Sore throat acid reflux

Sore Throat and Acid Reflux

To manage a sore throat that accompanies acid reflux, it’s more effective to treat the underlying cause: GERD. Both over-the-counter (OTC) and prescription medications work by eliminating, reducing, or neutralizing stomach acids. The neutralizing process reduces heartburn and sore throat.

Eating habits

Changes to your eating habits may help relieve a sore throat caused by acid reflux. Experiment with different textures when eating to find items that soothe your throat. People who have trouble swallowing may find that eating sticky foods or drinking liquids is more difficult and painful than soft foods or solids cut into small pieces.

Find out the foods and drinks that trigger heartburn. Because everyone’s triggers are different, you can try keeping a journal to record what you eat and drink and when you feel symptoms. This may help you narrow down the causes. Once you know what your triggers are, you can start changing your diet.

Eat small and frequent meals and avoid acidic, spicy, or overly fatty foods. These items are more likely to induce symptoms such as heartburn and sore throat.

You should also avoid drinks that can trigger your heartburn and irritate your esophageal lining. These vary from person to person, but often include:

  • caffeinated drinks (coffee, tea, soft drinks, hot chocolate)
  • alcoholic beverages
  • citrus and tomato juices
  • carbonated sodas or water

Try not to lie down within a few hours of eating to prevent GERD symptoms. Talk to your doctor before using herbal supplements or other medications to soothe a sore throat. Although the pain is uncomfortable, it’s important to treat your symptoms safely.

Medications

You may want to consider medications if your acid reflux isn’t helped by changing your eating habits. GERD medicines that help reduce or neutralize stomach acids include antacids, H2 receptor blockers, and proton pump inhibitors (PPIs).

Antacids are OTC medications. They work to neutralize stomach acid and relieve symptoms of GERD with salts and hydroxide or bicarbonate ions. Ingredients you should look for include:

  • calcium carbonate (found in Tums and Rolaids)
  • sodium bicarbonate (baking soda, found in Alka-Seltzer)
  • magnesium hydroxide (found in Maalox)
  • aluminum hydroxide formulas (usually used in combination with magnesium hydroxide)

H2 blocker medications work by stopping cells in your stomach from producing so much acid. There are both OTC and prescription H2 blockers available. Some of the OTC options include:

  • ranitidine (Zantac, Zantac 75, or Zantac OTC)
  • cimetidine (Tagamet or Tagamet HB)
  • famotidine (Pepcid AC or Pepcid Oral Tabs)
  • nizatidine (Axid AR)

PPI medications are the strongest drugs for reducing stomach acid production. In most cases, your doctor will need to prescribe them (one exception is Prilosec OTC, which is a weaker version of Prilosec). PPI drugs for GERD include:

  • omeprazole (Prilosec)
  • lansoprazole (Prevacid)
  • rabeprazole (Aciphex)
  • pantoprazole (Protonix)
  • esomeprazole (Nexium)

Could Your Sore Throat Be Caused by Acid Reflux?

Have you had a cough, tickle in the throat, itchy throat, or raspy voice that will not go away despite not having a cold or feeling sick? Is excess mucus causing you to clear your throat so often that it is annoying and, at times, embarrassing? Many who suffer from these symptoms are treated by doctors and urgent care physicians with allergy medications, nasal sprays, decongestants, and even antibiotics. Despite this, symptoms do not get better. Often these symptoms are not caused by allergies, a sinus infection, or a cold, but by laryngopharyngeal reflux (LPR). Also called airway reflux, reflux laryngitis, or atypical reflux, LPR is one of the most common diseases of the 21st century. Unlike gastroesophageal reflux disease (GERD), which primarily affects the esophagus, LPR will affect the larynx and pharynx—your voice production system. Lissette Giraud, MD, provides insight into and answers common questions about this widespread condition.

What causes LPR?

