Laryngopharyngeal reflux (LPR) is the backflow of acid from the stomach to the back of the throat and/or voice box. LPR is caused by the failures of the lower and upper esophageal sphincters to contain stomach acid. The lower esophageal sphincter is an unconsciously controlled band of muscles, located between the oesophagus and the stomach. The upper esophageal sphincter is a consciously controlled band of muscles, located at the upper end of the oesophagus.
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LPR symptoms may be broken into four classifications: vocal, swallowing, pulmonary and laryngeal. Vocal afflictions include hoarseness, a cracked voice, a weak voice, or a change in voice. LPR may cause one to regurgitate food, experience the constant feeling of something in the throat or have difficulty swallowing. Patients with pulmonary symptoms may exhibit chronic throat irritation and clearing, excessive phlegm or mucous, a chronic cough, wheezing or blocked air passages. LPR may also cause the larynx to spasm, which makes breathing difficult.
LPR can be diagnosed using laryngoscopy or 24-hour pH testing. Laryngoscopy is a procedure that allows doctors to examine the effects of LPR on the back of the throat, larynx and vocal chords. Doctors perform indirect laryngoscopy by placing a mirror at the back of the throat, while direct laryngoscopy is performed by placing either a rigid or flexible laryngoscope down the patient's throat. Twenty-four hour pH testing is used by doctors to determine whether acid is moving up into the oesophagus from the stomach. A small, thin tube with an acid-reading device is placed down the oesophagus and positioned 2cm above the lower esophageal sphincter.
Stomach acid is caustic. It can cause burning, irritation and swelling in the larynx and vocal chords. Furthermore, the healing of any previous vocal chord injuries may be hampered by acid reflux.
LRP and GERD (gastro-oseophageal reflux disease) may seem similar, but they are two separate disorders. LRP manifests above the oesophagus, while GERD appears below the oesophagus. Contrary to LRP, GERD occurs when only the lower esophageal sphincter fails. Furthermore, GERD's primary symptom is heartburn. LRP sufferers do not typically experience heartburn. LRP patients experience acid reflex during the day, when the body is positioned upright. GERD patients experience reflux at night, when the body is reclined.
LRP treatment can be grouped in three classifications: lifestyle modification, pharmaceutical treatment and surgery. Patients modify their lifestyle by avoiding fatty, greasy and spicy foods, overeating, alcohol and caffeine. Antacids, H2 blockers (Tagamet HB) and Proton Pump Inhibitors (Prevacid) can be taken to neutralise the effects of acid. Surgery can be employed to tighten the lower esophageal sphincter, nissen fundoplication, by wrapping the upper part of the stomach around the lower part of the oesophagus.
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