of reflux can cause lots of trouble. Even after surgery it is possible to reflux a bit. The wrap has to be tight enough to keep the acid in and loose enough to allow food to pass. It's a very tricky balance.
Surgeons prefer to work on people who are refluxing large quantities of acid and food, as they know they will find immediate relief. Atypical symptoms are a bit less clear cut.
Others here have had symptoms similar to the ones you're describing and have done very well. Hopefully they'll be by soon to add share their experiences.
I hope you find an answer soon, and start feeling better!