It is commonly accepted that this condition is caused by reflux of acid or bile. GERD symptoms like heartburn are not typical of the condition but may appear. The most common symptoms of LPR are hoarseness, sore throat, excess mucus in the throat, persistent cough, asthma-like, symptoms (wheezing, chest tightness, and difficulty breathing), postnasal drip, sensation of a lump in the throat, difficulties swallowing, and ear pain. However, LPR presents differently in each person.

When should I see a doctor?

If you have a sore throat, painful swallowing, cough, difficulty swallowing, or hoarseness for 10-14 days, you should seek medical attention, preferably from an ENT.

What is the treatment for LPR?

Treatment will vary in accordance with the severity of symptoms. It can be as simple as making changes to your diet, like avoiding spicy foods, tomatoes, chocolate, caffeine, citrus beverages or foods, and alcohol.

Other solutions include:

  • Avoiding large meals
  • Eating three hours or more prior to going to bed
  • Elevating the head eight inches when sleeping
  • Smoking cessation
  • Losing weight if you are overweight

Your doctor may also recommend a medication to reduce acid production in the stomach, like Zantac or Pepcid, for a few weeks or longer.Stronger medications may be recommended if diet and life style changes have not worked.

Do I need any tests like CT scans, X-rays, or MRI’s to diagnose LPR?

The diagnosis of LPR is mostly based on symptoms and an office procedure called flexible laryngoscopy—an endoscopic exam of the voice box and throat performed by an ENT—and response to treatment. In some cases an upper endoscopy examination to evaluate the stomach and esophagus for inflammation, ulcers, or any abnormal lesion may be recommended. More advanced tests like pH testing and esophageal manometry are less frequently recommended and are typically done for difficult cases.

What are the complications from untreated LPR?

If LPR is left untreated, patients may experience vocal cord lesions like polyps or granulomas, chronic laryngitis, or asthma.

If you or a loved one suffers from the above symptoms, visit an ENT doctor, who will be prepared to do a complete evaluation and determine if you have LPR and recommend treatment.

Could Your Sore Throat Be Caused by ‘Silent Reflux’?

Despite its name, silent reflux, also known as Laryngopharyngeal Reflux (LPR), is anything but quiet. The condition, which causes throat irritation and pain, is referred to as silent reflux because it often lacks the hallmark symptom of GERD and typical acid reflux – heartburn.

Despite the absence of heartburn, many people with LPR report a wide variety of symptoms due to the damage the acid causes to their voice box, respiratory system, teeth, and throat.

“Reflux can be what we call extra-esophageal,” notes Michael Vaezi, MD, PhD, clinical director of the division of gastroenterology and hepatology and director of the Center for Esophageal Motility Disorders at Vanderbilt University in Nashville, Tenn. “These patients may not have heartburn sensation in the chest. It’s not really silent, presenting atypically.”

Not So Silent Symptoms

If you have LPR you may experience:

  • Hoarseness. As stomach acid comes up onto your voice box, or larynx, you may find your voice sounds more hoarse or harsh than usual. This symptom may be particularly noticeable in the mornings, since acid is often more likely to move up the throat when you are lying down.
  • Throat problems. Acid reflux into the pharynx, or back of the throat, can also cause atypical symptoms. You may feel as if you constantly have sore throat, or always need to clear your throat. Additionally, it may feel as if there is a lump in the back of your throat that won’t go away. Other symptoms include frequent hiccups, trouble swallowing, or a nagging cough.
  • Respiratory problems. People with silent reflux can experience wheezing or difficulty catching their breath as a result of airway irritation due to acid reflux. LPR can often exacerbate underlying asthma and make it more difficult to treat.
  • Tooth decay. Stomach acid that backs up into the mouth can erode or eat away at the protective enamel of the teeth, causing teeth to become fragile and discolored.

