Laryngopharyngeal Reflux 

Do you have difficulty swallowing, persistent throat irritation or cough without any signs of heartburn? You might be dealing with Laryngopharyngeal Reflux (LPR). Unlike acid reflux, LPR doesn’t always show typical symptoms, making it a challenging condition to identify and manage. Read on to learn more about this condition.

What is a Laryngopharyngeal Reflux?

Laryngopharyngeal reflux (LPR) occurs when the upper esophageal sphincter, which typically prevents stomach acid from pouring back up, weakens or relaxes abnormally. This enables acid to enter the voice box and throat, irritating and inflaming it. LPR is also referred to as "silent reflux" since it does not result in heartburn or other classic acid reflux symptoms.

Symptoms and Causes of Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR) is believed to constitute approximately 10% of the total ENT (ear, nose, and throat) clinic patients, and accounts for 50% of patients with voice-related concerns.

One symptom of LPR is a persistent cough. This cough is frequently dry and unproductive, leading to discomfort and annoyance for those affected. Additional prevalent indications include hoarseness, frequent throat clearing, a feeling of a lump in the throat, excessive mucus production, and even trouble with swallowing.

The reasons for LPR can vary from person to person. The primary contributing factor is the upper esophageal sphincter's dysfunction, which results in an incorrect closure. As a result, the delicate tissues in the larynx and pharynx becomes irritated when stomach acid and other digestive fluids ascend into these areas.

A person's lifestyle choices may also contribute to LPR. These include excessive alcohol consumption, consuming acidic or spicy foods, smoking, being overweight, going through stressful times, and even taking certain medications.



An expert in ear, nose, and throat disorders should be consulted by anyone exhibiting the symptoms in order to receive a precise diagnosis and a personalized treatment strategy. People can reclaim back their identity by obtaining the proper documentation. 

Diagnosing Laryngopharyngeal Reflux

To confirm a diagnosis of LPR, doctors may recommend the following tests and procedures:

1. Laryngoscopy: This procedure involves using a flexible tube with a camera (endoscope) to examine the throat and larynx for signs of inflammation or irritation.
2. pH Monitoring: A pH probe is inserted through the nose into the esophagus to measure acid levels over a 24-hour period. This test helps determine if acid reflux is reaching the throat.
3. Barium Swallow: This test involves swallowing a liquid containing barium while X-rays are taken. It helps evaluate the structure and function of the esophagus.
4. Esophageal Manometry: This test measures the pressure and coordination of muscle contractions in the esophagus to assess its function.

By utilizing these diagnostic methods, healthcare professionals can accurately diagnose Laryngopharyngeal Reflux and develop an appropriate treatment plan tailored to each patient's needs.

LPR Treatment Options

Lifestyle changes to manage Laryngopharyngeal Reflux

While medications can help alleviate symptoms, making certain lifestyle changes can also be beneficial in managing LPR.

1. Dietary modifications: Avoiding trigger foods such as spicy or acidic foods, caffeine, alcohol, and fatty foods can help reduce reflux symptoms.
2. Eating habits: Eating smaller, more frequent meals and avoiding lying down immediately after eating can prevent reflux episodes.
3. Weight management: Maintaining a healthy weight can reduce pressure on the stomach and lower the risk of reflux.
4. Posture: Keeping an upright posture during and after meals can help prevent reflux.
   

Medications for LPR

In addition to lifestyle changes, medications may be prescribed to manage LPR symptoms. These can include:



1. Proton pump inhibitors (PPIs): These medications reduce stomach acid production and can provide relief from reflux symptoms.
2. H2 blockers: These medications also reduce stomach acid production but work differently than PPIs.
3. Antacids: Over-the-counter antacids can provide temporary relief by neutralizing stomach acid.

It is important to consult with a healthcare professional to determine the most appropriate treatment plan for managing LPR symptoms. They can evaluate the severity of the condition and recommend the best course of action, which may include a combination of lifestyle changes and medication.

Foods to avoid for Laryngopharyngeal Reflux

While there are various factors that contribute to LPR, diet plays a significant role in managing and preventing this condition. Here are some foods to avoid:

1. Acidic foods: Citrus fruits, tomatoes, and vinegar-based products can trigger acid reflux symptoms.
2. Fatty and fried foods: High-fat foods like fried chicken, french fries, and fatty cuts of meat can relax the lower esophageal sphincter (LES), allowing acid to flow back into the throat.
3. Spicy foods: Spices like chili peppers, hot sauce, and garlic can irritate the throat and worsen LPR symptoms.
4. Caffeine and carbonated drinks: Coffee, tea, soda, and energy drinks can increase stomach acid production and contribute to reflux.
5. Alcohol and tobacco: Both alcohol and tobacco can weaken the LES, making it easier for stomach acid to flow back up into the throat.

It's important to note that triggers may vary for individuals, so keeping a food diary can help identify specific foods that worsen LPR symptoms. Consulting with a healthcare professional or registered dietitian is also recommended for personalized dietary advice.

Impact of Laryngopharyngeal Reflux on vocal cords

While acid reflux is commonly associated with heartburn, LPR primarily affects the voice and throat. When stomach acid reaches the vocal cords, it can cause irritation, inflammation, and swelling. This can lead to vocal cord dysfunction, hoarseness, and difficulty speaking or singing.

To care for your voice when dealing with LPR, it is important to manage the underlying reflux. This may involve lifestyle changes such as avoiding trigger foods, maintaining a healthy weight, and elevating the head during sleep. Medications that reduce stomach acid production can also be prescribed by a healthcare professional.



In addition to managing reflux, vocal hygiene practices are crucial. This includes staying hydrated, avoiding excessive throat clearing or yelling, and practicing proper vocal warm-ups and exercises.

By addressing both the reflux and taking care of your voice, individuals with LPR can improve their vocal health and minimize the impact of this condition on their voice quality and function.

Conclusion

Laryngopharyngeal Reflux (LPR) is a condition where stomach acid flows back into the throat and voice box, causing irritation and inflammation. Common symptoms include hoarseness, chronic cough, throat clearing, and a sensation of a lump in the throat. Lifestyle changes such as avoiding trigger foods, eating smaller meals, and elevating the head while sleeping can help manage LPR. Medications may also be prescribed to reduce acid production and relieve symptoms. It is important to consult with a healthcare professional for an accurate diagnosis and appropriate treatment.

FAQ (Frequently Asked Questions)

Q: Can stress worsen LPR symptoms?

A: Yes, stress can exacerbate LPR symptoms by increasing acid production in the stomach.

Q: Are there any home remedies for LPR?

A: While lifestyle changes can help manage LPR, it is important to consult with a healthcare professional for appropriate treatment options.

Q: Can LPR be cured?

A: While there is no cure for LPR, it can be effectively managed with lifestyle changes and medications. Regular follow-ups with a healthcare professional are recommended.

Q: Can LPR lead to complications?

A: If left untreated, LPR can cause complications such as laryngeal granulomas and even laryngeal carcinoma. Seeking early diagnosis and treatment is important to prevent further damage.

Q: Are there any dietary restrictions for LPR?

A: Certain foods like spicy foods, citrus fruits, and caffeine can trigger LPR symptoms. Avoiding these trigger foods may help manage symptoms.

Medical Reviewers

ENT Care Centers | ENT Health Library

Last Review Date: December 2023

Content Reviewers:

• Dr. Jeffrey Nau, MD
• Dr. Joseph J. Creely, MD
• Dr. Bryan Murphy, MD
• Dr. Thomas Higgins, MD, MSPH
• Dr. Elizabeth Burckardt, MD