Laryngopharyngeal reflux (LPR), also known as silent reflux, is a condition where stomach acid and digestive enzymes flow back into the larynx (voice box) and pharynx (throat), causing irritation and discomfort. Unlike gastroesophageal reflux disease (GERD), which primarily affects the esophagus, LPR often doesn’t present with classic heartburn symptoms. Instead, it can manifest with a range of symptoms affecting the throat and voice.

Symptoms

The symptoms of LPR can vary but often include:

• Chronic cough: A persistent cough that doesn’t seem to go away.
• Hoarseness or voice changes: Difficulty with voice, or a raspy voice.
• Sore throat: A feeling of irritation or discomfort in the throat.
• Lump in the throat: A sensation of something stuck in the throat, often described as “globus sensation.”
• Post-nasal drip: Mucus dripping down the back of the throat, which can be a result of irritation.
• Throat clearing: Frequent clearing of the throat to relieve irritation.

Less commonly, LPR can cause symptoms like sore ears, dental erosion, or a dry throat.

I am very familiar with LPR because I have been struggling with the condition since 2021. It is a persistent, annoying, and at times frightening condition which is quite resistant to treatment. I have a lump of mucus in the back of my throat the majority of the time, and this lump grows and starts to drain within a minute after eating most meals. I must frequently clear my throat to rid it of the mucus, and when the condition is particularly severe, my voice becomes raspy. The other thing I experience is very severe coughing which at times is so violent that I end up vomiting. It’s a horrible condition to have.

Diagnosis

Diagnosing LPR can be challenging because its symptoms often overlap with other conditions, such as allergies or infections. The diagnostic process typically involves:

1. Medical History and Symptom Review: A healthcare provider will take a detailed history of symptoms and may inquire about diet, lifestyle, and other health conditions.
2. Laryngoscopy: A procedure where a flexible tube with a camera (laryngoscope) is inserted through the nose or mouth to visualize the larynx and pharynx. This can help identify signs of acid damage or inflammation.
3. 24-Hour pH Monitoring: This involves placing a small probe in the esophagus or throat to measure the amount of acid reflux over a 24-hour period. This can help confirm the diagnosis of LPR by documenting acid exposure.
4. Esophageal Manometry: Sometimes used to assess how well the esophagus is functioning, though it’s less commonly needed for LPR diagnosis.
5. Empirical Treatment Trial: In some cases, doctors might start treatment based on symptoms and response to medication as a way to confirm the diagnosis if other tests are inconclusive.

Treatment Options

Treatment for LPR often involves a combination of lifestyle changes, dietary adjustments, and medications:

1. Lifestyle Modifications:
   • Elevate the Head of the Bed: Sleeping with the head of the bed raised can help reduce nighttime symptoms. *NOTE: I do not personally find this to be helpful at all.
   • Avoid Eating Late: Try not to eat within 2-3 hours of bedtime to reduce nighttime reflux.
   • Maintain a Healthy Weight: Excess weight can increase abdominal pressure and contribute to reflux.
   • Quit Smoking: Smoking can irritate the esophagus and throat, worsening symptoms.
2. Dietary Changes:
   • Avoid Trigger Foods: Common triggers include acidic foods (like tomatoes and citrus), spicy foods, caffeine, chocolate, and fatty foods.
   • Eat Smaller Meals: Larger meals can increase pressure on the lower esophageal sphincter, leading to reflux.
3. Medications:
   • Proton Pump Inhibitors (PPIs): These reduce stomach acid production and are often effective in treating LPR. *NOTE: Please be aware that I am not a fan of this treatment method.
   • H2-Receptor Antagonists: These medications also reduce acid production but are typically less potent than PPIs. *NOTE: Please be aware that I am not a fan of this treatment method.
   • Antacids: Can provide short-term relief by neutralizing stomach acid. *NOTE: Please be aware that I am not a fan of this treatment method.
   • Alginate-Based Medications: These form a protective barrier on top of the stomach contents to prevent reflux.
4. Surgery: In severe cases where lifestyle and medication don’t help, surgical options like fundoplication (a procedure to wrap the top of the stomach around the lower esophagus) might be considered to prevent acid reflux.

Managing LPR often requires a comprehensive approach, including lifestyle and dietary changes combined with appropriate medical treatments. Regular follow-up with a healthcare provider is crucial to monitor the condition and adjust treatment as needed.