RELATED: 7 Surprising Facts About GERD and Acid Reflux

Treating Silent Reflux

If your doctor suspects LPR they may order some tests to confirm their diagnosis and determine which treatment option is best for you. These tests include:

  • Barium swallow. This test involves a series of X-rays of the upper gastrointestinal system, or digestive tract, performed after a patient drinks a special barium solution. The contrast solution allows doctors to evaluate the digestive tract for structural problems that may be associated with LPR.
  • Endoscopy. Doctors insert a lighted tube attached to a small camera into the throat. The tube is used to examine the larynx, pharynx, and esophagus for signs of damage consistent with acid reflux. Tissue samples are usually taken to test in the laboratory for any evidence of chronic irritation, inflammation, infection, or abnormal cells.
  • pH monitoring. A thin tube is inserted through the patient’s nose and down into the esophagus. A device at the end of the tube measures the acidity, or pH, of the inside of the esophagus over a period of one to two days. Alternatively, a capsule is attached to the wall of the esophagus to monitor pH levels. The capsule then detaches and is passed through the patient’s digestive system. Abnormally high levels of acidity are suggestive of LPR.
  • Proton pump inhibitor test. Your doctor may try to diagnose your problem by treating you with a trial of proton pump inhibitors, which reduce the amount of acid secreted by the stomach. If your symptoms improve or disappear with medication then you most likely have LPR.

Silent reflux is most often treated with proton pump inhibitors such as Nexium (esomeprazole), Protonix (pantoprazole), Prevacid (lansoprazole), Aciphex (rabeprazole), or Prilosec (omeprazole).

Lifestyle changes can also help reduce LPR symptoms. Your doctor may recommend:

  • Quitting smoking
  • Avoiding alcohol
  • Eliminating caffeine
  • Losing weight
  • Ditching meals three hours prior to bedtime
  • Elevating the head of your bed four to six inches
  • Avoiding restrictive clothing
  • Dietary changes (Foods that are fatty, fried, spicy, or include mint or chocolate should be avoided)

In some cases, LPR symptoms may persist despite lifestyle changes and medications. In these instances, surgery may be recommended to tighten the lower esophageal sphincter.

Although LPR is an uncomfortable and potentially serious condition, with the right diagnosis it is possible to keep symptoms under control and avoid complications.

What Are the Symptoms of GERD?

Not everyone with GERD has heartburn, but the primary symptoms of GERD are heartburn, regurgitation, and an acid taste in the mouth.

Heartburn usually is described as a burning pain in the middle of the chest. It may start high in the abdomen or may extend up the neck or back. Sometimes the pain may be sharp or pressure-like, rather than burning. Such pain can mimic heart pain (angina). Typically, heartburn related to GERD is seen more commonly after a meal. Other symptoms of GERD include:

  • Hoarseness; if acid reflux gets past the upper esophageal sphincter, it can enter the throat (pharynx) and even the voice box (larynx), causing hoarseness or sore throat.
  • Laryngitis
  • Chronic dry cough, especially at night;GERD is a common cause of unexplained coughing. It is not clear how cough is caused or aggravated by GERD.
  • Feeling as if there is a lump in your throat
  • Sudden increase of saliva
  • Bad breath

In infants and children, GERD can produce these symptoms:

  • Recurrent vomiting
  • Coughing
  • Breathing problems
  • A failure to thrive

Sore Throat and a Red Hypopharynx: Is It Reflux?

To best manage this group of patients, the most important question that the gastroenterologist has to answer before embarking on any testing is “how far am I willing to pursue the cause for this patient’s symptom? Is my role to rule in or rule out GERD, or am I to take on the task of finding out what is causing the patient’s symptom?” Most gastroenterologists do not wish to assume the chronic care and management of these patients. In fact, this is true for most ENT physicians as well, who are also uncertain about what to do, thus the reason for the current clinical dilemma. To better understand our role, we must be critical of the practice norm and question the current diagnostic and management strategies. Recent investigations in this area are paving the way for better understating of this area.

