Laryngopharyngeal reflux (aka Silent Reflux)
OK, long story as usual with me.
This winter, 2 episodes of bronchitis, a cold, and parainfluenza all followed by laryngitis. This last episode of laryngitis has lasted 4 weeks as of today.
I have seen an ENT as the bronchitis got better but the laryngitis was getting worse and was scoped (fibreoptic tube up the nose down the throat - nasty but not worse than child birth:)
Any, had first visit with ENT 3 weeks ago and was told that I had swelling from laryngitis and swelling behind the vocal cords from acid reflux. I told him that I don't have acid reflux, never had heartburn except when pregnant, and he said oh yes you do have it. Laryngopharyngeal reflux (LPR) -- silent reflex -- as the symptoms are not like regular heartburn or GERD and for many, aside from having to clear your throat you may not know you have it. The danger from this is the throat/voice box does not have the protective coating the the esophogus does and it can do its damage without one really knowing it.
So, he told me to not speak for 5 days and take prilosec for reflux; went back 2 weeks ago and not talking did not help. He then said to not speak for 7 days. Yesterday morning, I did have a voice, spoke to my daughter for about 5 words and it disintegrated. Plus all weekend I had to clear my throat a lot and then this last week I developed a cough at night again. But, not sick otherwise and aside from a contant swelling feeling in my throat, I felt not great but not sick.
I was to call him yesterday to let him know how I was and when he heard my voice or lack thereof said he had to see me.
Went in yesterday afternoon and he scoped me again. He said I was so full of mucus in my throat he could not even see cords. Removed the scope and had me blow my nose (gross, but nothing came out). He put it back in again, and something must have moved because he could see a little. Said I still had swelling from the acid reflux but again so much mucus.
Anyway, I have to double the prilosec, watch diet. I asked does acid reflux cause the mucus and he said no, I was probably having a allergic reaction to a virus in my system (remember I mentioned the coughing I was doing last week and just overall, I have not felt well in so very long but not in a sick way, just not right -- just drained.
So, now he said I can talk because not talking hasn't helped and gave me a nasal spray to help with mucus.
So, my friends, does anyone have this reflux issue, how long did it take, did you voice come back? ENT says my vocal cords are not damaged just swollen, but from everything I read on the internet, continued irritation can cause problems down the road.
Also, for anyone that has acid reflux, what type of diet do you follow? I know losing weight will help and I am trying, I reinducted Atkins last week and lost 5 lbs.
I will need to revamp my diet because from what I have read online high fatty food (along with spicy, tomato, citrus fruit -- which I don't eat if I am on Atkins) can be damaging. So, alot of Atkins is high fatty stuff.
So, is there anyone out there with is or GERD (although this is not the same, as GERD as it affects the esophogus and LPR comes all the way to the throat) but the foods to avoid should be the same.
Thank you so much.
Hi Barbara! First - :hugs: :console: :friends: I'm SO sorry you're having such a tough time of it!!
I suffered from GERD for many years - went to Atkins for weight loss and gee, the GERD disappeared! My doctor did say that excess weight is not good but I theorize also that eating grain products (and I did, a lot) probably contributed greatly as I am still convinced that we are NOT sufficiently evolutionized to properly digest them, resulting in a constant inflammatory process as the body tries to deal with the aftermath of ingesting those items.
I've read a lot on Dr. Eades' site and also a lot of Paleo info - and although I don't actually eat to Paleo, it all makes perfectly good sense to me.
The ONLY times I get acid reflux now are when I overeat, which of course allows stomach acid to back up into the espophagus as the poor stomach tries to deal with the overload.
So yes, *I* personally believe that weight loss/little to no grains/Atkins style eating resolved my problems with acid overproduction/backing up past the hiatus.
Both my maternal grandmother and my mother had/have hiatal hernias, so I really thought that was what was causing MY troubles, but scoping proved otherwise - I don't have one (or did not 12 years ago anyway when scoped) and changing my eating habits/losing weight (about 50 pounds) did the trick for ME.
