Reflux and hoarse voice
Reflux is the term commonly used to describe an event whereby the contents of the stomach leak up out of the stomach and into the oesophagus. Symptomatic reflux is usually referred to as Gastro-Oesophageal Reflux Disease (GORD) and it may contribute to an inflamed oesophagus (oesophagitis) which is evident during endoscopy. Reflux can occur more frequently in people who have been diagnosed with a hiatus hernia because the sphincter muscle at the top of the stomach cannot close as efficiently. Sometimes, the stomach contents, or vapour from the stomach can reach up as far as the larynx, and this is termed laryngo-pharyngeal reflux (LPR).
Symptoms of GORD may or may not include heartburn, but symptoms of LPR frequently do not include heartburn, which leads people to believe that they do not suffer from reflux. However, it is known that a high proportion of voice problems are caused or perpetuated by LPR, despite there being a lack of obvious symptoms.
Symptoms of LPR can include unexplained coughing, post-nasal drip, throat discomfort, excess mucus in the throat, a sensation of a lump in the throat, wheezing or episodic breathing difficulties, spasms of the vocal cords, night-waking, hoarse voice or vocal fatigue and a history of recurrent tonsillitis or ear infections.
If you suffer from GORD or LPR you may be prescribed a medication known as a PPI (proton pump inhibitor) which reduces the production of acid within the stomach and therefore limits the amount of damage that can be caused by acid reflux. Gaviscon Advance is also an effective medication that may be recommended to you, as it creates a raft of foam over the stomach contents thereby reducing episodes of reflux.
Medication can bring about a significant improvement for some individuals because it allows healing of the mucosa to occur. However, about a third of patients do not respond to PPI medication because acid erosion is not the main factor contributing to their symptoms. These patients may be suffering from a non-acidic form of reflux or have an alternative diagnosis which mimics the symptoms of reflux disease, such as allergic disease (Roth and Ferguson 2010). Emerging evidence suggests that inhalant or food allergies may account for presenting symptoms such as swallowing problems or a lump in the throat, which are often assumed to be due to reflux but can also be signs of another disorder called eosinophilic oesophagitis (Abuelhassan and Ally 2012). For these people, a guided elimination diet can identify trigger foods and may lead to an improvement of symptoms without the need for long-term medication.
Click here for more information on how to obtain help with the dietary management of reflux.