Laryngopharyngeal reflux (LPR) or “silent reflux” may be a primary or contributing factor to voice change. Patients complain of increased phlegm, throat clearing, cough, or a “raw” throat. However, the typical signs of gastroesophageal reflux (GERD), such as a burning sensation of the superior aspect of the abdomen or inferior chest, are often not seen.
The symptoms are often related to the time of day and meals. Patients may appreciate a change in their voice, which is bothersome. The diagnosis is made by taking a complete history and carefully examining the vocal cords either by flexible laryngoscopy (a flexible camera placed through the nose) or a videostroboscopy (a flexible or rigid exam of the vocal cords which allows for examination of the vocal fold mucosal wave).
The exam often reveals red and swollen tissue in the back part of the voice box. Treatment starts with behavioral changes, such as avoiding fatty or spicy foods, caffeine, or alcohol. Additionally, patients are advised not to lie down to sleep within four hours of completing a meal.
Medical therapy is usually started with a trial of a proton pump inhibitor, such as omeprazole, or an H2 blocker, such as ranitidine. In certain cases, patients may be referred for additional testing such as esophageal manometry (pressure monitoring of the esophagus) or pH probe testing under the care of a gastroenterologist.
Medical Illustration and Animation: Lynsey Steinberg, GHSU Class of 2012
Content Expert: Dr. Paul Weinberger, GHSU ENT department
Animation Expert Advisor: Michael Jensen, GHSU Professor of Medical illustration