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
[email protected]
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.