What is Reflux?
When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) that help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means “a backward or return flow,” and it usually refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.
What is GERD and LPRD?
Some people have an abnormal amount of reflux of stomach acid up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, and lungs) are much more sensitive to stomach acid so smaller amounts of reflux into this area can result in more damage.
Why Don’t I Have Heartburn or Stomach Problems?
This is a question that is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus becomes irritated. Most of the reflux events that can damage the throat happen without the patient ever knowing that they are occurring.
Common Symptoms of LPRD
Hoarseness, chronic (ongoing) cough, frequent throat clearing, pain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth (especially in the morning), asthma-like symptoms, referred ear pain, post nasal drip, singing difficulties (especially with high notes).
Diagnosis of LPRD
The following signs, seen by the physician, are strong indicators of LPRD:
Red irritated arytenoids (structures at the back of the vocal folds)
Red irritated larynx
Small laryngeal ulcers
Swelling of the vocal folds
Granulomas in the larynx
Evidence of hiatal hernia (may or may not be associated with reflux)
Significant laryngeal pathology of any type
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Treatment for LPRD
Stress
Take significant steps to reduce stress! Make time in your schedule to do activities that lower your stress level. Even moderate stress can dramatically increase the amount of reflux.
Foods
You should pay close attention to how your system reacts to various foods. Each person will discover which foods cause an increase in reflux. The following foods have been shown to cause reflux in many people. It may be necessary to avoid or minimize some of the following foods: spicy, acidic, and tomato-based foods like Mexican or Italian foods; acidic fruit juices such as orange juice, grapefruit juice, cranberry juice, etc.; fast foods and other fatty foots; caffeinated beverages (coffee, tea, soft drinks); peppermint and chocolate.
Mealtime Do not gorge yourself at mealtime, eat small (moderate amounts of food), eat meals several hours before bedtime, avoid bedtime snacks, do not exercise immediately after eating.
Body Weight Try to maintain a healthy body weight. Being overweight can dramatically increase reflux.
Tight Clothing
Avoid tight belts and other restrictive clothing.
Smoking
If you smoke, STOP! This dramatically causes reflux and many other evils to your body!
NSAIDS (e.g. Advil type medications), aspirin, steroids
All aggravate reflux.
Self-Destructive Behavior
Avoid smoking cigarettes. They are bad for the heart, lungs, and vocal tract. Also, avoid other irritant inhalant substances and mind-altering drugs. Tobacco and marijuana are irritants to the vocal tract. When you sing you must be in control of all body systems: physical, spiritual, and mental. Smoking is a disaster for the speaking and singing voice.
