Laryngopharyngeal reflux, also known as extraesophageal reflux disease or EERD, is a disease where the contents of ones stomach move back up the esophagus and into the airways. With this condition, the sphincter muscles at the top and bottom of the esophagus do not function properly, allowing the stomach acid to back up to the throat and voice box. Unlike GERD (also known as acid reflux) that has heartburn as one of its distinguishing factors, patients with laryngopharyngeal reflux rarely have heartburn, leading it to be called “silent reflux.” The body naturally produces pepsin, a stomach enzyme designed to digest proteins. It is believed that when one experiences laryngopharyngeal reflux, the pepsin moves back up into the airways where they cause damage by breaking down protein inside of mucus cells.
Since it lacks the typical heartburn symptom, it can also be quite difficult to diagnose. Doctors cannot diagnose this condition based on symptoms alone. Typically, it is only diagnosed after one of two medicals tests are completed, combined with a physical exam and medical history. Most commonly, an endoscopic exam is conducted. This involves using a flexible viewing instrument to view the vocal chords and throat and is typically performed in a doctor’s office. If a patient has laryngopharyngeal reflux, their voice box will appear red, irritate and inflamed from the acid damage. The second test that is used much less often is pH monitoring. Using sensors that are placed in the throat and esophagus via a catheter through the nose, the doctor can detect the levels of acid present. Monitoring is typically done over a period of 24 hours and measurements are recorded by a computer worn around the waste.
Silent reflux is a common ailment in infants due to their underdeveloped sphincters and the fact that they are predominantly laying down. In adults, the cause is unknown but it does seem to happen more often as people age. For patients with laryngopharyngeal reflux, there are a number of symptoms. For adults, symptoms include:
- Persistent sore throat
- Difficulty swallowing
- Postnasal drip
- Chronic coughing
- Chronic throat-clearing
- Globus pharynges, which is the persistent sensation of having something caught in one’s throat when there is nothing there
- Loss of the high end of the vocal range
- Sensation of drainage down the throat
Some patients do also experience heartburn, but it is far less common that those with GERD.
Symptoms in Children and Infants
For infants and children with laryngopharyngeal reflux, their symptoms include:
- Trouble feeding
- Spitting up
- Chronic cough
- Noisy breathing
- Failure to gain weight
If left untreated, laryngopharyngeal reflux can lead to dangerous complications. For adult, these complications include:
- Scarring of the voice box and throat
- Increase risk of cancer
In infants and children, complications include:
- Narrowing just below the vocal chords
- Buildup of middle ear fluid
- Chronic ear infections
- Contact ulcers
Luckily, there are a number of treatment options that can reduce or eliminate laryngopharyngeal reflux. These treatment options vary depending on the patient being treated. For adults, the options include:
- Losing weight if overweight
- Quitting smoking
- Avoiding alcohol, especially before bedtime
- Following a restrictive diet that avoids foods known to cause reflux, such as chocolate, citrus, tomatoes and caffeine
- Not eating for 2–3 hours before going to bed
- Elevating the head of the bed by 6 inches when sleeping
- Wearing loose clothing
- Chewing gum
Treatment options for infants and children are typically:
- Smaller, more frequent feedings or meals
- Staying upright for 30 minutes after eating
There are also a number of medications available for treatment in adults of this condition, including:
- Proton pump inhibitors
- H2 Blockers
- Prokinetic agents
If these treatments do not work, there are two surgical procedures that can help alleviate this condition. The first is called a fundoplication; it involves wrapping the upper part of the stomach around the lower esophagus to prevent the acid form coming back up. The second procedure involves putting a ring of titanium beads around the lower esophagus to strengthen it.
Laryngopharyngeal reflux is a condition that falls under the broader disease of acid reflux, although unlike its more prevalent counterpart, patients with laryngopharyngeal reflux do not experience the typical symptoms of acid reflux. This makes receiving a proper diagnosis more difficult but not impossible. Luckily, like acid reflux it can be successfully reduced or eliminated with the right treatment.
Please remember the information provided here is meant to be informative, not replace the advice of a medical professional. If you are experiencing symptoms, you should always consult a medical professional for a proper diagnosis and treatment plan.