Have you had a cough, tickle in the throat, itchy throat, or raspy voice that will not go away despite not having a cold or feeling sick? Is excess mucus causing you to clear your throat so often that it is annoying and, at times, embarrassing? Many who suffer from these symptoms are treated by doctors and urgent care physicians with allergy medications, nasal sprays, decongestants, and even antibiotics. Despite this, symptoms do not get better. Often these symptoms are not caused by allergies, a sinus infection, or a cold, but by laryngopharyngeal reflux (LPR). Also called airway reflux, reflux laryngitis, or atypical reflux, LPR is one of the most common diseases of the 21st century. Unlike gastroesophageal reflux disease (GERD), which primarily affects the esophagus, LPR will affect the larynx and pharynx—your voice production system. Lissette Giraud, MD, provides insight into and answers common questions about this widespread condition.
What causes LPR?
It is commonly accepted that this condition is caused by reflux of acid or bile. GERD symptoms like heartburn are not typical of the condition but may appear. The most common symptoms of LPR are hoarseness, sore throat, excess mucus in the throat, persistent cough, asthma-like, symptoms (wheezing, chest tightness, and difficulty breathing), postnasal drip, sensation of a lump in the throat, difficulties swallowing, and ear pain. However, LPR presents differently in each person.
When should I see a doctor?
If you have a sore throat, painful swallowing, cough, difficulty swallowing, or hoarseness for 10-14 days, you should seek medical attention, preferably from an ENT.
What is the treatment for LPR?
Treatment will vary in accordance with the severity of symptoms. It can be as simple as making changes to your diet, like avoiding spicy foods, tomatoes, chocolate, caffeine, citrus beverages or foods, and alcohol.
Other solutions include:
- Avoiding large meals
- Eating three hours or more prior to going to bed
- Elevating the head eight inches when sleeping
- Smoking cessation
- Losing weight if you are overweight
Your doctor may also recommend a medication to reduce acid production in the stomach, like Zantac or Pepcid, for a few weeks or longer.Stronger medications may be recommended if diet and life style changes have not worked.
Do I need any tests like CT scans, X-rays, or MRI’s to diagnose LPR?
The diagnosis of LPR is mostly based on symptoms and an office procedure called flexible laryngoscopy—an endoscopic exam of the voice box and throat performed by an ENT—and response to treatment. In some cases an upper endoscopy examination to evaluate the stomach and esophagus for inflammation, ulcers, or any abnormal lesion may be recommended. More advanced tests like pH testing and esophageal manometry are less frequently recommended and are typically done for difficult cases.
What are the complications from untreated LPR?
If LPR is left untreated, patients may experience vocal cord lesions like polyps or granulomas, chronic laryngitis, or asthma.
If you or a loved one suffers from the above symptoms, visit an ENT doctor, who will be prepared to do a complete evaluation and determine if you have LPR and recommend treatment.
Lissette Giraud, MD, is a board certified otolaryngologist at New York Eye and Ear Infirmary of Mount Sinai and Mount Sinai Doctors Tribeca with more than 15 years of experience. She treats both pediatric and adult patients with an emphasis in management of sinus disease/surgery, laryngopharyngeal reflux, thyroid surgery, dizziness, and ear diseases. Dr. Giraud is fluent in English and Spanish.
What's the difference between LPR and GERD?
Both LPR and GERD are caused by acid reflux. GERD, the more well known condition, occurs when stomach acid backs up into the esophagus. Patients with this condition may experience nausea and heartburn. LPR occurs when stomach acid reaches the back of the throat or, in some cases, the nasal passage.
Frequently, primary care physicians correctly make the diagnosis of LPR. Patients may be reluctant to start treatment since the typical “acid reflux” symptoms—like heartburn, belching, and regurgitation of acid contents—are not present. Additionally, when patients see a gastroenterologist after a referral by their primary care provider or otolaryngologist (ear, nose, and throat physician, also known as ENT), they are frequently told they do not have “acid reflux.” This confuses many patients and creates further frustration.
