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 that are 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 difficult to diagnose and why it is sometimes called silent reflux.
The hiatus is an opening in the diaphragm (a muscle separating the abdomen and chest) that the esophagus or swallowing tube passes through to reach the stomach. If the hiatus weakens and stretches, part of the stomach and/or the esophagus can squeeze into the chest cavity, producing a hiatal hernia.
There are two main types of hiatal hernias: sliding and paraesophageal (next to the esophagus).
In a sliding hiatal hernia, the stomach and the esophagus slide up into the chest through the...
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 is not known.
With laryngopharyngeal reflux, adults may have heartburn or a bitter taste or burning sensation in the back of the throat. But they are less likely to have such classic signs of GERD. More often, symptoms in adults are vague and may be easily confused with other problems. The most common symptoms include:
Excessive throat clearing
A "lump" in the throat that doesn't go away with repeated swallowing
In adults, silent reflux can scar the throat and voice box. It can also increase risk for cancer in the area, affect the lungs, and may irritate conditions such as asthma, emphysema, or bronchitis.
Diagnosis of Laryngopharyngeal Reflux
Although silent reflux is harder to diagnose than GERD, a doctor can diagnose it through a combination of a medical history, physical exam, and one or more tests. Tests may include:
An endoscopic exam, an office procedure that involves viewing the throat and vocal cords with a flexible or rigid viewing instrument
pH monitoring, which involves placing a small catheter through the nose and into the throat and esophagus; here, sensors detect acid, and a small computer worn at the waist records findings during a 24-hour period.