Colleen Reisz, MD September 21, 2025
Understanding Laryngopharyngeal Reflux (LPR)
Laryngopharyngeal reflux (LPR) is a condition in which stomach acid flows back up into the throat (pharynx) and voice box (larynx), irritating the lining of these areas. Often referred to as “silent reflux,” LPR differs from the more commonly known gastroesophageal reflux disease (GERD) because it frequently occurs without the hallmark symptom of heartburn.
Causes and Mechanism
LPR occurs when the upper esophageal sphincter (UES), a ring of muscle that separates the esophagus from the throat, fails to function properly. This allows acid and digestive enzymes from the stomach to travel upward into the throat and voice box, where the tissues are much more sensitive to acid than the lining of the esophagus.
Symptoms of LPR
Symptoms of LPR can be subtle and are often mistaken for other conditions. Common signs include:
- Chronic cough
- Hoarseness or voice changes
- Sensation of a lump in the throat
- Frequent throat clearing
- Sore throat
- Difficulty swallowing
- Excess mucus or postnasal drip
Unlike GERD, patients with LPR may not experience heartburn, making diagnosis more challenging.
Diagnosis
Diagnosing LPR usually involves a combination of a physical examination, symptom assessment, and sometimes diagnostic tests such as:
- Laryngoscopy – to visualize inflammation in the throat and voice box
- pH monitoring – to detect acid in the upper airway
- Esophageal manometry – to assess muscle function in the esophagus
Treatment and Management
Treatment of LPR focuses on lifestyle changes and, when necessary, medication. Common strategies include:
- Dietary changes: Avoiding acidic, spicy and fatty foods; limiting caffeine and alcohol
- Lifestyle modifications: Eating smaller meals, not eating before bedtime, elevating the head of the bed
- Medications: Proton pump inhibitors (PPIs), H2 blockers or antacids
In severe or persistent cases, surgery may be considered, but this is rare.
Conclusion
Laryngopharyngeal reflux is a frequently overlooked condition that can significantly affect quality of life, especially in individuals who rely on their voice professionally. Early recognition and proper management are key to preventing long-term damage to the throat and vocal cords. If symptoms persist or worsen, it’s important to consult a healthcare provider, ideally an ENT (ear, nose and throat) specialist.
