Silent reflux or Laryngopharyngeal reflux (LPR) is a condition where acid that's created in the stomach travels up the esophagus (swallowing tube) and gets into the throat. This acid then causes inflammation in these areas, which aren't equipped to protect themselves from gastric acid. Natural treatments can help.

What's silent reflux?

What's laryngopharyngeal reflux or silent reflux?

Laryngopharyngeal reflux (LPR) is a condition where acid that's created in the gut travels up the esophagus (swallowing tube) and gets into the throat. Laryngopharyngeal reflux is also known as silent reflux. It is another potential complication that can develop with chronic gastroesophageal reflux disease (GERD), heartburn, or acid reflux. It occurs when the sphincter muscle at the end of the esophagus doesn't operate correctly, and stomach acid backs up into the throat, the larynx, or even your nasal passage. This acid then causes inflammation in these areas, which aren't equipped to protect themselves from gastric acid.

Silent reflux occurs more frequently among babies because their sphincter muscles aren't fully grown. Babies & infants also have a shorter esophagus, and they lie down most of the time. Silent reflux symptoms in adults aren't the same as GERD due to the region of the body the acid is impacting. The acidity is targeting the larynx, in place of the esophagus, which makes the diagnosis more challenging because of the symptoms present as a cough.


See: Acid reflux in the morning remedies

Who gets silent reflux?

Who gets laryngopharyngeal reflux?

Everyone can get LPR, but it happens more frequently as people age. Individuals who are more likely to have LPR include those that are obese stressed, have specific dietary habits, and wear tight clothing.

See: Acid Reflux Foods To Avoid

Silent reflux causes

Laryngopharyngeal reflux causes

LPR is caused by stomach acid that flows up into your throat. When you swallow food that you eat, food passes down your throat and through your esophagus to your stomach. The lower esophageal sphincter is a muscle that controls the opening between the esophagus and the stomach like a valve.

The muscle stays tightly closed except when you consume food. If this muscle fails to close, the acid-containing contents of the stomach can travel back up into the esophagus. This backward movement is known as reflux.

See: Acupuncture treatment for GERD

Silent reflux symptoms

What are the signs of laryngopharyngeal reflux?

When stomach acid flows into the throat and larynx, it can result in long-term irritation and damage to the throat tissue. Silent reflux can scar the voice box and throat in adults. It may also increase the risk for cancer in the region, affect the lungs, and might aggravate conditions like asthma, emphysema, or bronchitis. Since silent reflux symptoms affect the larynx in contrast to the esophagus, like GERD, it's harder to diagnose and might go untreated. A physician can diagnose silent reflux by performing technical tests. The symptoms of LPR are felt in the throat and contain the following:

- Sore throat

An inflamed and painful throat is frequent for LPR. Silent reflux shoots up your stomach and then into your own throat. So it is no surprise that many suffer from sore throat.

- A sensation of a lump in the throat

Many people feel like they have a lump in their throat, or just like something is stuck there. Inflammation causes swelling of your mucus membranes. So when you've got silent reflux, you may really have something such as a lump on your neck, such as a bulge of swollen tissue. The swelling will not be round and big, but enough to give you that feeling.

- The feeling of mucus sticking in the throat and airways

When our mucous membranes are irritated, they often produce more mucus as a defense mechanism. That's the reason silent reflux can cause excessive mucus everywhere in your airways.

- Red, swollen, or irritated larynx (voice box)

Silent reflux can irritate your larynx or voice box lining. All sections of your throat can potentially be at risk of being irritated. The irritation can make your larynx or voice box red in color with the reaction.

- Excessive throat clearing & persistent cough

In the same manner that silent reflux can cause asthma, it may also make you cough. This stems from damages to your lungs. Additionally, silent reflux or LPR strikes the mucous membrane on your airways. This irritation can lead to a cough and throat clearing also. It can be tough for a doctor to tell if a chronic cough is caused by reflux. There are many conditions that may cause a cough. This is the reason quiet refluxers with chronic cough are often not getting the proper diagnosis easily.

- Hoarseness & pain while speaking

It's no surprise that a different name for silent reflux is laryngopharyngeal reflux (LPR). The larynx is very near the esophagus and any possible reflux. At precisely the same time, our voice reacts strongly to some disturbance. So even minor inflammation can result in serious voice difficulties. Laryngitis is a common silent reflux symptom.  Most problems occur when the vocal cords are inflamed, as those are used to speak. 

