LPR is similar to Gastroesophageal Reflux Disease, or GERD. It occurs when the lower esophageal sphincter (LED) does not close properly and the stomach contents are allowed to leak back or reflux into the esophagus and then up to the voice box and possibly the back of the nose and sinus cavity. When the refluxed stomach acid comes into contact with the lining of the esophagus, it causes a burning sensation in the chest or in the throat that we call heartburn or acid indigestion. When stomach contents irritate the voice box and back of the throat/nose, symptoms are less often heartburn, and more often consist of post nasal drip, throat clearing, cough, and lump in the throat.
GASTROESOPHAGEAL REFLUX DISEASE
Acid reflux can lead to heartburn and difficulty eating but it can also result in a sore throat. Find out more about the link between acid reflux and sore throat, what causes it, how to treat it or relieve symptoms at home, how it can affect children, and how to distinguish this from other types of sore throat. Children with symptoms of LPR that appear alongside breathing and feeding problems need to see a doctor as soon as possible.
You don’t want to study them and find that they have reflux, and then they say, “Now what do we do?” I study them on therapy and look for events that I can mark as a symptom event. You almost never find that. I talk to their family members if I can to help them cautiously and carefully school that behavior into a less repetitive pattern.
Seasonal allergies caused by plants releasing their pollen may cause trigger postnasal drip, as the body produces extra mucus to try and eliminate the pollen spores. The nose, throat, and sinuses are all constantly producing mucus.
That is to say, the acid can travel all the way up to your nose and sinuses (for instance, while you are lying down asleep), and this acid can inflame the nose and sinus linings. This problem is more common in children – but it may also be seen in adults. Sometimes, the symptoms of GERD can mimic some of the symptoms of sinusitis. The sensation of post nasal draining and the need to clear your throat constantly may be due to post nasal drip – but may also be due to GERD.
I have them swallow rather than cough or repetitively clear their throats. I emphasize the importance of fluids, because if their secretions become viscous, it creates a noxious effect. You want to prevent that by having them be well hydrated so the secretions don’t get thick. What do we do with these patients?
- You don’t want to study them and find that they have reflux, and then they say, “Now what do we do?” I study them on therapy and look for events that I can mark as a symptom event.
- For many people, reflux occurs most often at night and sets up the irritation that continues to bother during the daytime.
- Irwin RS, Madison JM. Diagnosis and treatment of chronic cough due to gastro-esophageal reflux disease and postnasal drip syndrome.
- In the prospective trials on GERD and laryngopharyngeal reflux disease, when they performed a meta-analysis, it suggested that these patients have increased response to antireflux therapy.
Sometimes, there can be more than one cause that needs to be addressed. Sinusitis occurs when viruses or bacteria infect the sinus cavities, usually due to blockage of the small drainage pathways that lead to the nasal passages. This causes an inflammation of the sinuses, which stops proper drainage.
Therefore, physicians need to perform a full evaluation to determine whether backflow of stomach fluids affects both the voice box and esophagus. Some patients with reflux laryngitis do experience heartburn (a burning sensation in the chest that is not due to a heart problem but due to irritation and/or inflammation of the esophagus or esophagitis). You should see your doctor if you have a hoarse voice for more than 3 weeks.
Chronic sinusitis may be caused by allergies and can last up to three months. Antibiotics and home remedies can relieve sinus infection (sinusitis) symptoms.
Gastroesophageal reflux disease (GERD) – With GERD, stomachacid, digestive enzymes andbile back up (reflux) into youresophagus. It may reach up to thevoice box. In severe cases, refluxmaterial may get into the lungs.These substances are irritating to your respiratory tract and can trigger a cough.Coughing itself may cause acid reflux, turning it into a vicious cycle.
But take good voice history, listen to what they are doing, watch for repetitive throat clearing and coughing, talk to their family members, and ask what their voice habits are during the day. It’s critical to get them involved with an otolaryngologist who is interested in voice.
The clinical features of GERD-related cough include heartburn, regurgitation, and/or worsening of cough after foods or medications known to decrease lower esophageal sphincter-pressure, with extraesophageal manifestations such as hoarseness, wheezing, sore throat, chest pain, and globus also described. Chronic cough is a persistent and frustrating symptom for many adults and children and a frequent reason for primary or secondary care visits or referrals.