Laryngopharyngeal reflux- the chronic cough

Have you experienced an irritating cough that doesn’t get better despite cough mixtures and antibiotics? If yes, then you may be suffering from laryngopharyngeal reflux (LPR); also known as ‘silent reflux’. Most patients may not have the typical symptoms of gastroesophageal reflux (GERD) such as heartburn.

LPR occurs when the acid contents of the stomach is washed up (refluxed) all the way up to the throat (larynx) and even the back of the nose. It may be due to laxity of the muscle sphincter or gatekeeper between the oesophagus and stomach. The mucosal lining of the throat gets inflamed when exposed to the acid.

Symptoms of laryngopharyngeal reflux (LPR)

• Chronic cough
• Frequent throat clearing
• Feeling of mucous at the back of the throat
• Hoarseness
• Foreign body sensation or feel of a ‘lump’ in the throat
• Difficulty swallowing
• Sore throat
• Difficulty breathing

Diagnosis of laryngopharyngeal reflux

Most of the time the ENT Surgeon would make a diagnosis of LPR from the medical history and throat examination with a 70 degree scope or flexible nasopharyngolaryngoscope. This will allow visualization of the larynx, showing inflammation of the vocal cord and surrounding areas.

Sometimes a double probe pH monitoring may be required. This involves inserting a small tube through the nose into the oesophagus to record the frequency and severity of the acid reflux. This would have to be worn for 24 hours. However this test is only necessary for certain cases.

Treatment of laryngopharyngeal reflux

The inflammation of the larynx due to acid reflux may take weeks to months to recover. The doctor would recommend some medication such as proton pump inhibitors, antacids, prokinetic agents.

However it is also important that the patient adhere to some lifestyle changes for better recovery and control of the reflux in the long run. Smoking habit and some food can aggravate the condition. Patients who are obese and overweight are also prone to LPR.

Most patients respond well to medication and lifestyle modification/ dietary change. Some may require prolonged treatment. Only a few patients may not respond to the above measures and require surgery; which involves wrapping around the muscle sphincter to improve its strength.

Home care measures for LPR

• Stop smoking
• Lose weight
• Avoid alcohol
• Avoid caffeinated drinks such as coffee, tea including cola fizzy drinks
• Avoid acidic fruit juices such as orange, grapefruit, tomato
• Avoid spicy and fatty foods such as curry, tomyam even tomato based sauces
• Do not wear tight fitting cloths especially at the waist
• Stop eating at least 3 hours before going to bed
• Elevate the head of the bed at least 4-6 inches
• Take the medications prescribed according to instructions. Proton pump inhibitors are taken 30 minutes before meals and most are given for twice a day.

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