It’s normal to have a hoarse voice here and there. But if you find that you’re regularly raspy, you could be dealing with a condition called laryngopharyngeal reflux (LPR), a.k.a. “silent reflux.”

For the record: silent reflux is a form of acid reflux, but it’s not as well known as its sister illness, gastroesophageal reflux disease (GERD). So, what is laryngopharyngeal reflux and how can you know if you have it? Experts break it down.

What is silent reflux?

Laryngopharyngeal reflux (LPR) is a condition where the contents of your stomach reflux into your pharynx (your throat) or larynx (your voice box). One study published earlier this year called LPR a “relatively understudied syndrome,” noting that knowledge around it “continues to evolve.”

“It’s not as common as gastroesophageal reflux disease, but it’s the same process and disorder as acid reflux, except it affects the back of the throat,” says gastroenterologist Dr Babak Firoozi.

But instead of leading to heartburn and indigestion as GERD does, silent reflux usually messes with your voice, throat, and sinuses, Dr Firoozi says.

What are the signs and symptoms of silent reflux?

There are a few symptoms of silent reflux, according to the Cleveland Clinic. Those include:

  • Hoarseness
  • A lump or a feeling like something is stuck in your throat
  • Throat clearing
  • Chronic cough
  • Excessive mucus or phlegm
  • Difficulty swallowing
  • Chronic sore throat
  • Laryngitis
  • Wheezing
  • Postnasal drip
  • Frequent upper respiratory infections
  • New or worsening asthma

“Overall, hoarseness is one of the most common signs,” Dr Firoozi says. But having hoarseness isn’t a slam dunk for a silent reflux diagnosis, says Dr Kevin Leahy, a specialist in otolaryngology, head and neck surgery. “Hoarseness is a pretty generic term, and it can happen for a variety of reasons,” he says. “To use that as the only thing to indicate LPR is difficult.”

How is silent reflux diagnosed?

There is no single test or procedure that’s considered the gold standard to diagnose silent reflux. However, Dr Firoozi says patients will usually be diagnosed by an ear, nose, and throat doctor since they often go to the doctor for their chronic hoarseness.

Doctors will usually do a flexible laryngoscopy to see inside the throat or perform an upper endoscopy, which looks further into your GI tract, the Cleveland Clinic notes. An oesophageal pH test may also be done to monitor acid levels in your throat or oesophagus, or an oesophageal manometry test, which measures the muscle activity in your oesophagus.

How is silent reflux treated?

Some cases of silent reflux can be difficult to treat, given that the mechanisms of why some people deal with this condition (vs. GERD) are still being worked out, Dr Firoozi says. However, he says that patients are usually treated with a mix of medications to help suppress the production of acid in the stomach, as well as lifestyle modifications. “It’s just like how we treat GERD,” Dr Firoozi says.

That can mean taking proton pump inhibitors for a few months to neutralise the acid in your reflux and to protect the tissues in your throat while they heal, he says. But if your symptoms continue, you may need to use acid-blocking medication long-term, including proton pump inhibitors and a class of medications known as H2 blockers.

While it’s not common, doctors may recommend a minor surgery known as a Nissen fundoplication to help with severe cases of laryngopharyngeal reflux, Dr Firoozi says.

How to prevent silent reflux

There are a few things you can do to prevent silent reflux, and Dr Firoozi says they’re the same lifestyle modifications you’d be encouraged to make if you’re already dealing with the condition. Those can include:

  • Avoiding spicy and acidic foods
  • Avoiding acidic drinks like coffee
  • Cutting back on how much alcohol you drink
  • Eating dinner earlier in the evening
  • Avoiding smoking
  • Eating smaller meals

“If you suffer from LPR, it’s also recommended that you sleep with the head of your bed elevated,” Dr Firoozi says. 

When to see a doctor

Again, hoarseness is the most common sign of silent reflux. If you’ve been dealing with hoarseness for more than four weeks, Dr Leahy says it’s time to get evaluated. “Occasional hoarseness or a sore throat is common,” Dr Firoozi says. “But if it lasts for more than a few weeks, you should get it checked out.”

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