"I can come by here and have a couple of polyps lasered off my vocal cords and then go straight to work."
— Daryl Collins, age 53

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Laryngopharyngeal Reflux

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 GERD. Gastroesophageal reflux disease may occur at any time, day or night. A common anatomic condition known as a hiatal hernia predisposes people to acid reflux. The most common symptom of acid reflux is heartburn, due to irritation of the lining of the esophagus.

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 called silent reflux, atypical reflux, or laryngopharyngeal reflux.

Causes or Contributing Factors:

Eating habits, diet and obesity all can contribute to larngopharyngeal reflux (LPR). Eating fewer, larger meals can lead 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
  • Alcohol

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

Symptoms:

LPR 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 the esophagus in rare instances.

Preventive measures:

  • Hydration of the throat by drinking lots of water
  • Weight loss
  • No smoking
  • Eating smaller meals, three or four times a day
  • Avoidance of food at least three hours before bedtime
  • Eating slowly
  • Avoidance of acid-producing medications such as aspirin and NSAIDs
  • Sleeping with head elevated

Diagnosis:

The Emory Voice Center team will ask the patient about symptoms and medical history, followed by a thorough head and neck examination. The examination likely will involve several members of the 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 acid. The acid activity is then recorded over a 24-hour period.

Non-Operative Treatments:

Most cases can be managed through medications to reduce acid production, diet modifications, and a weight loss program.

Operative Treatments:

In some severe cases or in cases with complications, surgery may be necessary. 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.