What is Laryngopharyngeal Reflux? The Silent One…

Have you ever had this persistent cough that just won’t go away? And with that an excessive clearing of the throat?

Has your significant other ever asked you why your voice has been hoarse lately and this persistent cough and clearing of the throat is waking up the newborn baby which is, in turn, waking her up during the night?

Do you find yourself working at your job in the lab where there are absolutely no allergens or irritants and you find yourself with this continuous post-nasal drip and mucus?

Does your throat seem to be sore much of the day and you are having trouble swallowing?

Have you ever been short of breath and you do not have COPD or asthma?

What if you had all of these symptoms intermittently as a mixed pog of coughing, frog in the throat, sore throat, hoarseness, trouble breathing, trouble swallowing, and you are always clearing your throat?

All of these symptoms are quite vague. They resemble and mimic many problems related to pulmonary, gastro, and ENT. This is why Laryngopharyngeal reflux or  LPR. has been coined “The Silent Reflux”.

Many times LPR is not immediately diagnosed it is a condition in which hydrochloric acid (HCL) that is made in the stomach travels up the esophagus and is bathing the throat, the voice box, and sometimes the trachea. This can be very subtle at first. Then the symptoms begin to increase in frequency and adding more symptoms over time. Eventually if left untreated, you can suffer great damage to all of these organs it comes in contact. 

Is Everyone At Risk For laryngopharyngeal reflux?

Yes… no one is immune to LPR. In fact, infants to geriatrics are the span of ages.  However, the majority of these diagnoses are in aging adults. The most risk is those who have a poor diet, overweight, highly stressed and wear tight clothing daily. 

What Does laryngopharyngeal reflux Happen?

There is a sphincter or what is supposed to be a one-way valve at the beginning of your stomach and at the end of your esophagus that opens to let food in, then it closes tightly. Stomach acid such as the HCL mentioned previously is made by the stomach and the pH is extremely low… a pH of 2 means it can burn through your finger if you stuck your finger in a jar of HCL. The evolution of our species made it possible for humans to have this chemical produced and exposed to the stomach lining without cause of harm to the tissue. In fact, the stomach lining is one of the fastest cell producing organs in our anatomy. 

Unfortunately, the overproduction of HCL occurs during times of stress and all of the variables above make it possible for acid to blow past the sphincter. Repetitive exposure will, in fact, burn the sphincter and allow continuous blow-back of HCL. This will become more severe over time and subtle. The “Reflux” will eventually reach the voice box, etc. And yes these organs are never exposed to low pH acids so they can become damaged.

In infants, they have a shorter esophagus. LPR in infants is because their sphincter is not fully functional yet and they are always lying flat most of the time. If left untreated here, there could be a narrowing of vocal cords, contact ulcers, recurrent ear infections, and long term build-up of fluid in the middle ear.

In adults, there can be scarring of the throat and voice box. It also leaves a higher chance of transforming damaged cells into cancer.

How Do I Or My Child Get Diagnosed And Treated For laryngopharyngeal Reflux?

Gastroesophageal Reflux Disease or GERD is easier to diagnose that the silent one-LPR. Classic GERD is a burning sensation and pain down in the stomach area. In fact, sometimes it mimics a myocardial infarction or heart attack because the pain will radiate to the chest. However, LPR, while sometimes difficult, be diagnosed through history and physical assessment, then through an endoscopic exam such as what we use in ENT. Also monitoring of the pH in the throat and esophagus with a small catheter prob and a small device that records a 24hr period of pH change.

The treatment in infants is common sense in that you would feed then in smaller but frequent feedings and simply keep the infant upright for 30 min after eating.

Medications such as HCL blockers or medications that slow the production of HCL (proton inhibitors) are used with success. 

In severe cases, surgical intervention may be needed.

In adults, the variables that can be changed are weight, not smoking or drinking alcohol or at least cutback. Restricting your diet which is to not eat food that will encourage the proton pumps to make more HCL, avoid tight-fitting clothes around the waist.

Additional easy to help LPR symptoms are to not eat 4-6 before bed and maybe chewing gum so that the saliva produced will neutralize the HCL.

Medical interventions such as proton pump inhibitors, antacids, h2 blockers are found over the counter as well as readily prescribed by your doctor.