The driving force behind the suspicion of GERD as the etiology of chronic throat symptoms is the initial laryngoscopic evaluation, resulting in cascade of testing and referrals. Laryngeal exam in this group of patients might show subtle or dramatic changes. Contact ulcers in the larynx were the first laryngeal signs associated with GERD.2x2Ott, D.J., Ledbetter, M.S., Koufman, J.A. et al. Globus pharyngeus: radiographic evaluation and 24-hour pH monitoring of the pharynx and esophagus in 22 patients. Radiology. 1994; 191: 95–97
PubMed | Google ScholarSee all References However, since then other routinely observed laryngeal signs have been attributed to GERD (Table 1Table 1). Inclusion of these subtle signs has increased the sensitivity of laryngoscopy, at the expense of specificity, in identifying GERD-related ENT irritation. This might explain why some patients with laryngeal signs do not respond to GERD therapy. A recent survey3x3Ahmed, T.F., Abelson, T.I., Hicks, D.M. et al. Chronic laryngits associated with GERD: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians (abstract). Gastroenterology. 2005; 128
Google ScholarSee all References found that ENT physicians depend on erythema and edema of the larynx to diagnose LPR, which are too subjective and not very specific for GERD. In addition, laryngoscopic evaluation of normal subjects without GERD suggests that normal laryngeal tissue is a rarity, reporting abnormal findings in 87% of the healthy volunteers.4x4Hicks, D.M., Vaezi, M.F., Ours, T.M. et al. ENT signs of GERD. J Voice. 2002; 16: 564–579
Abstract | Full Text | Full Text PDF | PubMed | Scopus (195) | Google ScholarSee all References This raises an important question: If the “norm” in laryngeal structure is “abnormal,” one must question what truly defines “laryngeal sign of GERD.” There are no established universally accepted and used signs for GERD-related laryngeal abnormality; thus, we must question the specificity of the signs currently used to diagnose LPR.1x1Vaezi, M.F., Hicks, D.M., Abelson, T.I. et al. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003; 1: 333–344
Abstract | Full Text | Full Text PDF | PubMed | Scopus (211) | Google ScholarSee all References Reliance on subjective laryngeal signs combined with poor interobserver and intraobserver agreement on laryngeal signs4x4Hicks, D.M., Vaezi, M.F., Ours, T.M. et al. ENT signs of GERD. J Voice. 2002; 16: 564–579
Abstract | Full Text | Full Text PDF | PubMed | Scopus (195) | Google ScholarSee all References has, over time, resulted in dilution of LPR diagnosis with patients whose laryngeal symptoms and signs are due to other etiologies. As such, not all patients will respond to therapy for GERD, and many will not have pH or impedance findings explaining their symptoms because GERD is not the cause of their problem.

Table 1Laryngopharyngeal Signs Often Suggested as GERD-Related

Edema and hyperemia of larynxa

Hyperemia and lymphoid hyperplasia of posterior pharynx (cobblestoning)a

Interarytenoid changes

Vocal cord granuloma/noduleb

Contact ulcersb

Laryngeal polyps

Reinke’s edema

Subglottic stenosis

Posterior glottic stenosis

View Table in HTML aMost commonly used signs but also the least specific for GERD. bLess commonly used signs but possibly more specific for GERD.

