Laryngopharyngeal Reflux (LPR): Symptoms, Causes, Treatment

What are the symptoms of laryngopharyngeal reflux?

Laryngopharyngeal reflux (LPR), also known as silent reflux or extraesophageal reflux, occurs when stomach acid flows back up into the larynx (voice box) and pharynx (throat), causing irritation and inflammation. The symptoms of laryngopharyngeal reflux can vary but often include:

1. Hoarseness: Persistent hoarseness or changes in voice quality, often described as a raspy or rough voice.
2. Throat Clearing: Frequent throat clearing or a sensation of needing to clear the throat due to irritation.
3. Chronic Cough: A dry, persistent cough that does not seem to be related to cold or respiratory infection. The cough may worsen at night or after eating.
4. Sore Throat: A sensation of throat discomfort, soreness, or a lump-like feeling (globus sensation).
5. Difficulty Swallowing: Known as dysphagia, this symptom may occur if acid reflux causes irritation or narrowing of the esophagus or throat.
6. Postnasal Drip: Excessive mucus or phlegm in the throat, which may lead to frequent throat clearing or coughing.
7. Ear Pain: Some individuals with laryngopharyngeal reflux may experience ear pain or earaches due to the refluxed acid irritating the Eustachian tube, which connects the throat to the middle ear.
8. Trouble Breathing: In severe cases or if reflux affects the upper airway, it may cause difficulty breathing or a sensation of shortness of breath.
9. Heartburn: Although less common in LPR compared to gastroesophageal reflux disease (GERD), some individuals may experience occasional heartburn or a burning sensation in the chest.
10. Voice Changes: Apart from hoarseness, LPR can affect vocal quality, causing fluctuations or instability in the voice.

It’s important to note that laryngopharyngeal reflux often presents with atypical or “silent” symptoms, meaning symptoms may not always include typical heartburn. Diagnosis involves a thorough medical history, physical examination, and sometimes additional tests such as laryngoscopy (direct visualization of the throat and larynx) or pH monitoring to confirm the presence and severity of reflux. Treatment usually includes lifestyle modifications, dietary changes, and medications to reduce acid production and relieve symptoms.

What are the causes of laryngopharyngeal reflux?

Laryngopharyngeal reflux (LPR) is a condition in which stomach acid and digestive enzymes flow back up into the larynx (voice box) and pharynx (throat). The causes of LPR can be attributed to a combination of factors, including:

1. Gastroesophageal reflux disease (GERD): GERD is a condition in which stomach acid and digestive enzymes flow back up into the esophagus, causing heartburn and regurgitation. In some cases, this acid can flow up into the larynx and pharynx, causing LPR.
2. Weakened lower esophageal sphincter (LES): The LES is a ring-like muscle that separates the esophagus from the stomach. A weakened LES can allow stomach acid to flow back up into the esophagus and, in some cases, the larynx and pharynx.
3. Increased intra-abdominal pressure: Conditions such as obesity, pregnancy, or ascites (fluid accumulation in the abdominal cavity) can increase intra-abdominal pressure, which can contribute to LPR.
4. Hormonal changes: Hormonal changes during pregnancy or menopause can relax the LES and lead to GERD and LPR.
5. Eating habits: Consuming large or late meals, lying down after eating, or eating spicy or fatty foods can contribute to LPR.
6. Drinking habits: Drinking large amounts of fluids or carbonated beverages can increase the risk of LPR.
7. Aging: As people age, the LES may weaken, making them more susceptible to LPR.
8. Anatomical factors: Abnormalities in the shape or size of the esophagus, larynx, or pharynx can increase the risk of LPR.
9. Other medical conditions: Certain medical conditions, such as hiatal hernia, diabetes, and gastrointestinal motility disorders, can increase the risk of LPR.

It’s essential to consult with a healthcare provider for proper evaluation and diagnosis of LPR.

How is the diagnosis of laryngopharyngeal reflux made?

The diagnosis of laryngopharyngeal reflux (LPR) is typically made through a combination of clinical evaluation, medical history, and diagnostic tests. Here are the steps involved in diagnosing LPR:

1. Clinical evaluation: A healthcare provider will perform a thorough clinical evaluation to assess the patient’s symptoms, medical history, and overall health.
2. Physical examination: A physical examination will be performed to evaluate the patient’s throat, larynx, and pharynx for signs of inflammation or irritation.
3. Medical history: The healthcare provider will ask questions about the patient’s symptoms, including the frequency and duration of episodes of laryngitis, hoarseness, and difficulty swallowing.
4. Endoscopy: An endoscopy may be performed to visually examine the larynx, pharynx, and esophagus for signs of inflammation, erosion, or damage.
5. Microbiological testing: A swab or biopsy may be taken from the larynx or pharynx to test for bacterial or fungal infections.
6. Imaging studies: Imaging studies such as X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans may be ordered to rule out other conditions that may be causing similar symptoms.
7. 24-hour pH monitoring: A 24-hour pH monitoring test may be performed to measure the acidity of the esophagus and detect acid reflux episodes.
8. Laryngoscopy: Laryngoscopy may be performed to visualize the larynx and pharynx and assess for signs of inflammation or irritation.
9. Esophageal manometry: Esophageal manometry may be performed to assess the muscles in the esophagus and evaluate their function.

In some cases, additional tests such as a barium swallow or a pH probe may be ordered to further evaluate the patient’s symptoms.

It’s essential to consult with a healthcare provider for proper evaluation and diagnosis of LPR.

What is the treatment for laryngopharyngeal reflux?

The treatment for laryngopharyngeal reflux (LPR) typically involves a combination of lifestyle changes, medications, and other interventions. Here are some common treatments for LPR:

Lifestyle changes:

1. Dietary changes: Avoiding trigger foods and drinks that can exacerbate symptoms, such as spicy, fatty, or acidic foods and drinks.
2. Elevating the head: Raising the head of the bed by 6-8 inches to prevent acid reflux at night.
3. Weight loss: Losing weight if overweight or obese to reduce pressure on the lower esophageal sphincter.
4. Avoiding tight clothing: Avoiding tight clothing that can put pressure on the throat and stomach.

Medications:

1. Antacids: Antacids such as Tums or Rolaids can help neutralize stomach acid and relieve symptoms.
2. Histamine-2 (H2) blockers: H2 blockers such as ranitidine or famotidine can reduce acid production in the stomach.
3. Proton pump inhibitors (PPIs): PPIs such as omeprazole or lansoprazole can reduce acid production in the stomach.
4. Acid reducers: Acid reducers such as sucralfate can help reduce acid production in the stomach.

Other interventions:

1. Laryngeal elevation surgery: In severe cases, surgery may be necessary to elevate the larynx and improve airflow.
2. Phrenic nerve block: In some cases, a phrenic nerve block may be performed to reduce nerve stimulation and alleviate symptoms.
3. Speech therapy: Speech therapy may be recommended to help improve communication skills and reduce vocal cord strain.

It’s essential to consult with a healthcare provider for proper evaluation and treatment of LPR.