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.