Understanding the Disorder
Reflux laryngitis is a voice disorder that results from irritation and swelling of the vocal folds due to the backflow of stomach fluids into the throat. This backflow is called laryngopharyngeal reflux (acid that reaches the level of the throat). Stomach fluids contain acids and enzymes that help digest food in the stomach, but cause problems elsewhere in the food pipe [esophagus, throat, and voice box]. Reflux disease can be acid or non-acidic. For Acidic reflux, it is broken down into GERD and LPR. Classic GERD symptoms include heartburn. LPR symptoms are more likely throat clearing, a lump in the throat sensation, and hoarseness.
Frequent Complaints
People with reflux laryngitis usually complain of hoarseness, frequent throat clearing, sensation of lump in the throat, cough, or sore throat. These patients do not commonly experience heartburn, which is a typical complaint in backflow of stomach fluids to the esophagus causing inflammation in the esophagus, also known as gastroesophageal reflux disease (GERD).
Overlapping Complaints
Patients with reflux laryngitis have complaints similar to other voice disorders, making it an easily missed voice disorder.
Lifestyle Habits
There are a number of lifestyle behaviors that contribute to reflux. These habits must be changed or stopped to gain relief. More importantly, failure to change these habits can hinder the success of any treatment for backflow of stomach fluids into the throat and voice box (reflux laryngitis).
Symptoms
The most common symptom is hoarseness, which is worse in the morning and after eating.
Common Symptoms Associated with Reflux Laryngitis
- Gravely, hoarse voice
- Low pitch
- Lump in the throat feeling
- Burning in the throat
- Excessive throat clearing
- Coughing
- Excessive mucous
- Bitter/sour taste in the mouth
- Worsening of symptoms with spicy foods
A Puzzle
For unclear reasons, patients with LPR do not commonly experience heartburn. Heartburn is a burning sensation in the chest that is not due to a heart problem but rather an irritation and/or inflammation of the esophagus (esophagitis) caused by backflow of stomach fluids into the esophagus, also known as gastroesophageal disease (GERD).
Diagnosis
How is the diagnosis of reflux laryngitis made?
1. Patient History
- A history of symptoms and how the voice fluctuates in relation to eating patterns is key to diagnosing reflux laryngitis.
2. Symptom Severity scales
- The laryngologist may use a questionnaire that asks questions about reflux symptoms in order to determine if the patients’ symptoms are abnormally high, indicating possible reflux.
3. pH Probe Monitoring
- In persistent or severe cases of reflux laryngitis, the patient may be asked to undergo a procedure called a pH probe monitoring. During this procedure, the patient wears a monitoring device that captures the backflow of reflux into the throat area. Treatment Role of Medical Treatment First line of treatment for reflux laryngitis involves using medicines that reduce stomach acid secretion. In addition, lifestyle and behavioral modifications, termed reflux precautions, are recommended.
Elements of Successful Treatment
For treatment to be successful, the patient must do the following:
- Take the proper amount of medicine
- Take the medicine regularly
- Take the medicine for the proper period of time
- Follow physician advice to prevent backflow of stomach fluids (reflux precautions)
- Go for follow-up check-ups with the physician
Particular Common Foods and Drinks
- Fats, especially fried foods
- Chocolates
- Mints
- Alcohol
- Any beverage with caffeine (tea, coffee)
- All soda/pop
- Tobacco
- In addition, certain foods and drinks can worsen mucosal irritation from backflow of stomach acids/enzymes:
- Spicy foods
- Citrus products
- Tomato products
Going to Bed on a Full Stomach
• Your stomach takes an average of three hours to empty after eating.
• Lying down too soon increases risk of backflow (reflux).
Tight-Fitting Clothing
Wearing clothing that puts pressure on your stomach increases risk of backflow (reflux).
Overeating
Eating large quantities of food such that abdominal pressure is increased can increase risk of backflow (reflux).
Stress
High levels of stress, nervousness and/or anxiety has been shown to increase the secretion of stomach acid in some people.
Obesity
Being very overweight increases risk of backflow (reflux).