Symptoms of Reflux Laryngitis

Key Glossary Terms

Reflux Laryngitis
Voice disorder caused by backflow of stomach fluids to the throat and voice box area; a type of supra-esophageal GERD

Laryngopharyngeal Reflux (LPR)
Backflow of stomach fluids to the laryngopharynx (voice box + lower back of throat)

Esophagus or Food Pipe
Muscular "tube" that connects throat to stomach; actively moves swallowed food/drinks into the stomach

Reflux
Backflow of stomach fluids which contain acid and enzymes

Gastro-Esophageal Reflux Disease (GERD)
Backflow of stomach fluids into the esophagus; associated with heartburn

Glossary

Reflux laryngitis can present in different ways.

1. Acute: A relatively short problem that responds well to treatment and never returns again
2. Chronic: A long-term condition that requires treatment for the rest of your life
3. Chronic intermittent: A long-term problem that occurs in short bouts – from several weeks to months – improves with treatment and goes away, only to return again several months to years later

The reason why reflux laryngitis presents in those different ways is not well understood.

Key Information

"Why don't I have heartburn if my voice problem is from backflow of stomach acids?"

A Puzzle

For unclear reasons, patients with LPR do not commonly experience heartburn. Heartburn is a burning sensation in the chest that is not due to a heart problem but rather an irritation and/or inflammation of the esophagus (esophagitis) caused by backflow of stomach fluids into the esophagus, also known as gastroesophageal disease (GERD).

Since acid that affects the voice box must first pass through the esophagus, the fact that most reflux laryngitis patients do not get heartburn is a puzzle.

Different Reactions to Stomach Fluid

Physicians believe that the esophagus may be better able to resist the effects of stomach fluids (acid and enzymes) than the voice box.

• When exposed to the same stomach fluid, the voice box is more sensitive or susceptible than the food pipe.
• If only small amounts of stomach acid backflow into both the esophagus and voice box – swelling and irritation may occur only in the voice box without affecting the "tougher" more resistant lining cover (mucosa) of the esophagus.

A Different Puzzle

Some patients with reflux laryngitis do experience heartburn (a burning sensation in the chest that is not due to a heart problem but due to irritation and/or inflammation of the esophagus or esophagitis).

Right Action Plan

Therefore, physicians need to perform a full evaluation to determine whether backflow of stomach fluids affects both the voice box and esophagus.

Swelling and irritation of the voice box caused by stomach fluid backflow into the larynx is associated with a number of common complaints listed below.

Common Complaints	Description	How Common
Hoarseness	Swelling and mucus production in the back of the voice box causes this feeling of a "lump in the throat"	Very common
"Feeling of a Lump in the Throat" (globus pharyngeus)	Swelling and irritation prevent full closure of the vocal folds in the voice box and normal vibration (For more information, see Anatomy & Physiology of Voice Disorders.)	Very common
"Feeling of Nasal Drip" (post-nasal drip) Note: Reflux laryngitis is not the only cause of nasal drip.	A feeling of mucus dripping down the throat More mucus is produced as a form of self-protection by the lining of the throat and voice box exposed to stomach contents This mucus is commonly thicker and travels down the throat causing the feeling of nasal drip	Very common
Frequent Throat Clearing	Needing to repeatedly clear the throat due to excess mucus production	Very common
Sore Throat	Soreness in the back of the throat from irritation and swelling caused by contact with stomach fluids	Common
Noisy Breathing (stridor)	Noisy breathing caused by narrowed air passage due to swelling caused by irritation from stomach fluids	Common
Chronic cough	A coughing reflex due to irritation of the nerve endings in the throat	Moderately common
Sudden Difficulty Breathing (laryngospasm)	Sudden inability to breathe due to closing off of the airway; instead of vocal folds opening and closing with ease, prolonged closure of the vocal folds may occur as the body reflexively tries to protect the air pipe from stomach fluids May sometimes be accompanied by severe throat tightening and coughing	Uncommon

Red Flag

• Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway and difficulty passing air.
• Any breathing difficulty needs immediate medical attention.

Key Information

Scary but Short-Lived

• Sudden difficulty breathing and throat tightness caused by closing off of the airway as a reflex reaction to stomach fluid backflow (laryngospasm) may wake the patient at night.
• Although frightening, this type of breathing difficulty is short lived, and normal breathing should resume again soon.

Red Flag

There are other causes of breathing difficulties which may wake the patient at night – such as heart problems. If breathing difficulty awakens you at night, you should contact your doctor immediately.

• "Slow creep" (gradual): Many patients report that they first notice their complaints from reflux laryngitis slowly, over the course of several weeks or months.
• Significant changes: On hindsight, patient complaints often started during one or more of the events below.
  • Change in dietary habits
  • Increased stress levels
  • Change in lifestyle habits
  • Fluctuations in weight
• Episodes of increased acid and/or pressure: These events are associated with backflow of stomach fluids because they are commonly associated with one of more of the situations listed below.
  • Increase in the levels of acid production by the stomach
  • Increased backflow pressure on the muscular sphincter between the food pipe and the throat (UES, upper esophageal sphincter)
  • Increased backflow pressure on the muscular sphincter between the food pipe and the stomach (LES, lower esophageal sphincter)

• After a cold: Other patients only notice their complaints after a cold or upper respiratory infection (URI).
• Key clue: Patients often report that the "cold complaints" such as aches and pains may disappear, but a nagging hoarseness, cough, or throat clearing remains.

Key Information

What a Cold Does

The cold does not cause reflux laryngitis – it can only add to the inflammation and swelling of already swollen vocal folds, intensifying symptoms and bringing the reflux laryngitis to the patients' attention.