Changes in voice and hoarseness can be the result of a number of different causes. One of the more common causes is gastroesophageal reflux disease (GERD). GERD occurs when stomach acid regurgitates back up the esophagus (swallowing tube). When the acid reaches the throat we refer to this as laryngopharyngeal reflux (LPR). This reflux can cause inflammation and swelling in the throat or in the larynx (voice box) and can result in a number of different symptoms. These include mild hoarseness which is typically worse in the morning, a sense of a foreign body or lump in the throat, a sense of mucous sticking or a need to frequently clear the throat. Oftentimes, LPR irritation in the throat and larynx is mistaken for sinus drainage because of the sensation of mucous.
LPR tends to become more prominent as people age, is often related to the timing and type of diet, and may be the source of chronic symptoms. LPR reflux may also be the cause of low grade sore throat and chronic cough, particularly cough that wakes people up the in the middle of the night.
Approximately, 50% of people with significant LPR have no symptoms of heartburn or stomach upset.
The diagnosis of LPR as a cause of throat symptoms is usually based on classic symptoms and physical findings of inflammation in the throat in locations consistent with LPR (back part of the voicebox). Often, the patient is treated for LPR without any further testing. More significant testing is usually not needed. However, on some occasions, some additional tests may be required such as a swallowing study with barium, an endoscopic evaluation of the esophagus and stomach, or a probe that measures acidity (pH) in the throat and esophagus.
The most important treatment of LPR is dietary. A somewhat blander diet, smaller but more frequent meals, avoidance of alcohol, tobacco and caffeine, and not eating within 3-4 hours of bedtime are the most important factors. Avoidance of acidic and fatty foods and mint are also important. Elevation of the head of the bed and avoidance of tight, binding clothing is of value. A person with reflux who is overweight should reduce weight, and reducing stress also frequently improves the symptoms.
A number of over-the-counter and prescription medications can be used to decrease LPR related throat symptoms. These include antacids such as Tums, Maalox or Mylanta, stomach acid reducers such as Tagamet or Zantac (ranitidine), and the strongest acid blockers, proton pump inhibitors such as Prilosec (omeprazole), Protonix or Nexium. Regular use of the prescribed medication for at least 2 months while observing dietary control is critical. Humidification, hydration, mucous thinners and avoidance of throat clearing are all of value for those people who have significant throat symptoms from gastroesophageal reflux.
Untreated LPR can lead to chronic swelling of the vocal folds, ulcerations of the vocal folds and formation of masses known as granulomas. LPR can also make asthma worse and there is some evidence that chronic uncontrolled LPR may play a role in laryngeal cancer development.