Hello, and welcome to Karen's Medical Coron. I'm Karen O'Day.
I'm a family nurse practitioner and a certified nurse midwife in Santa Fe,
New Mexico.
I have a family practice as well as aesthetic practice and
bioidentical hormone replacement therapy for patients.
Today we're gonna be talking about something that I see frequently in the family
practice aspect of the practice, and that is, uh, people who have,
uh, silent reflux or loren pharyngeal reflux as it's better known,
um, professionally. Now, uh,
the symptoms can be a little bit hard to determine what's causing the problem,
and that's why it turns into a bit of a detective hunt.
But if people know the signs and symptoms, sometimes they can, uh,
do some dietary environmental lifestyle modifications to see if it helps their
symptoms prior to coming in for evaluation.
So theary pharyngeal reflux occurs when you have a small amount of stomach
contents,
so stomach acid coming up into the larynx and the pharyngeal area.
So heartburn is when you have stomach acid that comes just into the
esophagus. That's where we have people who complain of heartburn.
They'll take anti acids. A although a lot of times with lore, pharyngeal reflux,
they don't have heartburn because the amount of acid required to cause
symptoms in the throat is much less than what's required in the esophagus.
So a lot of times I'll see patients,
they come in and they're complaining of chronic throat clearing,
or they're having a little bit of a sore throat,
worse in the morning than another time is during the day.
They might also complain of, uh,
what's called a globus sensation in the throat,
or feeling like there's a ball of mucus stuck in their throat or a lump in the
throat. Sometimes people will have chronic cough,
they may have some hoarseness.
Sometimes that'll be worse in the morning and kind of gets better throughout the
day.
Sometimes they'll have a little bit of increase in postnasal drip,
uh, choking sensation in the throat. Um,
but one of the main things that I hear about is just the chronic throat
clearing. Uh, they'll feel like they have a cold and it just doesn't get better,
or they'll have a cold, and then after the cold is gone,
they'll continue with these symptoms.
One of the most common causes of recurrence of
lary pharyngeal reflux is having an upper respiratory infection,
because if you're coughing a lot,
you're actually putting pressure on the, um,
closure between the stomach and the esophagus,
and that can let acid escape, uh, little bit of it up into the throat.
So this can be really bothersome for people. They also, uh,
can't seem to clear it up with routine, uh, treatments like, uh,
cough medicine or antihistamines. So they'll come in for evaluation.
When we look at laryngeal reflux and these symptoms,
there's a couple of ways to diagnose it.
Sometimes providers will initially try, uh, to do a,
um, kind of a tentative diagnosis and have people do things at home,
as well as give them antacids or what we call proton pump inhibitors
to see if their symptoms get better. But for an actual diagnosis,
the gold standard, which I don't know if it's done a lot,
uh, would be what's called a Hemi pH.
So a Hemi pH is a hypo pharyngeal esophageal,
um, test,
which checks the pH of
refluxed contents into the, um,
lgo pharyngeal area over a 24 hour period of time.
It is an invasive test,
so a lot of times that might not be done as a first line treatment,
but it is considered the gold standard. However, a lot of, um, ear,
nose and throat providers and, uh,
with my training in E N t I do that in my office as well,
is with a flexible fiber optic laryngoscopy where you can actually take a
little magnified scope and go in through the nose down to the base
of the throat and evaluate the vocal cords and the, um,
the entire area to see if you see any staining from acid, uh,
to check for any polyps or masses. Uh,
you can check the paraform sinuses, see if they're, uh, a little bit, uh,
swollen, and that can oftentimes give a diagnosis.
You can have the person move their vocal cords to determine how
the vocal cords are working.
And so this is oftentimes when somebody's referred to ear, nose, and throat,
the testing that would actually be done because it's an an in-office procedure,
it's very, very easy to do. It takes only a few minutes to do it.
Sometimes people will have it done without any type of numbing to the nasal
cavity,
and sometimes other people will have a little bit of Afrin and,
um, topical lidocaine placed so that they don't feel the scope.
Uh, but the scope usually isn't painful. It usually just makes your eyes water,
uh, going in through the nose bypasses the gag reflex so that the patient isn't
gagging.
So it's an easy way to kind of check to see what's going on at the base of the
throat. Now, things that can also cause these symptoms,
so we have to have what's called a differential diagnosis because you can't
assume that everybody who has chronic throat clearing or some hoarseness has
laryngeal reflux. So differential diagnosis would be, you know,
an upper respiratory infection, uh, asthma, allergies,
sinus infection, uh,
chronic inflammatory conditions of the upper respiratory tract. And also,
you know, obviously anytime.
Somebody has symptoms,
we always have to rule out that we see any masses or nodules or potential for,
uh, for cancer.
