What is Silent/Laryngopharyngeal Reflux?

Everyone has acid and enzymes in their stomach which digest food. At the top of the stomach is a valve which closes up to prevent food and stomach juices escaping back up into the foodpipe. If the valve does not work properly the juices can leak back into the foodpipe (gastric reflux) and can cause heartburn. Sometimes the juices travel up the back of the throat and spill over into the voice box causing irritation. This is called silent or laryngopharyngeal reflux. Often there is no associated heartburn.

What are the symptoms?

Some of the following may indicate you have irritation of the voice box from acid:

  • Hoarseness of the voice.
  • Cough (tickling and irritating).
  • Too much mucus or phlegm in your throat.
  • Nasty taste in your mouth.
  • Difficulty swallowing, especially tablets.
  • Throat clearing.
  • Feeling something is stuck in your throat.
  • Choking episodes at night.
  • Dryness.

How can it be prevented and treated?

  • Stop smoking – you are likely to suffer symptoms after every cigarette.
  • Reduce caffeine intake – try substituting with herbal teas or decaffeinated hot drinks.
  • Avoid fruit juices and fizzy drinks.
  • Limit your intake of fatty foods and butter. Avoid fried foods, chocolate, cheese and pastry.
  • Reduce the amount of alcohol you drink, especially white wine and spirits.
  • Don’t eat within 3 hours of going to bed.
  • If you are overweight, try losing a little and see if this helps.
  • Raise the head of the bed and try to sleep on your left side.
  • Bend from the knees not from the waist.

Caring for your voice

Keep well hydrated – aim for 6-8 glasses of water a day. Steam inhalation can also help.

Have regular breaks if you are using your voice over long periods.

Cut out throat clearing – take a sip of water or swallow instead

Medical treatments

The damage to the throat is caused by acid and an enzyme called pepsin in the digestive juices. An ‘alginate reflux suppressant’ such as Gaviscon Advance may be recommended to be taken 4 times daily, or last thing at night before you go to sleep (this must be the last thing you swallow). It acts as a raft and lies above the stomach contents.

Sometimes the GP may suggest you take tablets called proton pump inhibitors (PPIs) which help suppress acid production in the stomach. These should be taken half an hour before breakfast and half an hour before your evening meal. PPI’s twice daily and Gaviscon Advance last thing at night can be helpful and should be discussed with your GP.