Chronic throat clearing and silent reflux
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Chronic throat clearing is a symptom of many different conditions ranging from post-nasal drip to chronic sinusitis to acid reflux. Gastric reflux is the back flow of stomach contents and gastric acid up from the stomach into the esophagus, the tube that connects the throat to the stomach. Gastric acid can damage the esophagus and cause irritation. With chronic exposure to stomach acid, sufferers feel symptoms of indigestion and heartburn. These symptoms are from a common disorder known as GERD, or gastroesophageal reflux disease.
Beyond GERD and Up to the Throat
Sometimes, the back flow of stomach acids goes beyond the esophagus, reaching up into the voice box and throat and sometimes even go into the nose and sinuses. As the reflux progresses, there are many associated symptoms, including hoarseness, post-nasal drip, a lump in the throat, pain, shortness of breath, difficulty swallowing, a chronic cough and, the most common, excessive throat clearing.
This syndrome is called laryngopharyngeal reflux or LPR. People who suffer from LPR may not experience heartburn and indigestion because the stomach acid is going higher than the esophagus. Sufferers of LPR may experience a range of symptoms, only a few or many. Because these symptoms can be masked, LPR is often called “silent reflux.”
Diagnosing Silent Reflux/LPR
Since there are many causes of throat clearing, silent reflux may sometimes go undiagnosed. If you experience any of the symptoms, especially throat clearing, see an ear, nose, throat (ENT) doctor. Making a diagnosis of LPR is not painful. Usually, a flexible endoscope is inserted through the nose into the throat, which allows the ENT to see the lining of the throat. The stomach acid causes the irritated lining to become red and sometimes there is evidence of damage. The throat is much more sensitive to stomach acid than the esophagus, so even a small amount of acid may cause irritation and chronic throat clearing.
The most effective way to lessen symptoms and help treat LPR is a modifying the diet. Many foods cause reflux, including citrus, tomatoes, onions, fatty foods and caffeinated foods. Alcohol, particularly red wine, and nicotine also increase symptoms.
Losing weight and easing stress can be helpful, too. The timing of meals is also important. Patients are recommended to avoid eating two to three hours before bedtime to reduce nighttime symptoms.
Some patients may need to take a proton pump inhibitor (PPI), like Nexium, Aciphex, Protonix, a half hour before breakfast every morning. Other patients may be required to take an additional medication like an H2 blocker (Zantac). In some cases, treatment is required for several weeks, and in others, long-term therapy is needed to control symptoms.
As time progresses, with the right, tailored treatment, symptoms may lessen. It is always important to keep your physician up to date on all of your symptoms, so that treatments can be tweaked as necessary. Be especially careful to alert your doctor to all your symptoms and their severity, even if you feel it may not be related. For instance, some LPR cases cause ear pain and nasal congestion.
Information provided by Stacey Silvers, MD, Attending Otalaryngologist (ENT) at Beth Israel Medical Center.