Laryngopharyngeal Reflux


Description and Etiology

Laryngopharyngeal Reflux(LPR) is a back flow of gastric contents into the larynx or pharynx(voice box or throat).  It can manifest from dysfunction of the esophageal sphincters, side effects to certain medication, stress, obesity gastric distention, certain foods (fried, spicy, high fat, tomato based, citrus)

  • Perceptual Signs and Symptoms

o      People often describe

§       Hoarseness

§       Clearing your throat                                                               

§       Excess throat mucous                                                             

§       Difficulty swallowing food, liquids or pills                           

§       Coughing after eating or after lying down                                

§       Breathing difficulties or choking episodes                             

§       Troublesome or annoying cough                                              

§       Sensations of something sticking in your throat or a lump in your throat

§       Heartburn, chest pain, indigestion, or stomach acid coming up

o      Singer’s often describe           

§       Increased effort when voicing                                                

§       Loss of vocal range                                                                

§       Problems with soft pitches                                                     

§           Vocal fatigue                                                                                   

§       Change in vocal quality                                                          

§       Hard tonal onset                     

  • Features of Visual Assessment

o      Red and swollen vocal folds

o      Presence of a contact ulcer or a granuloma

o      Excessive mucous

o      Red and swollen back part of the larynx(interarytenoid area)


 

  • Management

o      Life style modification

§       Avoid eating at least 2 hours before laying down

§       Avoid tight fitting clothes

§       Avoid slouched posture

  • Puts pressure of the stomach

§       Understand side effects to prescription medication

§       Sleep on an incline

o      Medication often prescribed

§       Over the counter (OTC) antacids

  • Antacids contain weak bases that helps to neutralize acids for a short period of time

§       OTC and prescription H2-receptor antagonists

  • H2-receptor antagonists inhibit gastic acid secretion yet have no effect on LES pressure or esophageal clearance.

§       Prokinetic agents

  • Prokinetic agents are used to increase lower esophageal sphincter pressure and accelerate esophageal clearance and gastric emptying.

§       OTC and prescription strength proton pump inhibitors

  • Proton pump inhibitors suppress an enzyme that creates acid secretions and can last up to 18 hours with a single dose.

o      Behavioral voice therapy

§       Help reduce compensatory tension that might develop