I hope you can find what will work best for YOU ASAP! Sounds like NO fun at ALL. :hugs:
Thank you for responding and letting me know about you. I will check out Dr. Eades' site. I am still trying to figure out what to eat or not eat and I wish in some way, I had symptoms to know which food bothered me.
I guess eating Atkins with very low dairy is doable but now without being able to eat marbled meat (I am sick of tuna fish, getting very sick of chicken, don't like many of the seafood options here) as that is a basis for my menus.
I am just having a pity party -- a voiceless pity party.
But thanks honey.
TMI warning-A few years ago I complained to my doctor about waking up at night, choking on mucus. I thought it was from allergies. He said it was from reflux, the body supposedly produces mucus in response to acid, especially at night. After being on low-carb for quite a few months most of my digestive issues have settled down, and I rarely have the problem now. Prilosec/Previcid took care of it back then. I also don't get colds/bronchitis/pneumonia like I used to, only one infection in 18 months compared to several a year.
Barbara, why not try baby steps? Like, cut out the grain products and see if that helps?
I CAN eat sprouted grains, like Ezekiel bread for instance, and I love quinoa, which is a pseudo-grain, high in protein - it's a wonderful substitute for rice or bulgur or other places where you might use pasta etc.
In case you haven't looked him up before, Dr. Michael Eades is the Protein Power guy (along with his wife, Mary Dan Eades) and his website is really full of interesting stuff. Like most of the rest of us who don't "do" grains - he has fallbacks and he posts about the results - like eating a big pancake breakfast. He's actually pretty entertaining!
Have you checked out our own Recipes Help forum? SO many talented cooks on this board, LOTS of budget threads, low-fuss ideas (3 ingredients or less etc.) and people who will help you with any questions you might have!
Who knows, it may not be the answer, but it's a fairly simple one to try out for a few weeks and see if it helps you.
I have LPRD (Silent Reflux).:hugs: I suffered for many years before it was diagnosed.
Managing my diet strictly almost completely eliminates the problem...
But you're not going to like it...here goes:
Spicy, acidic, and tomato based foods
Orange, grapefruit and cranberry juices
If I follow this diet I have no issues. If I stay pretty strict, I can have something here or there without too many consequences.
To add to my problems, now that I am beginning menopause the issues are even more severe because the muscles that control the valve that keeps acid in the stomach have weakened due to a hormone imbalance. :stars: I'm more sensitive than ever to the list.
It's difficult to follow this diet, but the hoarseness, gagging, coughing, throat-closing sensation caused by the reflux was just awful.
At least now I can be in control.
Here were the other recommendations from my doctor:
-Do not gorge yourself at mealtime
-Eat sensible, moderate amounts of food
-Eat meals several hours before bedtime
-Avoid bedtime snacks
-Do not exercise immediately after eating
-Maintain a healthy body weight (being overweight dramatically increases refux)
-Avoid tight belts and restrictive clothing
-Do not smoke
-If it's really bad at nighttime - elevate the head of your bed 4-6 inches
Hope this helps....
Well, to be honest, aside from high blood pressure, cholesterol, thyroid, depression, I am a healthy person ;) and this winter I got slammed with bronchitis etc. So, this is a bit different for me. Do you still take prilosec?
Great suggestions, Char! I do have to check out Eades' plan.
I try to follow a low-carb diet, very much Atkins-like. I do eat more fruits and veggies then recommended, though. I do avoid dairy completely and have substituted soymilk for my biggest dairy consumption, which is milk in my tea.
My biggest symptom was an uncontrollable cough. I could feel it starting, I could feel the mucous in my throat, and then I would be coughing and almost gasping for air. I would often have to leave wherever I was in order to gather myself and recover. This was happening more and more frequently. I could be in church, a meeting, a play, a concert, etc... It was awful. Nothing worked to control it. At first, I thought it was a reaction to hot air or dry air, or perhaps a change in temperature from outdoors to indoors air. Also, neither cough medicine nor cough drops had any effect. I became afraid to put myself in a situation were I might have a coughing fit that would be disruptive to those around me. Or worse yet place myself somewhere that I could not get up and escape. This is the main reason I manage it so closely now. The other but less severe symptoms for me are throat burning/irritation and hoarseness.
