Laryngopharyngeal Reflux Disease (LPR)
Acid reflux may be a primary cause of or a contributing factor to voice problems. Many people have heard of acid reflux disease. When the refluxing of stomach acid primarily affects the esophagus, it is termed gastroesophageal reflux disease (GERD). When the refluxing affects primarily the voice production system – the larynx and pharynx – it is called laryngopharyngeal reflux disease (LPR). It may also be called 'reflux laryngitis'.
When normal, healthy individuals eat or drink, swallowing propels food and liquid from the back of the mouth down into the esophagus, the tube connecting the mouth to the stomach. Two esophageal sphincters, or valves, open and close in such a way as to promote passage of food into the stomach and prevent backflow.
GERD, or 'classic' reflux, occurs when the acid contents move from the stomach backwards up the esophagus, due either to improper functioning of one or both sphincters (which can be aggravated by a condition known as 'hiatal hernia') or due to muscular spasms of the esophagus.
LPR occurs when refluxed stomach contents reach all the way up into the throat. Almost everyone experiences reflux occasionally. When acid reflux occurs often, however, the larynx can become irritated, because the larynx and back of the throat do not have the same type of lining as the esophagus to protect from acidic fluids. Sometimes, if the LPR is severe enough, it can cause a non-cancerous lesion (growth) on the back of the vocal fold, called a granuloma.
Symptoms of LPR can include: a choking sensation, sometimes severe enough to wake a person up at night; sore throat; voice changes; a sensation of something caught in the throat; frequent coughing and throat clearing; and a sour or bitter taste in the mouth, especially upon rising in the morning. The 'classic' symptoms of heartburn, burping or chest pressure are associated with GERD, but not necessarily with LPR.
Many patients with voice problems caused by LPR are not even aware that they have acid reflux problems. Because of the many bothersome symptoms of LPR, this condition can create habits which further contribute to the voice problem, such as constant throat-clearing or using excessive muscle tension when speaking.
LPR is treated primarily in two ways. Making some simple lifestyle, or behavioral changes can help prevent or decrease LPR and improve the voice.In conjunction with lifestyle changes, medications can also be used to help control LPR. Behavioral changes should always accompany medication regimens to help the medication work most effectively. In many instances, it can take a few months of regular medication use before the LPR symptoms are significantly reduced.