Laryngo-Pharyngeal Reflux Disorder (LPRD)

Gastroesophageal Reflux Disorder (GERD) is a well-known problem in this country, with advertisements for the many medications used to treat it commonly seen on TV.  GERD occurs when stomach acid makes its way back up the esophagus, causing indigestion, stomach upset, and, especially, heartburn.  The acid may travel all the way up the esophagus, and spill over onto the larynx.  This is especially common during sleep, when the individual is lying down, and acid does not have to fight gravity to move up the esophagus.  When symptoms of acid reflux are more apparent in the larynx or pharynx, then the disorder may be called Laryngopharyngeal Reflux Disorder (LPRD).  It should be noted that the juices from the stomach may have a low acid content, but still be highly irritating to the larynx.

Other Names

• Reflux
• Gastro-Esophageal Reflux Disorder (GERD)

Symptoms

• Dry, choking sensation, especially during the night
• Voice quality that is worst in the morning
• Raw, burning sensation in the throat
• Pain in throat, neck, or running from back of chin along neck
• Frequent coughing or desire to clear throat
• Rough, gritty voice quality
• Decline in voice quality or comfort with continued voice use
• A sour taste in your mouth upon waking up

Cause

Juices from the stomach refluxes back up through the esophagus and spills over onto the larynx. This irritates the vocal folds and creates inflammation, which causes the vocal folds to vibrate unevenly. Coughing and throat clearing from the irritation can make the inflammation worse. The resulting voice disorder is often related to the poor vibratory quality of the inflamed vocal folds and the muscle tension created by effortful attempts at compensation.

Treatment

Anti-reflux medication and dietary precautions are the first line of defense. Functional voice therapy is useful to teach techniques for reducing effortful compensation and instruct the individual in improved vocal hygiene.

At the Lions Voice Clinic, we do not hand out a list of foods and beverages that must be avoided. Rather, we educate about types of foods and beverages known to cause reflux and encourage the individual to systematically investigate which foods stimulate their own reflux. Also, the individual is encouraged to manage reflux under the care of a Gastroenterologist (gastrointestinal - GI - specialist).

Lifestyle and mechanical changes that may help reduce symptoms of GERD/LPRD

• Eat smaller meals more frequently throughout the day, rather than three large meals
• Elevate the head of your bed 2-3 inches (don't just use extra pillows for your head)
• Avoid clothes that fit tightly around the waist
• Avoid lying down within 2-3 hours of eating (don't eat dinner late at night)

Types of foods known to trigger increased stomach acid

• spicy food (such as chili or jalapeño peppers, Thai or Szechuan spices)
• acidic foods such as tomato products or citrus products
• greasy foods
• caffeine
• alcohol
• carbonation
• roughage, such as popcorn and peanuts, or raw vegetables
• dairy products
• strong mint such as peppermint candies
• chocolate

Reading this list might make you think you can only eat bread and oatmeal for the rest of your life. Fortunately, most individuals are not triggered by everything on this list. For example, for every person who is lactose intolerant and has problems with dairy products, there may be someone else whose digestive system is calmed by milk. Therefore, we recommend that you experiment with your own dietary habits, changing one food class at a time. Also, if you have recently started taking anti-reflux medications, you may want to wait for several months, to see how the medication works without any change in your dietary habits.