In order to determine what my biggest triggers were I completely eliminated all of the items on the "do not consume" list for two or three weeks. I felt so much better and had no coughing fits at all. Quite honestly it felt like a miracle - quite a relief. I then started introducing various things one at a time (and not combined with any other item on the list) to see what I might be able to tolerate. My biggest triggers are caffeine and chocolate. I found if I eliminate them completely my other triggers are manageable in small amounts.
Oh ...something not on the doctor's list, but which I found to irritate my throat, is carbonated beverages.
They are a huge trigger for me.
My symptoms are also much worse if I have a cold or a sinus infection.
Let me know if I can answer any other questions.
Margaret, thank you so much! I feel like I have been hit out of left field with this and thank you so much for sharing with me.
I just hope my voice comes back -- I haven't spoken normally since March 26th.
Here's some helpful info. I found when I was first researching LPR on my own. The valve they talk about in the article has weakened considerably for me this past year. So now I actually do have episodes of heartburn, for the first time ever, after eating anything spicy. I have since read that some of that weakening is also due to the onset of menopause (which is wreaking havoc in other areas of my life right now...:stars:).
After reading this again, I really should be taking an antacid regularly. :
Silent Reflux - LARYNGOPHARYNGEAL REFLUX (LPR)
Silent Reflux Can Cause:
The term REFLUX comes from a Greek word that means “backflow,” and it usually refers to “the back flow of stomach contents.” Normally, once the things that we eat reach the stomach, digestion should begin without the contents of the stomach coming back up again....refluxing.
The term Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR can occur during the day or night, even if a person who has LPR hasn't eaten a thing.
Not everyone with reflux has a lot of heartburn or indigestion. In fact, many people with LPR never have heartburn. This is why LPR is called SILENT REFLUX, and the terms “Silent reflux” and “LPR” are often used interchangeably. Because LPR is silent, it is sometimes difficult to diagnose.
MANY PEOPLE WITH LPR DON'T HAVE HEARTBURN...WHY IS THAT?
Some people with LPR do have heartburn. Some people with LPR don’t have heartburn very often, but actually about half the people who have LPR never have any heartburn at all. This is because the material that refluxes does not stay in the esophagus for very long. In other words, the acid does not have enough time to irritate the esophagus and cause heartburn.
However, if even small amounts of refluxed material come all the way up into the throat, other problems can occur. This is because compared to the esophagus, the voice box and throat are much more sensitive to injury and irritation from stomach acid. Also, LPR can sometimes affect a person’s breathing and lungs.
HOW DO I KNOW IF I HAVE LPR?
Chronic hoarseness, throat clearing and cough, as well as a feeling of a lump in the throat or difficulty swallowing, may be signs that you have LPR. Some people have hoarseness that comes and goes, and others have a problem with too much nose and throat drainage, that is, too much mucus or phlegm. If you have any of these symptoms, and especially if you smoke, you should ask your doctor about LPR. The specialist who most often treats people with LPR is the Otolaryngologist (Ear, Nose and Throat Physician).
If your doctor thinks that you could have LPR, he or she will probably perform a throat exam first and look at the voice box and the lower throat. If this area looks swollen and/or red, you probably have LPR. At that point, your doctor may order some tests or recommend specific treatment.
WHAT TESTS MIGHT MY DOCTOR ORDER?
If your doctor orders tests, this is to be sure about your diagnosis, to make sure that you don’t have any complications of LPR, and to help pick the best type of treatment for you.
The two most common tests for LPR are pH monitoring, also called pH-metry, and a barium swallow. These two tests are different, and it is common to have both tests done.
