Often, individuals find it difficult to believe they have silent reflux, also called laryngopharyngeal reflux (LPR). They do not complain of heartburn or feel a sense of food coming up the back of their throat. Instead, these people often complain of voice problems, hoarseness, throat clearing, postnasal drip, excessive phlegm in their throat or a lump in their throat. On occasion, patients have swallowing problems, complain of a chronic cough and have symptoms of allergy, asthma, sinus or cold-like symptoms.
These patients have been on multiple rounds of antibiotics, decongestants, antihistamines and nasal steroids without significant benefit.
Why is the diagnosis so challenging and what is the treatment?
Patients with silent reflux do not complain of heartburn because acid is not the issue. Backflow of stomach contents bathes the back of the throat and voice box.
Digestive enzymes, mainly pepsin, causes a swelling that can only be detected by looking at the back of the voice box by an ENT. In some individuals, the swelling is so severe that it causes numbness in the back of the throat that can lead to swallowing issues.
We perform an exam in the office called Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) to test the sensation of the voice box. This procedure is performed in our office by our speech-language pathologist. Our speech-language pathologist can help patients improve their vocal issues and also improve their swallowing difficulties.
Treatment for laryngopharyngeal reflux consists of taking medications, making dietary changes and reducing the activity of the enzyme pepsin that causes injury to the back of the throat.
It is recommended to take a proton pump inhibitor in the morning, and avoid eating or drinking for 20 minutes. Also avoiding carbonated beverages, tomato-based products, citrus products, spicy foods, chocolate, breath mints, coffee, caffeinated beverages and alcohol reduces the activation of pepsin.
I recommend drinking alkaline water with a pH greater than 9.5 to reduce the activation of the pepsin enzyme in the stomach.
It may take 3 to 6 months of treatment before the swelling subsides and your symptoms improve. Books are available online to help plan meals.
Patients with long term symptoms will need to have an exam to visualize their esophagus by Transnasal Esophagoscopy in the office or an EGD performed under anesthesia.