Anatomy of the Condition

The root cause of laryngopharyngeal reflux is often gastroesophageal reflux disease, or GERD. This disease occurs in both adults and children. Irritating acidic juices back up from the stomach into the esophagus and throat. GERD may occur at any time, day or night. A common anatomic condition (hiatal hernia) may predispose you to acid reflux. The most common symptom of acid reflux is heartburn. Irritation of the lining of the esophagus causes the heartburn.

Acid reflux can also cause problems in the larynx (voice box) or the pharynx (back of throat). This can happen even if you are not aware of any heartburn. These cases are known as silent reflux, atypical reflux, or laryngopharyngeal reflux.

Causes or Contributing Factors

Eating habits, diet and obesity all can contribute to laryngopharyngeal reflux (LPR). Eating fewer, larger meals can lead to the disorder. Instead, eat three or four smaller meals each day. Avoid certain foods and products:

  • 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. They actually irritate the throat lining and stimulate acid production.

Symptoms

LPR, or silent reflux, may exist without any feelings of heartburn or with very mild symptoms. Yet, heartburn is often 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. It can cause major complications like pneumonia, vocal scarring, airway narrowing and ulcers in the larynx. Chronic laryngopharyngeal reflux can even lead to cancer of the esophagus.

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 of LPR

Our team will discuss your symptoms and medical history. We will perform a thorough head and neck examination. Our evaluation team often involves several members of the Emory Voice Center. We will assess vocal quality, efficiency, and proper speaking technique.

We may complete a laryngeal videostroboscopy. In this minimally invasive procedure, we use an endoscope (a small tube equipped with a fiber optic camera.) A stroboscopic light source lets us check laryngeal function and vibration.

We may order a test called ambulatory 24-hour pH monitoring. This test uses a small measuring tube inserted in the patient's throat to track acid. Acid activity is recorded over a 24-hour period.

Non-Operative Treatments

Non-operative treatments offer relief for most patients. These include medications to reduce acid production, diet modifications, and weight loss.

Operative Treatments

In some severe cases or in cases with complications, surgery may be necessary. We may recommend microlaryngoscopy. A physician will examine the vocal folds of the larynx with magnification tools. We conduct this procedure under general anesthesia.