The barium swallow is an xray test in which you must swallow chalky material that can be seen on the xrays. This test shows how you swallow and it shows if there is a narrowing or other abnormality of the throat or esophagus. It is a good test to evaluate the entire swallowing mechanism.
WHAT IS IT LIKE TO HAVE pH-METRY?
pH-metry is a special, overnight test that takes about 24 hours to complete. People are not usually admitted to the hospital for this test. pH-metry is used to actually measure acid in your esophagus and throat. Some people say this test is annoying, but it is not painful.
To do this test, you will have a small, soft, flexible tube placed through your nose, which stays in your throat overnight. The tube, called a “pH probe,” is connected to a small computer (a box that you wear around your waist) that measures acid in your esophagus and in your throat. pH-metry is the best test for LPR, and it can help your doctor determine the best treatment for you.
HOW IS LPR TREATED?
Treatment for LPR should be individualized, and your doctor will suggest the best treatment for you. Generally there are several treatments for LPR:
Dietary and lifestyle changes alone are not often enough to control LPR - medications that reduce stomach acid are also usually needed. These must be prescribed by our doctor.
TIPS FOR REDUCING REFLUX AND LPR
Control your LIFE-STYLE and your DIET!
Most patients with LPR require some treatment most of the time and some people need medicine all of the time. Some people recover completely for months or years and then may have a relapse.
In one way, having LPR is a little like having high blood pressure – with treatment, LPR does not usually cause serious medical problems, but without treatment, LPR can be serious, even dangerous.
For people with severe LPR, or people who cannot take reflux medicine, “antireflux” surgery (to restore a new and better stomach valve) may be recommended. In people who have this surgery, most get good relief from LPR for many years.
WHAT KIND OF PROBLEMS CAN LPR CAUSE, AND ARE THEY SERIOUS?
LPR can cause serious problems. LPR can cause noisy breathing, choking episodes, breathing problems (such as asthma or bronchitis), and very uncommonly, cancer of the esophagus, lung, throat or voice box. (For cancer to develop as a result of LPR, the LPR must be very severe and go untreated for many years.)
Margaret, thank you so much for posting that information for me.
You're welcome, Barbara.
I'm happy if it helps you in any way.
The other item on the list that I forgot about, because I just avoid it completely now, is mint!
If I had mint candy, mint gum, or peppermint tea, I had an immediate reaction.
I feel like all I do now is study labels looking for hidden citric acids, mints, cocoa, and caffeine.
I never eat pizza anymore...sigh. But I do have to say that the overall quality of my life has improved tremendously.
How are you doing now? Did your voice come back again?
I've also found a lot of relief from Slippery Elm and DGL lozenges. They are natural emulcents that coat your throat and esophagus, which will give you immediate relief from the irritation, and with regular use they promote healing. One other piece of information - antidepressants can cause irritation of the esophagus as well. I've tried to take them, without much luck, because I get terrible dry mouth, which in turn causes esophagus and stomach problems. If changing your diet alone doesn't do it, ask your doctor if this could be an issue.
Hope you're doing well!
Thank you for asking; yes, after 5 weeks my voice came back last Wednesday! I just came back from a check up with the ENT doctor this morning. He said I am doing well and to continue with prilosec and the nasal spray as I still have coughing and constant feeling of needing to clear my throat. He said mucus is breaking up. I am to call him next MOnday and let him know how the coughing and throat clearing goes.
He also asked if I had a gastro doc for the reflux and I said no, do you recommend one but he said we can talk next week.
I do go through alot of cough drops (now on my 11th bag since 3/27) but they are the Halls non sugar ones; I will check in to the two you mentioned. Probably need to go to a health store for those as I don't think I have seen them at my grocery store.
I do take cymbalta for depression but have never had dry mouth. I do try to drink about 3/4 of a gallon a water a day!
Thank you so much!
I was diagnosed with this about 2 months ago. I had had a sore throat and raspy voice since Christmas. I had no symptoms besides the sore throat and voice issue. I dont get heartburn unless I drink.
I did 6 weeks of the meds 2 x a day. I started getting a sore throat again after I finished them and am now trying another 1 week course on my own.
