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Laryngopharyngeal Reflux (Silent Reflux)

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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 LPR, 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.

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Causes of LPR

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 LPR, 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.

Symptoms of LPR

Symptoms in infants and children may include:

With LPR, 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
  • Persistent cough
  • Hoarseness
  • A "lump" in the throat that doesn't go away with repeated swallowing

Other symptoms may include:

Complications of LPR

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, LPR can cause:

  • Narrowing of the area below the vocal cords
  • Contact ulcers
  • Recurrent ear infections from problems with eustachian tube function
  • Lasting buildup of middle ear fluid

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.

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