Laryngopharyngeal Reflux (LPR)
Laryngopharyngeal reflux is a form of reflux condition that can significantly affect the throat, voice, and overall quality of life. It often persists without the typical symptoms of acid reflux, making a diagnosis challenging.
Understanding the risk factors and recognising the symptoms can help you seek prompt treatment when needed and prevent unwanted complications. If you suspect you may have LPR, consulting with an ENT specialist for an accurate diagnosis and personalised treatment plan is important. With the right approach, many individuals with LPR can significantly relieve their symptoms and protect their vocal and throat health.
What is Laryngopharyngeal Reflux?
Laryngopharyngeal reflux (LPR), also known as silent reflux, is a condition where the contents of the stomach, including acid and enzymes, flow back up into the throat, voice box (larynx), and nasal passages.
Unlike gastroesophageal reflux disease (GERD), LPR involves stomach contents rising higher in the food pipe (oesophagus), near the throat and voice box, whereas GERD primarily affects the lower oesophagus and is commonly associated with heartburn in the chest area. LPR often lacks the distinctive heartburn symptom associated with GERD, making it more challenging to diagnose. Instead, it targets the upper airway and voice box, causing symptoms that significantly affect vocal health and overall quality of life.
Symptoms of Laryngopharyngeal Reflux
LPR symptoms can be subtle or mimic other conditions, making diagnosis challenging. It can also be present without exhibiting other symptoms, hence dubbed ‘silent reflux’.
Common symptoms include:
- Hoarseness or voice change, particularly in the morning or after eating
- Feeling of a lump in the throat when swallowing (globus sensation)
- Frequent throat clearing due to the presence of phlegm or Globus sensation
- Chronic cough, especially at night time in bed
- Excessive mucus or phlegm (there may also be an increase in phlegm after meals)
- Difficulties swallowing
- Persistent sore throat
- Difficulties breathing, especially at night time
- Bad breath
- Burping
- Dry mouth
- Itchy feeling in the throat
- Regurgitation of stomach contents (spitting up food/liquid/stomach acid from the mouth)
Causes of Laryngopharyngeal Reflux
The primary cause of LPR is the malfunction of the lower and upper oesophagal sphincter (ring-shaped muscle), which are responsible for the respective functions below to prevent stomach contents from flowing back up:
- Lower Oesophagal Sphincter (LES): keeps food in the stomach and prevents contents from travelling up.
- Upper Oesophagal Sphincter (UES): opens to allow food in and prevents acid from the stomach from entering the throat.
In patients with LPR, the UES is typically loose, creating a passageway for stomach contents to travel back up to the throat, voice box, or even into the nasal airway.
It is important to note that there are factors that can contribute to LPR, such as:
- Dietary Habits: Consuming large meals, and eating late at night, as well as intake of fatty foods, caffeine, alcohol, chocolate, and spicy foods.
- Lifestyle Factors: Obesity, smoking, and high levels of stress.
- Medications: Certain medications can relax the LES, including antihistamines, calcium channel blockers, and antidepressants.
- Medical Conditions: Hiatal hernia, pregnancy, and conditions that increase abdominal pressure can contribute to LPR.
In young infants, LPR is possible due to an undeveloped sphincter and shorter oesophagus.
How does a Throat Specialist in Singapore Diagnose Laryngopharyngeal Reflux?
To determine if you have LPR, it is recommended that you seek medical evaluation from an ear, nose and throat (ENT) specialist in Singapore.
At Aglow ENT Centre, our ENT specialist may carry out the following procedures for a comprehensive evaluation:
- Medical History: Discussion of symptoms, dietary habits, and lifestyle factors.
- Laryngoscopy: A visual examination of the throat and larynx using a flexible scope to identify signs of irritation or inflammation.
- pH Monitoring: Measurement of acid levels in the throat over a 24-hour period to confirm the presence of reflux.
- Barium Swallow Test: An X-ray examination of the oesophagus and stomach during swallowing to identify abnormalities.
What are the Treatment Options Available?
In most cases, LPR can be managed with lifestyle modifications, dietary changes, and oral medication. Rarely, surgery may be required to address the condition.
If you are diagnosed with LPR, you may be recommended the following as part of your treatment plan:
Dietary Changes
- Avoid food that triggers reflux, such as caffeine, oily and spicy food, and carbonated drinks.
- Avoid alcohol and smoking
- Avoid peppermint, spearmint, menthol, and eucalyptus
- Avoid foods known to be acidic, such as certain fruits, raw tomatoes, raw onions, and raw garlic.
- Avoid fatty meat
Lifestyle Modifications
- Eat smaller, frequent meals and do not eat 2-3 hours before bedtime
- Do not wear tight clothing when eating
- Drink at least 2 litres of plain water each day
- Lose weight for those who are overweight
- Quit smoking
- Manage stress effectively
Medications
- Take your prescribed medication to reduce reflux episodes and protect your throat and larynx from damage.
- Medications generally include proton pump inhibitors (PPIs) or H2 blockers to minimise acid production.
Elevation
- Try not to sleep flat and prop the head 6-10cm higher with pillows.
Once you start implementing the above or as advised by your specialist, you should see improvements in a few months. If your symptoms persist, you may be referred to a gastroenterologist for further examination. In some patients, it is possible to have GERD on top of LPR simultaneously.
When should you see a Throat Specialist in Singapore for Laryngopharyngeal Reflux?
Other than the fact LPR can cause near-constant discomfort in your throat area, leaving it untreated may cause serious complications, including:
- Excessive Mucus and Infections: Stomach acid can trap infections by hindering mucus clearance in the throat and sinuses.
- Chronic Voice and Throat Irritation: Irritation of the throat or voice box that causes difficulty speaking or swallowing may lead to more serious complications in the future. Over time, you may develop vocal cord lesions (non-cancerous growths) or even long-term vocal inflammation, which increases the risk of laryngeal cancer.
- Respiratory Complications: Acid can travel from the voice box into the lungs, especially during sleep. This could lead to bronchial (lung airways) inflammation and infections.
To prevent the above from happening, be sure to seek medical advice before your symptoms worsen. If you notice symptoms related to LPR and suspect you may have it, schedule an appointment with Dr Ker Liang, Medical Director and ENT specialist at Aglow ENT Centre.
Frequently Asked Questions
What food should I avoid if I have laryngopharyngeal reflux?
Foods that are acidic, spicy, fatty or oily in nature tend to trigger a reflux.
Is there a difference between laryngopharyngeal reflux and GERD?
Yes. While both are acid reflux conditions, the acid in patients with LPR travels up further to reach the throat area, whereas patients with GERD experience acid travelling up their lower oesophagus.
Can laryngopharyngeal reflux lead to throat cancer?
LPR may increase the chance of throat cancer when not managed properly.
Would laryngopharyngeal reflux go away on its own?
LPR may not go away entirely on its own without intervention, which may include lifestyle modifications and medications.
How do I prevent laryngopharyngeal reflux?
Once your condition is under control, you must continue to remain mindful of your diet and lifestyle choices to ensure long-term management of LPR. This may include adopting the following to prevent LPR from recurring:
- Voice Care: Avoid shouting or prolonged talking, and stay hydrated to protect the voice.
- Monitoring Symptoms: Keeping a diary of symptoms and potential trigger foods or activities can help identify patterns and prevent flare-ups.
- Regular Follow-ups: Periodic check-ups with your ENT specialist to monitor the condition and adjust treatment as necessary.
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
Medical Teaching
Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.
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