Heartburn/GERD Health Center

Laryngopharyngeal Reflux (Silent Reflux)

Laryngopharyngeal reflux (LPR) is similar to another condition -- GERD -- that results from the contents of the stomach backing up (reflux). But the symptoms of LPR are often different than those that are typical of gastroesophageal reflux disease (GERD).

With laryngopharyngeal reflux, you may not have the classic symptoms of GERD, such as a burning sensation in your lower chest (heartburn). That's why it can be difficult to diagnose and why it is sometimes called silent reflux.

Causes of Laryngopharyngeal Reflux

At either end of your esophagus is a ring of muscle (sphincter). Normally, these sphincters keep the contents of your stomach where they belong -- in your stomach. But with laryngopharyngeal reflux, the sphincters don't work right. Stomach acid backs up into the back of your throat (pharynx) or voice box (larynx), or even into the back of your nasal airway. It can cause inflammation in areas that are not protected against gastric acid exposure.

Silent reflux is common in infants because their sphincters are undeveloped, they have a shorter esophagus, and they lie down much of the time. The cause in adults is not known.

Symptoms of Laryngopharyngeal Reflux

Symptoms in infants and children may include:

• Hoarseness
• "Barking" or chronic cough
• Reactive airway disease (asthma)
• Noisy breathing or pauses in breathing (apnea)
• Trouble feeding, spitting up, or inhaling food
• Trouble gaining weight

With laryngopharyngeal reflux, adults may have heartburn or a bitter taste or burning sensation in the back of the throat. But they are less likely to have such classic signs of GERD. More often, symptoms in adults are vague and may be easily confused with other problems. The most common symptoms include:

• Excessive throat clearing
• Persistent cough
• Hoarseness
• A "lump" in the throat that doesn't go away with repeated swallowing

Other symptoms include:

• A sensation of postnasal drip or excess throat mucus
• Trouble swallowing
• Trouble breathing
• Sore throat

Complications of Laryngopharyngeal Reflux

Stomach acid that pools in the throat and larynx can cause long-term irritation and damage. Without treatment, it can be serious.

In infants and children, laryngopharyngeal reflux can cause:

• Narrowing of the area below the vocal cords
• Contact ulcers
• Recurrent ear infections from problems with eustachian tube function
• Lasting buildup of middle ear fluid

In adults, silent reflux can scar the throat and voice box. It can also increase risk for cancer in the area, affect the lungs, and may irritate conditions such as asthma, emphysema, or bronchitis.

Diagnosis of Laryngopharyngeal Reflux

Although silent reflux is harder to diagnose than GERD, a doctor can diagnose it through a combination of a medical history, physical exam, and one or more tests. Tests may include:

• An endoscopic exam, an office procedure that involves viewing the throat and vocal cords with a flexible or rigid viewing instrument
• pH monitoring, which involves placing a small catheter through the nose and into the throat and esophagus; here, sensors detect acid, and a small computer worn at the waist records findings during a 24-hour period.