Laryngopharyngeal Reflux

Laryngopharyngeal reflux (LPR) is often present with a chronic cough that can mimic the cough associated with asthma.

Symptoms
If you suffer from LPR, it is likely you complain of dry cough, chronic throat clearing, post nasal drip, intermittent hoarseness, thick or large amounts of post nasal mucus in the throat, heartburn, a sensation of something being stuck in the throat and/or difficulty swallowing. These symptoms develop from acid produced in the stomach backing up or refluxing into the throat and voice box (larynx). This is in contrast to gastroesophageal reflux (GERD) where acid regurgitates only to the level of the esophagus, not the throat. Acid that persistently pools in the throat and/or voice box causes chronic irritation and inflammation, resulting in the symptoms of LPR.

Diagnosis
LPR may be confused with allergies, asthma and/or GERD because of several shared symptoms. The diagnosis of LPR is based on symptoms and a careful examination of the nose, throat and voice box (larynx). LPR usually is not accompanied by lower esophageal inflammation or complaints of heartburn.

A flexible fiberoptic laryngoscope is a thin flexible fiberoptic lens that allows the physician to look directly at your voice box and throat. This examination is usually done after the nose and throat have been decongested and numbed with a local anesthetic. Redness and swelling of the laryngeal tissues support a diagnosis of LPR. This exam may also rule out other possible voice disorders that can mimic the symptoms of LPR.

If symptoms do not resolve with medical treatment, a special examination of acid movement in the esophagus can be performed. This procedure, called ambulatory 24 hour pH monitoring, can be carried out as an outpatient and involves inserting a tiny tube through the nose into the esophagus. Monitors on the tube can measure and record the amount of acid that backs up in the lower (distal probe) and upper (proximal probe) portions of the esophagus.

Prevention and Treatment
Treatment of LPR can include behavioral modification, posture changes during sleep, weight reduction, diet modifications and medications to reduce stomach acid or to promote clearance of food and acid and surgery.

To prevent or improve LPR, try the following:

Avoid smoking
Avoid tight fitting clothing around the waist
Avoid eating at least 3 hours prior to bedtime
Avoid large meals at night
Lose weight
Elevate the head of the bed by 6 inches to decrease reflux significantly at night
Avoid the follow foods and beverages: caffeine, cola drinks, citrus beverages, mints, alcoholic beverages, cheese, fried food, chocolate, eggs

Medical treatment usually includes proton pump inhibitor medications that reduce acid secretion. Symptoms usually resolve after at least 2 months of treatment but may take as long as 6 months. Follow-up examination of the larynx shows slow resolution of the inflammation, but symptoms may return if treatment is stopped too quickly. Most experts believe that treatment should be ongoing for at least 6 months. In refractory cases, a surgical procedure called fundoplication is done, which tightens the lower esophageal sphincter, thus reducing reflux.