Current recommendations1x1Vaezi, M.F., Hicks, D.M., Abelson, T.I. et al. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003; 1: 333–344
Abstract | Full Text | Full Text PDF | PubMed | Scopus (211) | Google ScholarSee all References, 5x5Koufman, J.A., Sataloff, R.T., and Toohill, R. Laryngeal reflux: consensus conference. J Voice. 1996; 10: 215–216
Abstract | Full Text PDF | PubMed | Google ScholarSee all References, 6x6Ford, C.N. Evaluation and management of laryngopharyngeal reflux. JAMA. 2005; 294: 1534–1540
Crossref | PubMed | Scopus (286) | Google ScholarSee all References suggest empiric therapy for those suspected of LPR. However, the optimal dose and duration of such therapy are still unknown. A recent study3x3Ahmed, T.F., Abelson, T.I., Hicks, D.M. et al. Chronic laryngits associated with GERD: prospective assessment of differences in practice patterns between gastroenterologists and ENT physicians (abstract). Gastroenterology. 2005; 128
Google ScholarSee all References suggested that ENT physicians are more likely to treat this group of patients with once daily PPI therapy for 1–2 months, whereas gastroenterologists treat more aggressively with twice daily therapy for 3–4 months. This might be a result of differences in patient population evaluated. The only published open label observational study7x7Park, W., Hicks, D.M., Khandwala, F. et al. Laryngopharyngeal reflux (LPR): prospective cohort study evaluating optimal dose of PPI therapy and pre-therapy predictors of response. Laryngoscope. 2005; 115: 1230–1238
Crossref | PubMed | Scopus (149) | Google ScholarSee all References comparing PPI therapy dosing reported significantly better 2-month outcome after twice daily PPI therapy than once daily therapy. This study also reported no benefit to adding H2RAs to twice daily PPI therapy. These studies have to be balanced by the disappointing results of placebo-controlled trials.8x8Qadeer, M.A., Phillips, C.O., Lopez, A.R. et al. Proton pump inhibitor therapy for suspected GERD-related chronic laryngitis: a meta-analysis of randomized controlled trials. Am J Gastroenterol. 2006; 101 (2646–2454)
Crossref | PubMed | Scopus (190) | Google ScholarSee all References The largest placebo-controlled study of patients suspected of having GERD-related throat symptoms found no benefit to high-dose twice daily PPI therapy compared with placebo after 4 months of therapy,9x9Vaezi, M.F., Richter, J.E., Stasney, C.R. et al. Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope. 2006; 116: 254–260
Crossref | PubMed | Scopus (238) | Google ScholarSee all References once again highlighting the overdiagnosis of this condition.

In unresponsive patients after the initial empiric therapy, studies suggest low clinical yield for performing esophagogastroduodenoscopy and pH or impedance monitoring.1x1Vaezi, M.F., Hicks, D.M., Abelson, T.I. et al. Laryngeal signs and symptoms and gastroesophageal reflux disease (GERD): a critical assessment of cause and effect association. Clin Gastroenterol Hepatol. 2003; 1: 333–344
Abstract | Full Text | Full Text PDF | PubMed | Scopus (211) | Google ScholarSee all References, 10x10Ahmed, T. and Vaezi, M.F. The role of pH monitoring in extraesophageal gastroesophageal reflux disease. Gastrointest Endosc Clin N Am. 2005; 15: 319–331
Abstract | Full Text | Full Text PDF | PubMed | Scopus (40) | Google ScholarSee all References The clinical utility of proximal or hypopharyngeal pH monitoring is in question for this group of patients. There are several problems in using pH data in diagnosing reflux-related laryngitis: (1) proximal esophageal and hypopharyngeal acid exposure occurs in normal subjects; (2) lack of consensus on how much reflux in the hypopharynx is normal; (3) pH monitoring is not the perfect gold standard for diagnosing atypical GERD; only one half of patients with suspected laryngoscopic signs of GERD have abnormal esophageal acid exposure, irrespective of the location of the pH probe (distal, proximal esophagus, or hypopharyngeal); (4) the presence of hypopharyngeal reflux episodes does not seem to correlate with laryngoscopic findings; (5) those with abnormal hypopharyngeal acid reflux are not more likely to respond to acid suppressive therapy than those with no acid reflux detected by pH monitoring; and (6) in patients with continued symptoms despite twice daily PPI therapy, recent data suggest that the likelihood that pH monitoring will be abnormal is 1%,11x11Charbel, S., Khandwala, F., and Vaezi, M.F. The role of esophageal pH monitoring in symptomatic patients on PPI therapy. Am J Gastroenterol. 2005; 100: 283–289
Crossref | PubMed | Scopus (169) | Google ScholarSee all References which is not any better if the pH monitoring is carried out for longer time periods by using the wireless pH capsules.12x12Gilles, M., Ayers, G.D., and Vaezi, M.F. 96 Hour is no better than 24 hour pH-monitoring in atypical GERD. Gastroenterology. 2007; 132: A693
Google ScholarSee all References

