We all know what it’s like to have a head cold or spring allergies and feel the need to clear the mucus in the back of your throat with a little grunting sound. But if this behavior lasts weeks or months, you might be experiencing laryngopharyngeal reflux, also known as silent reflux. Besides annoying your family, friends, and coworkers, constant throat clearing that goes untreated may be detrimental to your health.

What is laryngopharyngeal (LP) reflux?

Most people are familiar with the diagnosis of GERD, gastroesophogeal reflux disease. Common symptoms include heartburn, indigestion, and tightness in the chest. But few people realize that there is another, related type of reflux - laryngopharyngeal (LP) reflux, or silent reflux. Sometimes accompanied by no symptoms at all, LP reflux occurs when stomach acid ascends all the way through the esophagus up into the throat and voice box area. The stomach acid is usually leaked by a faulty lower esophageal sphincter, a muscle that is supposed to close the stomach off completely from the esophagus.

What are the symptoms of laryngopharyngeal reflux?

Some people with LP reflux have no symptoms at all, while others may experience any of the following:

• Chronic need to clear the throat

• Chronic cough

• Hoarse voice

• Difficulty swallowing

• Sensation of a lump or mucus in the throat

How is LP reflux diagnosed?

Sometimes LP reflux is diagnosed based on the patient’s description of symptoms alone. However, sometimes one or more of the following tests is ordered by an ear, nose and throat (ENT) doctor or a gastrointestinal (GI) doctor:

• Swallow study: the patient swallows barium, a liquid that outlines the esophagus on X-ray and allows the doctor to see movement of food and liquid through the esophagus. This is not painful for the patient.

• Endoscopy: the doctor inserts a camera through the patient’s mouth via a long, thin tube so that any inflammation of the esophagus or stomach can be visualized internally. Often this is done under some sort of anesthesia to eliminate any discomfort.

• Esophageal pH test: the level of acidity inside the esophagus can be measured by a small probe on the end of a thin tube inserted through the nose. The patient can press buttons on a device to indicate when they are experiencing symptoms. While the insertion of the probe may cause some feelings of pressure, it is not considered painful.

If my symptoms don’t bother me, should LP reflux be treated?

It’s important to treat LP reflux if it is interfering with activities of daily living, such as eating, drinking, swallowing, or talking. Some people may not notice how often they are clearing their throat until it is pointed out to them by friends or family members. Additionally, untreated LP reflux can lead to worsening asthma, ulcers or swelling of the vocal folds, and may even contribute to cancer of the voice box due to the chronic inflammation. The best course of action is to consult with a doctor.

How is LP reflux treated?

Some people may find relief from their symptoms by making dietary and lifestyle changes, such as:

• Avoiding alcohol, caffeine, and tobacco

• Avoiding spicy and fatty foods

• Avoiding mint and chocolate

• Avoiding eating two hours before bedtime

• Wearing loose clothing

• Sleeping with an elevated head of the bed

• Decreasing stress

Other people may need the help of stomach acid reducers like ranitidine (Zantac®) or proton pump inhibitors (PPIs) such as omeprazole (Prilosec®) and pantoprazole (Prevacid®). These medications should not be taken for more than a few weeks without consulting a doctor.

Summary

If you’re experiencing chronic throat clearing, don’t just write it off as allergies or post-nasal drip. You may have laryngopharyngeal (silent) reflux, and there are simple solutions available to improve your quality of life and protect you from the dangers of chronic inflammation in the throat and voice box.

References

Cleveland Clinic. (2023, August 20). Laryngopharyngeal reflux (LPR). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr

Campos, M. (2022, April 5). Constantly clearing your throat? Here’s what to try. Harvard Health Publishing. https://www.health.harvard.edu/blog/constantly-clearing-your-throat-heres-what-to-try-202204052719

Icahn School of Medicine at Mount Sinai. (2022, June 30). Chronic throat clearing and silent reflux. Mount Sinai. https://health.mountsinai.org/blog/chronic-throat-clearing-and-silent-reflux/