Laryngopharyngeal reflux (LPR) is a common condition affecting many patients who seek attention in the Ear, Nose and Throat Doctors office. Frequently, the symptoms are nothing more than frequent throat clearing, the sense of extra phlegm in the throat, cough, hoarseness and even occasionally sore throat.
The condition is caused primarily by the backward flow of stomach contents up into the esophagus, even as high as the throat. The tissue of the throat is particularly sensitive to this since it is not constructed to withstand the rigors of acid exposure. Recent studies have shown that it is not only the acid but also the digestive enzymes that are present in stomach juice that cause the damage.
The diagnosis of LPR is made the usual way most medical conditions are diagnosed. A careful history is taken, a detailed physical examination is performed, often including a visualization of the structures of the larynx (voice box) sometimes using a scope or sometimes using a mirror. Frequently, a trial of diet and lifestyle modifications or prescription medicine therapy are initiated.
If there are complicating factors or if initial therapy is unsuccessful, 24 hour pH probe testing is the diagnostic test of choice. We have recently begun 24 hour pH probe testing in this office. A probe is placed through the nose into the esophagus and positioned in such a way as to measure pH at two locations in the esophagus. The patient is sent home with the probe taped in place and connected to a data collecting pack. 24 hours later the patient returns to the office, the probe is removed and the data is downloaded into our computer. Using the software we have available, we can analyze the pH pattern at two locations in the esophagus and determine whether significant acid reflux is really happening or not.
Many other medical conditions are influenced by LPR including obstructive sleep apnea, asthma and other forms of chronic lung disease. Hopefully, the ability to diagnose LPR and the associated problems it causes will enhance the quality of our patients lives.