If the entrance section of the larynx is the only one inflamed, this can cause some pain and trouble when speaking. The voice itself may sound mostly normal. The inflamed larynx interferes with the talking muscles from working correctly. But there are other parts of the throat and airways are part of our voice. Therefore, even when our larynx is healthy, other regions can lead to trouble with speaking. When the area between the nose and mouth (our palate) is inflamed, we may have trouble speaking. It may be more difficult to understand us, or we'll be in pain when talking. The muscles may cause problems and can get stressed from talking. We also use our lungs to speak. They need to deliver adequate airflow to speak correctly. Consequently, if acid strikes the lungs, we could have trouble with our voice also.

- Excessive belching

Many silent refluxers report that they belch a fair amount. However, it's hard to define whether that's a symptom or the cause of LPR. Every time we belch, air comes up and maybe transports pepsins and acids with it. Some belching is ordinary. Just when it becomes too much, it may cause the signs of silent reflux.

A "bulge" in the throat that does not go away with repeated swallowing

- Trouble breathing or Asthma-Like Symptoms

Experts have started to proclaim that many patients that are treated for asthma really have reflux. The symptoms are incredibly similar. It's essential to look at if people have trouble breathing out or in. If breathing out is the tricky part, then that speaks for asthma. Issues while breathing in seems more like a silent reflux symptom.

- Nausea

Some people get the feeling of needing to vomit from quiet reflux. That's simply because your throat gets aroused and can cause a vomit reflex. But it may also come from stomach problems, which may be the leading cause of your reflux.

- A feeling of postnasal drip or surplus throat mucus

Postnasal drip is a fancy word for a runny nose -- just the mucus runs down your throat. It occurs more often than a "normal" runny nose when you have reflux. The back part of your nose is simply closer to the stomach.

- Irritated Mucous Membrane

Silent reflux can irritate your system wherever it goes. So all sections of your throat, nose, and airways can potentially be at risk of being irritated. Some people suffer in their mouths, with a sensation of a burning tongue. Others may suffer from their nose. You may even get ear discomfort from reflux. The ears are attached through the eustachian tube with your nose, and also not immune from the action.

- Difficulty swallowing (Dysphagia)

The inflamed throat can cause swallowing problems or Dysphagia. When you have swelling, this causes your throat to be tighter than it ought to be. So it's harder for food to make it through. Additionally, when the swelling occurs in an unfortunate place, muscles can get hindered from functioning correctly during the swallowing process. 

- Low immunity

If your mucous membranes are inflamed all the time, it hinders your defenses from beating infections. That's the reason silent reflux patients are more affected hit by germs like viruses, bacteria, or fungal infections. Recurring infections of your own ears may also be an LPR symptom.





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Tests to Diagnose for Silent Reflux

Your doctor may use the following tests:

- Esophageal pH (acid) Evaluation - quantify the amount of acid in the throat and esophagus over 24 hours

Upper endoscopy- having a flexible tube to view the throat and vocal cords

- Silent reflux can be handled and handled in similar ways used to manage GERD. Specific lifestyle changes can be made to alleviate these symptoms in addition to some medications which can be used to control gastric acid.

See: GERD Cough Natural Treatment

LPR diet & lifestyle changes for silent reflux

Silent Reflux Diet & Lifestyle Changes 

- Maintain a healthy weight

- Quit smoking

- Avoid alcohol

- Eat at least three hours before bed

- Restrict foods that can trigger acid reflux: mints, fats, citrus fruits, chocolate, carbonated drinks, hot or tomato-based products, red wine, and caffeine

- Elevate the head of the bed around six inches

- Try chewing gum to increase saliva and lactic acid

- Avoid wearing tight-fitting clothes around the waist

If these treatments alone are not effective in relieving silent reflux symptoms, please consult with your physician.


See: Chewing gum advantages, disadvantages, & side effects

References

1. Kahrilas, P. J. (2018, January 31). Complications of gastroesophageal reflux in adults. Up-To-Date https://www.uptodate.com/contents/complications-of-gastroesophageal-reflux-in-adults?search=complications-of-gastroesophageal-reflux-in-adults%EF%BB%BF&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

2. Laryngopharyngeal reflux. (2012, April 16) https://my.clevelandclinic.org/health/diseases/15024-laryngopharyngeal-reflux-lpr

3. Mayo Clinic Staff. (2015, November 18). Infant reflux: Symptoms and causes http://www.mayoclinic.org/diseases-conditions/infant-acid-reflux/symptoms-causes/dxc-20157641

4. Waring, J. P. (2016, February 10). Laryngeal pharyngeal reflux http://www.aboutgerd.org/laryngeal-pharyngeal-reflux.html

5. Worried your sore throat may be strep? (2018, January 31) https://www.cdc.gov/features/strepthroat/index.html

6. Ahuja, V., Yencha, M. W., & Lassen, L. F. (1999, September 1). Head and neck manifestations of gastroesophageal reflux disease. American Family Physician, 60(3), 873-880 http://www.aafp.org/afp/1999/0901/p873.html

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