Laryngopharyngeal reflux is a lesser-known form of acid reflux in which stomach acid travels all the way into your throat, causing symptoms there. LPR can be the underlying cause of hoarseness, laryngitis, chronic throat clearing and related symptoms. You might not have typical acid reflux symptoms, like heartburn or indigestion.
Laryngopharyngeal (“la-Ring-go-fa-Rin-jee-al”) reflux, or LPR, is a special type of acid reflux. Acid reflux occurs when stomach juices (including acid) rise from your stomach into your esophagus (swallowing tube). Symptoms of acid reflux usually affect your lower esophagus, within your chest. But if you have LPR, the reflux has a habit of creeping higher up, into your larynx (voice box) and pharynx (throat).
LPR is also called “extraesophageal” reflux, because the reflux passes beyond your esophagus. This causes different symptoms from typical acid reflux — so different that you might not realize it’s a type of reflux at all. Instead of causing heartburn and indigestion, LPR tends to irritate your voice, throat and sinuses. Because you can have LPR without other reflux symptoms, it’s sometimes called “silent reflux.”
GERD stands for gastroesophageal reflux disease, otherwise known as chronic acid reflux. This is what we call it when stomach acid routinely rises into your esophagus, which runs from your throat down to your stomach. GERD more often affects your lower esophagus, while LPR reaches higher up in your throat. Some people have LPR in addition to GERD, but other people only have LPR symptoms.
Healthcare providers estimate that more than half of people who complain of chronic hoarseness have laryngopharyngeal reflux. About 10% of people who visit a throat specialist are diagnosed with LPR.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
Laryngopharyngeal reflux symptoms include:
For gastric juices to travel from your stomach all the way up through your esophagus and into your throat, they have to get past two important guards. These are your upper and lower esophageal sphincters — the muscular valves that seal off your esophagus at the top and bottom. The lower one separates your esophagus and stomach, while the upper one separates your esophagus and throat.
Normal acid reflux happens when something weakens your lower esophageal sphincter (LES), allowing stomach juices to flow back up into your esophagus. LPR happens when your upper esophageal sphincter (UES) also relaxes inappropriately. This allows reflux that’s already in your esophagus to creep up higher into your throat. Different things can affect these two sphincters and cause them to relax.
A lot of things can affect how well your esophageal sphincters close to keep substances out. Some of these factors weaken the muscles gradually over time, while other factors can affect them temporarily. Most people have more than one factor affecting them. Healthcare providers don’t always know exactly which ones caused LPR, but they often find that if you reduce these factors, your reflux reduces.
Your lower esophageal sphincter (LES) is the first guard against acid reflux from your stomach into your esophagus. Frequent, substantial acid reflux will cause symptoms of GERD, but you can have a small amount of reflux in your esophagus without feeling it. Your esophagus has many layers of protection against acid reflux, so it takes a lot to wear it down. Your throat doesn’t have the same protection.
Common factors that may weaken your LES temporarily include:
Medications. Certain medications can have a relaxing effect on your LES, including:
Foods and drinks. Foods and drinks that may have a relaxing effect on your LES include:
Lifestyle habits. Simple things can temporarily weaken your LES by increasing abdominal pressure against it, or by taking away the advantage of gravity, which helps keep it closed.
Common factors that may weaken your LES progressively over time include:
Once stomach juices are in your esophagus, it’s up to your upper esophageal sphincter (UES) to keep them out of your throat. You may only have a small, unnoticeable amount of reflux in your esophagus, but it doesn’t take much to irritate your throat tissues. They don’t have the same protective lining as your esophagus, and they also don’t have the same mechanisms that wash reflux out, so it stays longer.
Common factors that may weaken or relax your UES include:
Laryngopharyngeal reflux may cause:
If you have chronic hoarseness, there’s a 50% chance you have LPR. Look out for other related symptoms, as well. Most people with LPR are unaware of having acid reflux. You might think that you have allergies or an endless cold. Actually, many people develop their first symptoms of LPR shortly after an infection that irritated their throat. This irritation set the stage for reflux to do its own damage.