So once the diagnosis is made,
whether it's made through the Hemi pH test or through, um,
flexible fibro optic laryngoscopy, um, uh,
there are things that can be done to help treat the symptoms. So,
uh, we usually tell the patients initially that, uh,
dietary environmental and lifestyle modifications need to be made because there
really isn't a magic pill to treat Lorenzo pharyngeal reflux. Now,
if you have heartburn, you can take an antiacid like say, uh,
Tums or Pepcid or maybe a proton pump inhibitor like Prilosec
or otherwise known as omeprazole,
and symptoms tend to get better in about 20 minutes. Well,
sometimes when patients with laryngeal reflux are placed on these medicines,
they don't work as well because it takes a long time
to start to damage those delicate tissues with just a little bit of acid.
And so it's gonna take a long time for that area to heal.
So I always tell my patients,
you have to do the environmental dietary lifestyle modifications
in order to have symptom relief,
and if you want to have a prescription for the antacids or the
proton pump inhibitor, that may make your symptoms better quicker.
But things that people can do at home as far as dietary wise,
the first is to eat smaller meals. So instead of three big meals a day,
you would want eat five small meals a day. And in these meals,
you wanna avoid foods that increase your acid production or
increase your reflux into the throat. So that would be anything fried,
anything fatty, anything that's dipped in batter or rolled in breadcrumbs,
you wanna avoid spicy foods. So that includes foods like, uh,
hot sauce or green chili. Uh,
anything that is, uh, gonna burn the throat.
Other things to avoid would be alcohol,
because alcohol not only relaxes the closure,
that esophageal sphincter that isn't closes off the stomach to keep acid
in, but it also relaxes with alcohol.
So when you drink alcohol,
you'll have a slight relaxation of that closure and allow a little bit of acid
to come into the throat. Alcohol,
even if it's sweet also is, can be caustic to the throat. It,
it burns the throat as it goes down. Uh,
and that's pretty apparent with some of the harder alcohol, uh, products,
but it's also occurring even if you're drinking a leor, that's pretty sweet.
So alcohol would be something to be avoided. Caffeine as well.
Caffeine not only needs to be avoided because it also relaxes that closure
and will let just a little bit of acid come up into the throat.
And that's again,
what we wanna avoid in order for healing of those delicate tissues to occur.
Other things that can cause you to have more acid into the throat would be
anything like garlic or onions, any citrus fruit like oranges,
lemons lines, grapefruits,
anything that has carbonation in it. So if you're burping,
you're putting acid into your throat.
So if it's carbonated water, if it's carbonated soda,
no matter what it is, if you're consuming carbonated beverages,
you are going to have some reflux of, uh,
acid into your throat.
Other things that you would wanna avoid would be chocolate. Chocolate.
As well as mints also causes an increase of, uh,
um, acid into the throat because it again,
relaxes that closure into the, uh, from the esophageal spiner,
allowing acid to come up into the throat. Um,
other things that you would want to avoid would be anything that is
hard to digest, and that's why we say a lot of fried foods,
you wanna stay away from those as well. Um,
you wanna drink increased amount of water, uh,
because that's good for your system, although don't overfill with water.
That's why you should eat approximately five meals a day and not, and,
and also drink water throughout the day. But you wanna stop consuming, uh,
foods and you wanna stop consuming fluids about two to three hours before you go
to bed, because if you lay down with food or liquid in your stomach,
it's gonna put pressure on the esophageal sphincter, and that's going to allow,
again, a small amount of acid to come into the throat.
So making sure you're sitting upright after you eat a meal,
not laying down for two to three hours after eating a meal,
and then exercise as well. A lot of people want to exercise and,
and carrying extra weight also puts extra pressure on that esophageal closure
and allows acid to come into the throat.
So maintaining a good weight is really important and people wanna exercise
and maybe get some of that extra weight off,
but don't exercise for at least an hour to two hours after you eat
because you also don't wanna put pressure again on that closure and cause a
little bit of acid to come into the throat. And that includes bending over,
getting pans out of the, out of your cupboards if they're down on the ground,
you know, bend at your knees so that you're not bending over,
putting the head below the level of the heart and increasing that pressure in
the stomach. Uh, other things that, uh,
you wanna do is you wanna avoid wearing any tight clothing because tight
clothing, again, is putting pressure on the outside of the body,
uh, to the inside,
it increases the pressure to let a little bit of acid come up into
the throat. And then when people have things that come up,
like if they have allergies or an upper respiratory infection and they're
coughing, that's definitely, uh, going to increase their symptoms.
And so there's not a lot that you can do about that when you happen to have a
cold or you have allergies except to try and, and, uh,
either take home remedies or medications prescribed by your provider to help
treat those symptoms. Other things that you can do to help treat your symptoms,
um,
of acid coming into the throat is sleeping with the head of your bed elevated.
Now,
that does not include stacking pillows and sleeping on a stack
of pillows that actually can make your symptoms worse because when you sleep
with stack pillows, you tend to scrunch up at night and again,
putting more pressure on your stomach and allowing acid to come into the throat.
But you can buy bed blocks, you can buy them almost anywhere.
