Voice disorder caused by backflow of stomach fluids to the throat and voice box area; a type of supra-esophageal GERDLaryngopharyngeal 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
Backflow of stomach fluids which contain acid and enzymes
Gastro-Esophageal Reflux Disease (GERD)
Backflow of stomach fluids into the esophagus; associated with heartburn
Reflux laryngitis is a voice disorder that results from irritation and swelling of parts of the voice box due to the backflow of stomach fluids into the voice box area. This backflow is called laryngopharyngeal reflux.Stomach fluids contain acids and enzymes that help digest food in the stomach, but cause problems elsewhere in the food pipe [esophagus, throat, and voice box].
People with reflux laryngitis usually complain of hoarseness, frequent throat clearing, sensation of lump in the throat (globus pharyngeus), cough, or sore throat. These patients do not commonly experience heartburn, which is a typical complaint in backflow of stomach fluids to the esophagus causing inflammation in the esophagus, also known as gastroesophageal reflux disease (GERD).
Physicians determine whether a voice disorder is backflow of stomach fluids to the voice box or laryngopharyngeal reflux using the methods in the table below.
Part I. Inspection of the Voice BoxTest design: Office examination of the throat and voice box while the patient talks, sniffs, coughs
Instrument used: Special scope for the voice box that allows the physician to view the voice at work (rigid laryngoscope or flexible laryngoscope)
Looking for: Swelling, redness, signs of irritation of the voice box, increased mucous production
- Looking for: Improvement of hoarseness and/or throat symptoms after sufficient time and dose of medicine + reflux precautions
Confirmatory Testing, if necessary
Key confirmatory test: Prolonged two-site measurement of acid level or double-probe pH monitoring)
Test design: Record the amount of acid throughout a usual/routine day for acid level in the following sites:
Instrument used: Double-probe pH monitor
Looking for: Abnormal levels of acid, number of times throughout the day wherein backflow of stomach acid occurs
Overlapping Complaints: Patients with reflux laryngitis have complaints similar to other voice disorders, making it an easily missed voice disorder.
First line of treatment for reflux laryngitis involves using medicines that reduce or neutralize stomach acid secretion. In addition, lifestyle modifications, termed reflux precautions, are recommended.
Role of Surgery in Treatment
In most cases of clearly demonstrated reflux, surgical treatment is indicated when there is no improvement of the voice disorder, the voice box swelling and irritation, and/or throat pain despite adequate anti-reflux treatment and precautions, and other conditions causing voice dysfunction have been eliminated.In some cases, surgery may be indicated earlier in the treatment management.
Elements of Successful Treatment
For treatment to be successful, the patient must do the following:
- Take the proper amount of medicine
- Take the medicine regularly
- Take the medicine for the proper period of time
- Follow physician advice to prevent backflow of stomach fluids (reflux precautions)
- Go for follow-up check-ups with the physician
Patient education material presented here does not substitute for medical consultation or examination, nor is this material intended to provide advice on the medical treatment appropriate to any specific circumstances.
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