Laryngopharyngeal Reflux (LPR): How Acid Reflux Can Affect the Voice
What is LPR?
LPR stands for laryngopharyngeal reflux, which occurs when the stomach contents and acid make it all the way up past the esophagus and irritate the very delicate tissues of the throat and larynx. In some cases acidic foods and liquids (like soda and tomato-based foods) can also irritate the throat on the way down. This can result in frequent throat clearing, mucus sensation or fullness in the throat, chronic cough, and hoarseness of the voice.
What’s the difference between GERD and LPR?
When acid repeatedly “refluxes” from the stomach into the esophagus alone, it is known as gastroesophageal reflux disease (GERD). This typically causes the “classic” reflux symptoms of heartburn and regurgitation. However, if the stomach acid travels up the esophagus and reaches the throat or voice box (called the pharynx/larynx), it is known as laryngopharyngeal reflux (LPR). The lining of your throat is much more delicate than in your esophagus, so even small amounts of acid that are not enough to cause GERD symptoms can still cause LPR. In other words, it’s possible to have LPR without having heartburn!
How can laryngopharyngeal reflux affect the voice?
LPR can cause swelling of the vocal cords through direct contact by acid and digestive enzymes, or may cause a secondary effect on the voice by irritating the throat and swallowing muscles. These can cause a raspy or strained voice quality and alter pitch. Singers may experience vocal fatigue or loss of range, or feel discomfort with vocalization. Some laryngologists also believe that LPR puts patients at greater risk for developing nodules, polyps, and other irritation-related disorders of the vocal cords.
How is laryngopharyngeal reflux diagnosed?
Diagnosing LPR can be tricky, because many of the symptoms of LPR overlap with other voice and throat disorders. That’s why it’s helpful to be evaluated by a laryngologist with special expertise in voice care. Your laryngologist will take a detailed history and look for diet and lifestyle factors that may give clues that LPR is happening. A careful ear, nose, and throat exam including laryngoscopy or videostroboscopy will be done to check for signs of LPR, as well as other conditions that could cause similar symptoms. In some cases, specialized reflux testing may be performed.
How does Dr. Rafii treat laryngopharyngeal reflux?
Dr. Rafii believes in a “diet and lifestyle first, medications later” approach to treating LPR. When done right, most people can avoid medications. Initial steps include:
- Limit foods that can set off reflux. These “trigger foods” differ from one person to another but often include spicy or fried foods, alcohol, sodas and caffeinated drinks, peppermint, chocolate, and tomatoes.
- Avoiding eating for at least 3 hours before bed
- Portion control–eat smaller and more frequent meals throughout the day
- Quit smoking/vaping
- Weight loss, if needed
- All-natural alginate supplements, which keep acid in the stomach where it belongs.
In some cases these measures are not enough, and additional treatment with medication or diagnostic testing to look for underlying anatomic issues such as hiatal hernia or motility problems may be needed.If you’re experiencing any throat symptoms that you suspect may be caused by laryngopharyngeal reflux, give Dr. Rafii a call at 323.433.7744 to schedule a consultation!