You can buy them at Target, you can buy them at Walmart,
you can order them online. And those, uh,
bed blocks will either be, you know, starting at about four inches,
going up to about eight inches.
I'll usually tell people to start at a little lower wedge just because you
don't wanna feel like you're quite so elevated all at once. Um,
but you can start where wherever you'd like, but that again,
helps take pressure off of the stomach and, and, uh, so,
so those are some of the things that can help relieve your symptoms.
So if people are doing those things,
and they can also take anything like, uh, antacids,
as long as they're not contraindicated with any other medicines you're taking.
So that would be things over the counter like Tums or, um,
Pepcid or, um, uh,
you could take a proton pump inhibitor over the counter like omeprazole. Again,
if it's not contraindicated,
you wanna check with your provider prior to taking any over-the-counter
medications. And again, these are not magic pills. So a lot of times,
most of my patients don't wanna take medication because again,
all medication has side effects. So I'll tell 'em, you know,
if you can do all of these changes and give it about four to
six weeks, you'll start to see changes. But it's not overnight.
You can't make a dietary change. You can't raise the head of your bed and,
and expect for your symptoms to go away overnight. That tissue has to heal.
So when you have that inflamed tissue,
you're secreting extra fluids to try to heal it.
And that tissue is a very delicate, and it does take a while to get better.
So I usually tell patients don't expect to see any symptom relief for four to
six weeks,
and then you really won't see how well you're doing a symptom-wise for about
three months. And then if you go back to foods that you were eating before,
that can cause you to have that reflux into the throat. Like say, tomatoes,
which we know are acidic, uh, and you have symptoms,
well that's because your tissue is being, uh, damaged again.
And so a lot of these changes for larygeal reflux are need to
be permanent changes or else you'll have symptoms. Again, these symptoms can,
can also, you know, if you don't treat Loren pharyngeal reflux,
what's the dangers of not treating it well? The dangers of not treating it is,
it, it, you can have some acid that actually gets past those, uh,
vocal cords and down into the,
the lung tissue that can make asthma worse.
It can make any type of chronic obstructive pulmonary disease worse,
it can give you, uh,
if it's coming up past that area into the back of the throat,
it can actually irritate the sinuses and just cause a lot of, uh, sinus,
uh, irritation and chronic sore throats. Uh,
it changes the tissue over time at the DNA level and can,
if it's not treated, predispose you to having cancer, uh, in your throat,
in the vocal cords, uh, or the area known as the vocal voice box.
So it is important to treat it. Now,
sometimes people will have severe symptoms and they have been on medication
from their provider.
They are making all of the dietary environmental lifestyle modifications,
and sometimes they'll need to be seen by gastroenterology
because ear, nose and throat is usually the one that will diagnose it initially.
But if it's not improving, they may,
you may need a referral to go to see gastroenterology,
to see what's going on in the stomach,
because sometimes if people have a hiatal hernia,
that can make symptoms worse and make it a little bit resistant to, uh,
these treatments. And so if it's severe, there are, uh,
surgical interventions that can be done that can help correct the symptoms.
But seeing what you can do at home, you know, avoiding, uh,
foods that are offensive, making sure you're carrying, uh,
your optimal weight,
making sure that you're eating five small meals a day and not three
wearing loose clothing,
not laying down for two to three hours after you eat can all be,
um, remedies that can help you substantially at home and help keep you off
medications and hopefully help keep you off the path to surgery.
So this was just a short, um,
introduction to symptoms of loreal reflux.
Uh, heartburn is different again because it's affecting the esophagus and it
actually causing that pain in the esophagus,
but it's all caused by the same stomach contents, which is acid.
So we'll be putting on the website, um, a handout for,
uh, people to look at that give you these environmental dietary lifestyle
modifications. And then if you feel like you need to take any medication,
if your symptoms aren't getting better, uh, again, don't, don't wait.
See your healthcare provider, uh, if they are unable to do, um,
a scope on you to take a look in the vocal cords, request a referral to ear,
nose, and throat, and it's a simple procedure. It's not painful,
they can do it quickly and tell you, you if indeed yes,
that is what they believe is going on. Or if you need, uh,
more, uh, thorough, uh, evaluation with the Hemi pH test,
uh, which you know, may or may not be necessary,
or if you need evaluation by gastroenterology. So if you have any questions,
if you would like to, uh,
hear about any other topics or you have any input,
please feel free to, um, contact us at,
uh, our email, which is, uh,
evercare family practice@gmail.com or on our website,
www.evercarefamilypractice.com.
You can call us at (505) 780-8301 or you can
leave, um, a message on Facebook,
on Instagram, YouTube, or on any of the,
um, podcast that this is broadcast on.
And I wanna thank Kathy and Amanda
and Serena and all of the listeners out there from,
uh, California that we've seen on our site.
Thank you for listening and we appreciate, again, any input.
And thank you for, uh, taking time, uh,
to listen to our podcast and, uh, have a good night.