Anatomy of the Condition:
In adults and children, irritating acidic juices may back up from the stomach into the esophagus and throat.  It is frequently called gastroesophageal reflux disease or GERN.  This may occur at any time either day or night. A common anatomic condition known as a hiatal hernia predisposes people to acid reflux.  The most commonly recognized symptom of acid reflux is ?heartburn? due to irritation of the lining of the esophagus.

Most people do not know that acid reflux can also cause problems in the larynx (voice box) or the pharynx (back of throat).  This can happen to someone even if he or she is not aware of any heartburn, and is sometimes called silent reflux, atypical reflux, or laryngopharyngeal reflux.

Symptoms of acid reflux include: hoarseness, excessive mucous or phlegm, throat clearing, a sensation of a lump in the throat, sore throat, choking spells, wheezing, or post-nasal drip.  More serious problems can arise as well such as vocal fold ulcers or granulomas, vocal fold scarring, airway narrowing, or pneumonia.  There is also a small chance of developing cancer in the esophagus or throat due to long-term acid reflux.

Causes or Contributing Factors
Eating habits, diet and obesity are all contributory factors in causing Larngopharygeal Reflux, (LPR).  Eating one or two large meals each day can ead to the disorder, so it is best to eat three of four smaller meals each day.
Certain foods and products should also be avoided including:

• Carbonated beverages
• Coffee or tea
• Orange juice and other acidic beverages
• Spicy Food
• High Fat Foods
• High Fiber Foods
• Alcoholic Beverages

Mints, lozenges and mouthwashes may seem to soothe the throat, but can actually irritate the throat lining and stimulate acid production.

Preventative measures to remember include:

• Hydration of the throat by drinking lots of water
• Weight Loss
• No smoking
• Smaller meals, three or four times each day
• Avoidance of food at least three hours before bedtime
• Slow down eating (don?t gulp it down!)
• Avoidance of acid producing medications such as Aspirin and Non-Steroidal Anti-Inflammatory Drugs
• Sleeping with head elevated

Symptoms
Laryngopharygeal Reflux is sometimes called silent reflux because it may be
present without any feelings of heartburn or with very mild symptoms.
However, in many cases heartburn is a symptom.  Other symptoms include:

• Dry Cough
• Hoarseness or voice loss
• Postnasal drip
• Sensation of lump or something stuck in the throat
• Sore Throat
• Chronic Throat Clearing

In a very small number of cases, the condition may be more severe causing major complications such as pneumonia, vocal scarring, airway narrowing and ulcers in the larynx.  Chronic laryngophargeal reflux can even lead to cancer of esophagus in rare instances.

Diagnosis:
The voice team will ask the patient about symptoms and their medical history,
followed by a thorough head and neck examination. The examination likely will involve several members of the voice team to assess vocal quality, efficiency, and proper speaking technique.

Laryngeal videostroboscopy may be required.  This is a procedure using a flexible and/or rigid endoscope coupled to a video monitor and a stroboscopic light source to allow for detailed visual evaluation of laryngeal function and vibration.

In some situations, the physician may order a test called Ambulatory
24-hour pH Monitoring.  This test uses a small measuring tube which is inserted in the patient?s throat to monitor the amount of acid.  The acid activity is then recorded over a 24-hour period.

Treatments:
Non-Operative
Most cases can be handled with non-operative medical management.  These treatment options include:

• Medications to reduce acid production (prescription and non-prescription, with consultation from the doctor).
• Modifications of the patient?s diet
• Weight Reduction Program

Operative
In some severe cases or in cases with complications, surgery may be a necessary treatment.  Occasionally, microlaryngoscopy may be required.  It is a procedure conducted under general anesthesia which allows the physician to examine the vocal folds of the larynx with magnification tools.