Tag LPR

What Is Silent Reflux?

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Laryngopharyngeal reflux (LPR), sometimes called “silent reflux,” is a condition in which stomach acid or other contents flow backward into the larynx (voice box) and pharynx (throat). Unlike gastroesophageal reflux disease (GERD), LPR often doesn’t cause the classic symptom of heartburn. Instead, it presents with a variety of upper airway and throat symptoms that can be subtle, confusing, and sometimes frightening.

Common Symptoms of LPR:

  • Chronic throat clearing
    A frequent need to clear the throat due to irritation caused by acid or digestive enzymes.
  • Persistent cough
    Especially at night or after eating, the cough may not respond to traditional treatments.
  • Hoarseness or voice changes
    Vocal cords can become inflamed or irritated, leading to a raspy or weak voice, especially in the morning.
  • Globus sensation
    A feeling of a lump, tightness, or something stuck in the throat, even when nothing is there.
  • Postnasal drip or excess mucus
    The body produces mucus in response to irritation, which can feel like it’s collecting in the back of the throat.
  • Difficulty swallowing (dysphagia)
    Swallowing may feel effortful or uncomfortable, and food may seem slow to move down the throat.
  • Sore throat or burning sensation in the throat
    Especially after eating or while lying down.
  • Ear pain or a sensation of fullness
    Acid can irritate the Eustachian tubes or nearby structures, leading to ear discomfort.

Feeling Like You’re Drowning in Your Own Saliva

One of the more distressing and lesser-known symptoms of LPR is excessive saliva production (also called water brash), along with difficulty swallowing and a sensation of choking. This can feel as though saliva is pooling in the throat, leading to:

  • A sensation of choking on saliva
    Because the throat and swallowing reflexes may be disrupted by inflammation, even normal amounts of saliva can feel overwhelming.
  • Difficulty managing secretions
    Some people feel they can’t swallow quickly or completely enough, leading to a constant awareness of saliva in the mouth or throat.
  • Fear of aspiration
    The fear that the saliva or refluxate could “go down the wrong pipe” and enter the lungs, especially when lying down.
  • Shortness of breath or throat tightness
    These may be reflexive responses from the larynx trying to protect the airway, which can exacerbate the sensation of “drowning.”

Why This Happens

Stomach contents, including acid, pepsin, or bile, are not meant to come in contact with the sensitive tissues of the throat and larynx. Even a small amount of reflux reaching these areas can cause inflammation and nerve hypersensitivity. When this happens:

  • The muscles that control swallowing may become uncoordinated.
  • The throat may feel constricted.
  • The body’s natural response is to produce more mucus and saliva to soothe the tissues, which paradoxically makes the feeling of “drowning” worse.

What to Do

If you suspect you have LPR, especially if you’re experiencing this “drowning” sensation, it’s important to:

  • Consult an ENT or gastroenterologist
    They may perform a laryngoscopy or pH monitoring to confirm LPR.
  • Modify diet and lifestyle
    Avoid acidic, spicy, or fatty foods, eat smaller meals, and don’t lie down after eating. However, I will say that even a clean diet which follows these recommendations might not even make a difference at all. This has been the case for me.
  • Elevate the head of the bed
    This reduces nighttime reflux for some people. However, it won’t make any difference for other sufferers (like me).
  • Use supplements if needed
    These may include alginate-based therapies or other substances which create a physical “raft” to block off the backflow. Some physicians may recommend proton pump inhibitors (PPIs) or H2 blockers or allergy medications, but these medications might not have any effect on the condition.

While it’s not dangerous in most cases, the sensation of drowning in your own saliva due to LPR can feel alarming. The good news is that with proper diagnosis and treatment, symptoms can usually be well-managed and greatly improved.

What Is Laryngopharyngeal Reflux?

drstaceynaito 1 Comment

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.