Laryngopharyngeal Reflux - Causes, Symptoms, Diagnosis, and Treatment

Introduction

Laryngopharyngeal reflux is when the acid formed in the stomach travels back through the esophagus up to the throat resulting in a sore throat and irritated larynx. Laryngopharyngeal reflux is similar to another condition called gastroesophageal reflux disease (GERD) which is caused due to acid contents of the stomach due to reflux. The symptoms of laryngopharyngeal reflux are different from those caused due to gastrointestinal reflux disease, like a burning sensation in the lower chest. Laryngopharyngeal Reflux is called silent reflux, which is quite challenging to diagnose.

It can affect any age group, but it affects as people ages. It usually affects those who -

• Have specific dietary habits.

• Regularly wearing tight and binding clothes.

• Overweight.

• Overstressed.

What Are the Causes of Laryngopharyngeal Reflux?

When the food is swallowed, it passes down the throat through the esophagus into the stomach. The lower esophageal sphincter is a muscle that allows food from the esophagus to the stomach. This muscle is tightly closed and opens up only to allow food into the stomach. Acid reflux occurs when this muscle does not close properly, and the stomach acid tends to travel back through the esophagus. Due to this reflux, the acid may reach the throat (pharynx), voicebox (larynx), or back of the nasal airway. This results in inflammation and irritation of the area not protected against gastric acid. Silent reflux is commonly seen in newborns where the lower esophageal sphincter muscle is not completely developed, the esophagus is very short, and they lie down mainly, but the cause is unknown in adults.

What Are the Signs and Symptoms of Laryngopharyngeal Reflux?

The common symptoms are:

• Sore throat.

• Mild hoarseness.

• A sensation of a lump in the throat.

• The need to clear the throat frequently.

• Postnasal drip or feeling of muscle sticking in the throat.

• Difficulty in swallowing.

• Long-term cough.

• Red, swollen, inflamed, and irritated voice box.

• Problem gaining weight.

• Asthma.

• Apnea, noisy breathing.

Those adults who experience Laryngopharyngeal reflux will have heart burns, a bitter taste, and a burning sensation at the back of the throat. These people do not experience classic signs and symptoms of gastrointestinal reflux disease.

What Are the Complications of Laryngopharyngeal Reflux?

The stomach acid due to reflux can cause irritation and inflammation in the long term. Without proper treatment, it may cause some severe issues in newborns and children, such as:

• Narrowing of the region below the vocal cord.

• Contact ulcer.

• Frequent ear infection with eustachian tube function.

• Buildup of middle ear fluid.

In adults, long-term acid reflux can result in

• Scarring of the throat and voice box.

• Enhance the risk of cancer in the affected area.

• Affected lungs.

• Asthma.

• Emphysema.

• Bronchitis.

How Is Laryngopharyngeal Reflux Diagnosed?

Diagnosis of Laryngopharyngeal Reflux is Usually done with the help of the symptoms experienced by the person or the swelling in the throat or back of the neck. There is some test which is done during the diagnosis of this condition. These are:

• Swallowing Study: In this study, the person is asked to swallow barium liquid which stains the esophagus, stomach, and intestine so that they are clearly outlined in an X-ray. This helps the doctors track the food's movement along the esophagus to the stomach.

• Endoscope: A long thin, flexible tube attached to the camera at the end is used to view the inside of the stomach and esophagus. The doctor passes this tube through the mouth into the esophagus and then to the stomach.

• Esophageal pH: A thin, flexible tube with a device attached at the end monitors the pH level. This tube is gently passed down through the nose to the esophagus and is placed two inches above the lower esophageal sphincter. The tube is fastened in this position using tape. The other end of the tube, which comes out through the nose, is attached to a portable recorder placed on a belt or over the shoulder. The recorder has many options where the patients can record various events. This procedure is done to record the level of pH present in the esophagus.

How Is Laryngopharyngeal Reflux Managed?

Most of the people who experience Laryngopharyngeal Reflux do not require any treatment and can manage the signs and symptoms through some lifestyle changes, including the following:

• Following a bland diet with less acid, low fat, and spicy content.

• Frequent eating, small meals.

• Reduce weight.

• Avoid alcohol, tobacco, and caffeine.

• Food should be taken at least two hours before bedtime.

• The head should be raised while sleeping. This can be done by placing a solid object under the matter so that the head and the upper portion of the body are raised. This will prevent the stomach acid from backing up into the throat.

• Clearing the throat frequently should be avoided.

• Over-the-counter medications such as antacids, stomach acid reducers, or proton pump inhibitors can be used.

• In extreme cases of laryngopharyngeal reflux, the doctor will recommend surgery.

What Are the Medications Recommended to Manage Laryngopharyngeal Reflux?

Proton Pump Inhibitors:

1. Dexlansoprazole.

2. Esomeprazole.

3. Lansoprazole.

4. Omeprazole.

5. Sodium bicarbonate which helps to reduce gastric acid.

H2 Blockers:

1. Cimetidine.

2. Famotidine.

3. Nizatidine.

Prokinetic Agents: These medications are usually recommended to help enhance the gastrointestinal tract's forward movement and the pressure of the esophageal sphincter.

Sucralfate: This helps to deal with injured mucous membranes.

Antacids: Antacids are used to neutralize stomach acid, which is usually recommended when there is a symptom of heartburn

What Is the Cause of Long-Term Untreated Laryngopharyngeal Reflux?

If laryngopharyngeal reflux is not treated for a very long time, it can cause:

• Sore throat.

• Chronic cough.

• Swelling of vocal cords.

• Ulcers over vocal folds.

• Occurrence of granuloma in the throat.

• Worsening of certain conditions like asthma, emphysema, and bronchitis.

How Is Laryngopharyngeal Reflux Prevented?

To prevent laryngopharyngeal reflux, these are avoided:

• Intake of acidic, fatty, and spicy food.

• Alcohol.

• Tobacco.

• Caffeine (tea, coffee, soda, etc).

• Chocolate.

• Mint-flavored food.

• Avoid tight clothing.

• Reduce stress.

• Maintaining a healthy weight.

• Intake of food less than two hours should be avoided.

Conclusion

Laryngopharyngeal Reflux is caused due to stomach acid reflux when it reaches the throat. This acid reflux causes esophagus, throat, and voice box inflammation. The symptoms are different from those caused due to GERD. This condition does not always require treatment. Some lifestyle changes and medications can help to deal with this condition. In very severe cases, surgery is recommended.