Reflux and the throat (laryngopharyngeal reflux)
Hoarseness, throat clearing, a lump in the throat or a chronic cough caused by stomach contents reaching the throat at night. Often there is no heartburn, which is why it is missed.
When stomach contents reach the throat rather than just the lower gullet, the condition is called laryngopharyngeal reflux (LPR), or silent reflux. Most people with LPR have no heartburn at all; the symptoms are throat ones, and most of the refluxate reaches the throat overnight.
Common symptoms
- A feeling of mucus or a lump at the back of the throat (globus)
- Frequent throat clearing, particularly in the morning
- A hoarse or croaky voice that tires through the day
- A chronic dry cough, particularly at night or on waking
Why the throat reacts so strongly
The lining of the throat and voice box is far more sensitive to acid and pepsin than the gullet is, so a small amount of reflux the gullet tolerates silently can still inflame the larynx. This is also why symptoms can persist after acid is suppressed.
Assessment and treatment
Assessment is a careful history and examination of the throat and voice box with a small endoscope; a hoarse voice lasting more than three weeks always needs examination rather than guesswork. Treatment is an evening antireflux routine with an alginate (Gaviscon Advance) last thing at night, given six consistent weeks, with acid-suppressing medication and gastroenterology referral where needed. Mr Gane provides a detailed step-by-step routine to follow at home.
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This page is general information and not a substitute for individual medical advice.