Finally, surgical fundoplication in this group of patients resulted in no added benefit in those previously unresponsive to acid suppressive therapy.13x13So, J.B.Y., Zeite, S.M., and Rattner, D.W. Outcome of atypical symptoms attributed to gastroesophageal reflux treated by laparoscopic fundoplication. Surgery. 1998; 124: 28–32
Abstract | Full Text | Full Text PDF | PubMed | Scopus (166) | Google ScholarSee all References, 14x14Swoger, J., Ponsky, J., Hicks, D.M. et al. Surgical fundoplication in laryngopharyngeal reflux (LPR) unresponsive to aggressive acid suppression: a prospective concurrent controlled study. Clin Gastroenterol Hepatol. 2006; 4: 433–441
Abstract | Full Text | Full Text PDF | PubMed | Scopus (97) | Google ScholarSee all References A recent concurrent controlled study of patients with chronic laryngitis suspected GERD-related unresponsive to twice daily PPI therapy found no benefit from surgical fundoplication at 12 months after surgery.14x14Swoger, J., Ponsky, J., Hicks, D.M. et al. Surgical fundoplication in laryngopharyngeal reflux (LPR) unresponsive to aggressive acid suppression: a prospective concurrent controlled study. Clin Gastroenterol Hepatol. 2006; 4: 433–441
Abstract | Full Text | Full Text PDF | PubMed | Scopus (97) | Google ScholarSee all References Therefore, surgical fundoplication in patients with continued laryngeal symptoms on twice daily PPIs is not recommended.

Your Burning Chest: How to Stop Acid Reflux and GERD

Once GERD is confirmed, treatments include lifestyle changes, medications and surgery.

Lifestyle changes:

  • Quit smoking
  • Lose weight
  • Wear looser clothes
  • Avoid food for a couple of hours before bedtime
  • Prop yourself up slightly to sleep instead of lying flat
  • Eat smaller meals
  • Stay upright for three hours after a meal

Medications:

  • Over-the-counter antacids to neutralize the acid in your stomach (such as Maalox, Mylanta and Rolaids)
  • Prescription antacids
  • H2 blockers that reduce the amount of acid your stomach makes (such as Zantac and Pepcid)
  • Proton-pump inhibitors that further reduce the amount of acid your stomach produces and are available both over the counter and by prescription (such as Prilosec, Nexium and Prevacid)
  • Prokinetics that help clear stomach contents and strengthen the LES (such as Reglan)

Other therapies:

  • Upper endoscopy, in addition to helping diagnose GERD, can be used to tighten the LES or fix a hiatal hernia
  • Fundoplication is a surgical procedure in which the upper part of the stomach is wrapped around the lower part of the esophagus to strengthen the LES

If you’re suffering from acid reflux, talk to your doctor about your options or find a doctor near you.

At A Glance

  • Reflux of gastric acid can cause several throat problems
  • Symptoms and treatment of LPR are often different from typical GERD symptoms
  • LPR will usually heal well with proper diagnosis and treatment

Many people with throat discomfort are surprised when they are told by their doctor that they have laryngeal pharyngeal reflux (LPR). Gastric acid can cause significant inflammation when it falls on the vocal cords.

If this happens repeatedly, a person can be left with a number of bothersome throat problems. Examples include:

  • Hoarseness
  • Frequent throat clearing
  • Coughing,
  • Sensation like something stuck in the throat

There are individuals with gastroesophageal reflux disease (GERD) who have throat discomfort. People with GERD have gastric reflux into the esophagus. This typically causes heartburn and regurgitation (a sense of fluid coming up).

