LPRD – The Silent Throat Problem
What’s LPRD?
Have you ever had a cough that would not go away even after the cold that caused it did? Or felt a tightness or lump in your throat that you couldn’t alleviate no matter how many throat lozenges you took?
If you answered “yes” to either of these questions, you may have suffered from a common yet often misdiagnosed throat condition called Laryngo-Pharyngeal Reflux Disease or LPRD.
LPRD happens when the stomach acids produced during food digestion travels back up the upper sphincter and into the back of the throat causing irritation and even damage to the voice box or vocal
chords. This is unlike gastroesophgeal reflux disease or GERD, another problem caused by acid reflux, where patients experience chronic heartburn and indigestion. In fact, most patients who have
LPRD usually don’t know they have acid reflux because the symptoms are mostly throat related. Common symptoms of
LPRD are:
• chronic or intermittent throat pain
• hoarseness
• chronic cough
• frequent throat clearing
• excessive throat mucus
• feeling of “lump” in the throat
• post-nasal drip
• burning or tightness in the throat
• difficulty swallowing.
And since most people tend to think that throat problems are cold or allergy related, LPRD has become a “silent” throat problem that’s usually overlooked and misdiagnosed.
Diagnosing LPRD
Since many other diagnoses, both minor and serious, may also elicit symptoms of LPRD, a thorough physical examination coupled with a review of the complete medical history by a qualified physician is
necessary to correctly diagnose LPRD. In addition to the complete ear, nose, throat and head and neck examination, the otolaryngologist (ear, nose and throat doctor) will perform a diagnostic procedure with the use of a Laryngoscope. This is a state of the art, reed thin flexible fiberoptic instrument used to visualize the
voice box and the surrounding throat tissues for signs of LPRD. Once this area is visualized the physician will look for:
• red, irritated and swollen arytenoids (structures that the vocal
cords attach to in the back of the voice box)
• swelling around the vocal folds
• vocal cord nodules or polyps
• significant voice box problems of any type.
Once LPRD is diagnosed, treatment is relatively straightforward.
Treating LPRD
Along with a prescription of strong antacids like Prilosec, Nexium, or Prevacid, lifestyle and dietary modifications are a must for treating LPRD. Without reducing the stress that triggers acid reflux, no amount of medication can treat LPRD. Therefore, a regularly scheduled activity that reduces stress is strongly recommended as the first line of treatment for LPRD.
Also, since certain foods tend to increase the amount of reflux, patients with LPRD should avoid spicy, fatty foods or acidic
fruit juices. Those with LPRD should also avoid snacking or eating meals right before bedtime. With these changes in diet and lifestyle,
along with proper medication, LPRD is a problem that can easily be avoided. It is important to note that unlike GERD or heartburn, it takes longer for your symptoms to go away. Sometimes it may take weeks to months of aggressive therapy.
LPRD and Other Conditions
Chronic long-term LPRD has been implicated in certain types of throat cancers, although the true risk is very small. In children and adults, acid reflux has been shown to possibly aggravate asthma and other breathing disorders. Recent studies have also implicated acid in
aggravating ear and sinus infections. One study found stomach enzymes in middle ear infection fluid. Another study even linked chronic nasal congestion or runny nose (not due to allergies) to LPRD. Further studies are needed to determine the real- life applications of these preliminary findings.
LPRD and Snoring
If you snore and have LPRD symptoms, this may be an early sign that you may have obstructive sleep apnea (OSA). About 2/3 of patients with OSA will have significant reflux symptoms. OSA is a condition where one stops breathing intermittently throughout the night. With repetitive pauses, a vacuum effect is created, forcing
acid from your stomach into your throat. Therefore, if you are diagnosed with severe LPRD, you may want to get evaluated for
OSA.
Tips for LPRD:
• Try to take your medication 15 - 30 minutes before breakfast and
dinner.
• Avoid eating 3 hours before bedtime
• Avoid overeating or reclining after meals
• Avoid tight fitting clothes
• Cut down on foods or drinks like:
• alcohol
• coffee (including decaf.)
• spicy foods
• citrus juices
• fatty or greasy foods
• chocolates
• tomato products
• mints
• Reduce stress
• Quit smoking
Even if you feel better it is important to follow-up with your doctor, as the condition can return if not properly managed.
Steven Y. Park, M.D.
Otolaryngology – Head & Neck Surgery
(212) 315-9058