I have cut down to 1 coffee a day. I see reading a few posts up that mint can be a culprit. I better quit that! I have not stopped fatty meat or eggs as he didnt mention it. I think I maybe eat to big of a portion at a time. Maybe I should try smaller more frequent meals. He did say being heavy is a factor. I'm working on it but cant make that part go faster!
Good luck with this. I do think the biggest I have in this is that there aren't symptoms per se. I know for regular heartburn types, they eat something and a while later they get the symptom and can attribute it to what they ate.
I bought from amazon.com a book by Dr. Jamie Kouffmann (Koufmann or something like that). It is at home but it is about LPR and the foods to avoid/eat. So, I am trying to make a "diet" of it for me. It does have recipes but some of then I would not eat normally.
As I said, I still have a cough and feel like there is something in my throat, so do I assume that once I am under control the coughing goes away or if I eat that piece of chocolate that I will start coughing?
I just find this very confusing.
I agree with the no symptoms. It really is bizarre! I thought I had a throat infection or something when I had went in! I was talking to dh about this last night and he said I was doing lots of coughing after eating. I guess I just got used to it.
I started my day with no coffee. It just about killed me! I'm going to try smaller meals yet today. I fear I will be eating every 2 hours! On the reading I have done some sources say it is easily curable and some say never without replacing the bad valve. I hope it is!!!
If you find things that work well please share :)
I got used to coughing all the time, too. My kids used to joke and tell me to please quit smoking (I don't smoke),
but I coughed as if I smoked a lot!
I quit my one cup of coffee a day today. I rarely eat chocolate. I'll cut tomato for a while and see. That makes me sad as tomatoes are my favorite food. I do love spicy food. I'll try cutting it all as I finish up the prilosec and see how it goes. Oh I love lemons also but cut those out. What do you think about apple cider vinegar? I assume that should go%2
Jumpstart, sorry to bother with more questions but I have one more.
You mention when you stray and eat something you should not the coughing returns. Is it immediate?
I am sorry but I am just so in the dark about this. My voice has been back to normal since last Wednesday (May 2nd) and I saw the ENT on Monday and he said to continue what I am doing and to call him next Monday. Well, this morning, I was coughing (somewhat bad and usually it is during my sleep that I cough) and now my voice is gone with mild laryngitis and feels swollen inside again.
Last night I had 4 oreos which I know I should not have had but I did.
I have read online that some people drink it, very diluted with water, to decrease acid in their stomach. It seems that it works for some and not others. Are you using it that way?
Caffeine takes a little longer - maybe an hour or so later I'm feeling the effects. But let me just say, before I figured out I had LPR I could have issues anytime, day or night, right away or hours later...:stars:
How late did you eat the oreos?
You probably had a double whammy...chocolate, and perhaps eating too close to bedtime(?).
:hugs: Don't worry about asking questions. I don't know anyone else who has this, so I don't mind sharing my knowledge and exchanging info with anyone.
I had the oreos very late which I know was a double whammy but I couldn't resist.
I know I sound like a broken record but I still don't understand how we can get acid reflux in our throats and yet, I don't get any taste indication that something is coming up my throat, no feeling of needing to gag -- again, thinking that something was coming back up my throat.
Maybe acid is tasteless but the whole thing sounds so weird to me. Symptoms are coughing, laryngitis, and mucus. I never even knew I had mucus until I had the transanasal scope done.
I completely understand your confusion.
I had this for YEARS before it was diagnosed. It started right after I got pregnant with my first child, almost 20 years ago. Everyone just brushed it off as "this" or "that". And quite honestly it wasn't as bad back then, but that was just the start. It has gotten progressively worse through the years.