Many people with LPR do not have any of the typical GERD symptoms.

Learn more about the symptoms of GERD

This has lead to some controversies and misunderstandings about LPR:

  • Is LPR a symptom of GERD?
  • Are patients with LPR a subset of GERD?
  • Is LPR a completely different medical problem?

There is not a good answer to these questions, as there is some truth to each of them. It may be easier for physicians to manage LPR if it’s approached as a completely different problem.

People with GERD nearly always have heartburn. Additionally, they:

  • Usually improve quickly with appropriate medical treatment
  • Frequently require life-long medical treatment
  • Are at risk for developing significant damage to the lining of the esophagus, including esophagitis or sometimes Barrett’s esophagus

On the other hand, LPR is quite different. Many people with LPR do not have heartburn. Additionally, they:

  • Require larger doses of medications for weeks to months before seeing any improvement
  • Usually do not require long-term treatment
  • Rarely develop complications

Causes

LPR frequently begins after an upper respiratory illness. However, some of the symptoms seem to linger after the cold or flu is better. The theory is that there is some reflux of stomach acid into the throat, which irritates the already irritated vocal cords. If the acid reflux continues, the damage to the vocal cords will progress.

The amount of acid reflux required to cause this is very small. This explains why most of these individuals do not have heartburn. The injury may be greater in people who use their voice vigorously, such as singers or teachers.

Symptoms

Individuals with persistent throat symptoms, such as hoarseness, frequent throat clearing, or coughing should seek medical attention. The feeling that there is something stuck in the throat, a globus sensation, is a classic symptom of LPR.

Read more about Globus

Throat pain, weight loss, or smoking history should be considered worrisome. Throat pain is an uncommon manifestation of LPR.

Most patients eventually have a test called laryngoscopy by an ear, nose and throat (ENT) doctor. With this test, the ENT physician can visualize the vocal cords and look for the characteristic findings of LPR, such as swelling. Unfortunately, many people with normal examinations or a little redness are told incorrectly that they have LPR.

Treatment

Once the diagnosis is suspected, two things will help:

  1. The reflux needs to be well controlled. This usually requires a twice a day dose of a proton pump inhibitor (PPI). These powerful medications suppress stomach acid and relieve acid reflux. It often requires treatment for 2–6 months before significant improvement is seen.
  2. Attempts to improve vocal hygiene should be undertaken. The person should drink plenty of liquids to prevent a dry throat. Caffeine, alcohol, antihistamines, and menthol containing cough drops all have a drying effect and should be avoided. Avoid tobacco. Care needs to be taken to not overuse the voice by shouting, whispering, speaking for a long period of time, or clearing the throat.

Throat clearing is a common symptom. However, it tends to worsen the injury. Here are 3 things that may help stop the throat clearing:

  1. Try swallowing to clear the throat
  2. Exhale forcefully rather than cough
  3. Gently tap the vocal cords together rather than a forceful effort to clear the throat

People who improve should talk to their doctor to try to stop their anti-reflux medications. The majority of individuals with LPR do not require life-long medical treatment for their reflux.

Those who do not improve should see their doctor and consider a repeat laryngoscopic examination to re-evaluate the diagnosis.

The doctor may also consider doing a test to precisely measure acid reflux, such as ambulatory pH monitoring. In this test, a thin tube is passed through the nose and into the esophagus. The pH can be measured every few seconds for 24 hours. Rarely, people with LPR have severe enough symptoms that they require anti-reflux surgery.

Individuals with LPR usually do well with proper diagnosis and treatment. It may take several months for this to happen.

The keys to success are:

  • An accurate diagnosis
  • Good control of acid reflux
  • Good vocal hygiene during the healing process

Adapted from IFFGD Publication: Another Complication of Reflux: Laryngeal Pharyngeal Reflux (LPR) by J. Patrick Waring, MD, Digestive Healthcare of Georgia, Atlanta, GA.

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