An otolaryngologist — an ear, nose and throat doctor — typically diagnoses LPR. They’ll listen to your symptoms, then take a look inside your throat for signs of inflammation or tissue damage. A flexible laryngoscopy is a simple, in-office procedure they can use to look inside your throat. They pass a laryngoscope, a tiny, lighted camera on the end of a slim tube, through your nose into your throat.
Based on what they find, your provider might feel confident enough to guess that you have LPR. They might take the approach of treating it with medication to see if your symptoms improve and confirm your condition that way. Or they might want to run additional tests to confirm their suspicions or rule out other possible causes. Additional tests for laryngopharyngeal reflux (LPR) may include:
The approach to treating LPR depends on how severe it is and how serious the cause is. In many cases, there’s no serious problem with your esophageal sphincter muscles, and diet and lifestyle changes can make a real difference in reducing LPR reflux. Medication can help heal your tissues as these adjustments begin to take effect. But some people do need more extensive treatment than others.
Some people can solve their LPR with lifestyle adjustments alone. In general, LPR is more likely than GERD to improve without medication, because LPR may be caused by only a small amount of reflux. It takes time for LPR to heal, though, so it may be several months before you can tell if your adjustments are working. Medications called proton pump inhibitors (PPIs) can help speed up the healing process.
Treatment for laryngopharyngeal reflux begins with addressing the cause. Often, there’s no one obvious cause, so healthcare providers focus on diet and lifestyle adjustments to reduce all possible contributing causes. This might mean addressing habits like smoking, drinking alcohol or coffee, or adjusting the way you eat and sleep. Some people might need treatment for an underlying condition, like an esophageal disorder.
Medication usually plays a limited role in treating laryngopharyngeal reflux. For example, your provider might prescribe proton pump inhibitors for several months while you aim to reduce your reflux with lifestyle changes. These neutralize the acid in your reflux and also coat and protect the tissues in your throat while they heal. If this approach works, you’ll be able to discontinue medication after a while.
If you continue to have symptoms, you might need to use an acid-blocking medication or another medication long-term. Acid blockers like proton pump inhibitors and H2 blockers can help when you continue to have reflux despite efforts to reduce it. These medications reduce the acid content in your reflux. Medications called alginates can help protect against other irritants in your reflux, like enzymes.
Surgery isn’t typical for laryngopharyngeal reflux unless you have an obvious defect affecting your esophageal sphincter muscles, like a hiatal hernia. A minor procedure called a Nissen fundoplication can repair a hiatal hernia and reinforce your lower esophageal sphincter, which is your first guard against acid reflux. If your upper esophageal sphincter also needs reinforcing, similar procedures are possible.
Getting an accurate diagnosis, discovering the contributing causes and targeting them with the right treatment can be a process. But once the way is clear, treatment for LPR is usually brief and effective. Most people won’t need long-term prescription medications or other interventions. The key to recovery lies in making helpful lifestyle changes and taking care to protect your throat and voice while they heal.
Healthcare providers suggest that you:
Healthcare providers suggest that you:
A note from Cleveland Clinic
Symptoms affecting your throat, vocal cords and sinuses can have many causes. Most are temporary, like infections and allergies. When these symptoms continue for a long time without any obvious cause, it can be frustrating, as well as confusing. Most people don’t think of acid reflux as a possible cause of these symptoms, especially when they aren’t aware of having it. But that can be the case with LPR.
It only takes a small amount of acid reflux — which includes erosive enzymes like pepsin and stomach acid — to affect your sensitive throat and voice. An even smaller amount may escape through your throat into your respiratory system and do damage there. Fortunately, this also means that small adjustments are often enough to manage it. Treatment for LPR is usually successful and short-term.
Last reviewed by a Cleveland Clinic medical professional on 08/20/2023.
Learn more about our editorial process.