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What is laryngopharyngeal reflux

What is Laryngopharyngeal Reflux?
Photo used with permission, Blue Tree Publishing, Inc, Laryngopharyngeal reflux (LPR) is a condition when stomach acid and other
substances (bile, stomach contents) enter into the lower esophageal sphincter (LES) (the
one-way valve connecting the stomach and the esophagus that gets weak over time) up
the esophagus and into the back of the throat. The opening of the esophagus is behind the
larynx in the pharynx (at the top of the picture…not in the picture.) When you have this
severe of reflux, you generally need a more aggressive treatment course, including a
proton pump inhibitor (Prevacid, Nexium) taken twice daily, a liquid antacid taken after
meals and at bedtime, and a modification of diet.
Symptoms of laryngopharyngeal reflux include:
• Hoarseness • Voice breaks • Difficulty singing in the passagio • Decreased range • Sore throat • Tightness in the throat • Vocal fatigue • Cough (after meals, exercise, during the night) • Throat clearing • A sensation of a lump in the throat • A “foggy” voice early in the AM, the voice improves during the day and is Laryngeal Exam is often the way one is diagnosed with LPR. This is actually a more
severe form of Gastroesophageal Reflux Disease (GERD). Laryngeal findings can
include edema and erythema of the laryngeal and surrounding tissues, cobblestoning of
the tissue posterior to the vocal folds, signs of a pseudosulcus forming on the vibratory edge of the vocal folds, and evidence of acid burns on the vocal fold tissue and/or surrounding tissues in the posterior larynx and pharynx. Treatment
Prevacid, Nexium-taken 45 minutes before breakfast and dinner
Liquid Antacid (Maalox, Gaviscon (extra strength tablets ok Gaviscon)-taken 20-30
minutes after heavy or spicy meals and AT BEDTIME

Eliminate spicy and acidic foods and beverages from diet. This includes coffee (which is
an acid), citric juices (lemonade, orange juice, tomato juice, cranberry juice) tomatoes,
onions, citric fruits, hot peppers, peppermint, etc.
Go to bed on an empty stomach, which means stop eating 3 hours before you go to bed. Elevate the head of your bed, if you can stand it, to get your head at a higher level than your stomach, so the acid can’t pool in your throat while you sleep. The easiest way to do this is to go to Bed, Bath, and Beyond and buy bed raisers that come in 5” lengths and just use the head-board side to raise the bed frame. Caffeine, tobacco and alcohol are irritants to the esophagus and should be avoided. Also, wine/alcohol relaxes the LES and makes reflux worse by allowing more stomach contents into the esophagus. Alcohol and caffeine also stimulate stomach secretions. Minimize/eliminate. If you are overweight, you should lose weight. Ask us for a referral to a clinical dietician for assistance. Activities and exercises that require lifting, bending, stooping, and inversions (YOGA) should be minimized, especially while your acute symptoms are present, but particularly right after meals. Stress management is an important part of reflux management, as stress can make reflux worse. Water intake is an important part of vocal hygiene, but water should not be slammed or taken in quickly, as this may induce reflux.


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