You know who finally told me what it was...An endodontist who was about to perform root canal on me... she knew what it was because she had it! I was assuring her I wasn't sick, but that my coughing fits were uncontrollable and that I wasn't sure if I could have her hands in my mouth for an hour that day because it was so bad. I told her I thought it must be my "allergies" or a severe post-nasal drip. Well after she told me the symptoms of "Silent Reflux" I went home and looked it up and - BOOM - it was so clear that I had it! So, a new endodontist that I was seeing for the first time diagnosed me! I often wonder how much longer I would have suffered had I not needed that root canal.
I had already been to an allergist, my regular doctor, and an ENT. All with no real results. It wasn't until I went back to the ENT specifically complaining that I thought I had Silent Reflux that it was diagnosed by her. Anyway, I started correcting my diet immediately and the relief was miraculous.
I still choose to eat chocolate and have caffeine sometimes, but not a lot, and certainly not when I have to go anywhere! I really don't indulge in the other items on the do not eat list. I do miss tomato sauce. :sad:
I'm sure you've read a bunch of stuff already but here's more:
Laryngopharyngeal Reflux (Silent Reflux)
Laryngopharyngeal reflux (LPR) is similar to another condition -- GERD -- that results from the contents of the stomach backing up (reflux). But the symptoms of LPR are often different than those typical of gastroesophageal reflux disease (GERD).
With laryngopharyngeal reflux, you may not have the classic symptoms of GERD, such as a burning sensation in your lower chest (heartburn). That's why it can be hard to diagnose and is sometimes called silent reflux.
Causes of Laryngopharyngeal Reflux
At either end of your esophagus is a ring of muscle (sphincter). Normally, these sphincters keep the contents of your stomach where they belong -- in your stomach. But with laryngopharyngeal reflux, the sphincters don't work right. Stomach acid backs up into the back of your throat (pharynx) or voice box (larynx), or even into the back of your nasal airway. It can cause inflammation in areas that are not protected against gastric acid exposure.
Silent reflux is common in infants because their sphincters are undeveloped, they have a shorter esophagus, and they lie down much of the time. The cause in adults may not be known.
Symptoms of Laryngopharyngeal Reflux
Symptoms in infants and children may include:
Stomach acid that pools in the throat and larynx can cause long-term irritation and damage. Without treatment, it can be serious.
In infants and children, laryngopharyngeal reflux can cause:
Silent reflux treatment for adults may include these home care steps:
Thank you again and yes, I have read as much as I can, but I guess I can't wrap my head around the fact that acid can come up my throat and I not be aware of it - no sensation of "something" coming back up.
Oh well, it is what it is and I am sorry you had to wait so long for a diagnosis but you have some much knowledge and I appreciate your postings.
I've been having trouble with my voice for about a year, along with a wicked cough. I attributed both to asthma. Asthma was playing a big part in it, but I also had GERD. They have me taking Prevacid, and it's working like a charm. I haven't needed a Tums since I started on it. They've finally gotten me on an asthma med that I can tolerate. It's not as affective as the others they tried (Advair and Symbicort), but the others gave me thrush, and that took my voice away too. It's been quite a journey.
Barbara I can't wrap my head around it either since for mot people acid = heartburn. Not so for this at all!
Margaret thank for all the great info. I must say you are way more informative than the ENT! I'm also sorry to hear it took you so long to find out what the real problem was. The ENT pretty much just gave med to take twice a day with out much other instructions besides come back if it doesnt clear and you'll need an acid test.
I see caffeine is on the list but not necessarily coffee. Does that mean decaff is ok? I didnt have my coffee yesterday and had a migraine that got worse all day. Still had it this morning. It dawned on me it was likely the coffee missing so I had 1/2 a cup with half water. Headache was shortly gone. I'll just keep tapering off.
I had been using the ACV is salads and taking a drink of it every morning because it seems to help with water retention. I just love tart and sour things like vinegar and lemon. I'm surprised some people use it for acid problems. I thought it was quite acidic. I notice my throat is a bit less sore today so I'll keep the vinegar out of my diet for a while and see.
Magicsmom, I'm glad it is working like a charm for you! That is fabulous!
I wonder how big of a factor weight plays. I hope it is a big one because I do not want to take med forever or never have a tomato!
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