Most people associate acid reflux with the uncomfortable sensation of heartburn. Now more than ever doctors and their patients are beginning to recognize and treat excess stomach acid as the cause of other common medical problems that most wouldn’t realize are even related. Acid reflux has been associated in recent years with a range of ear, nose, and throat (ENT) conditions ranging from chronic sore throat/hoarseness to halitosis (bad breath) to throat cancer.
Acid reflux occurs when the acid produced in the stomach moves upward into the esophagus due to a weakened valve that normally prevents its passage. In some people the acid moves so far up the digestive tract that it also comes into contact with the lining of the respiratory tract and other structures in the throat. The acid makes direct contact with the tissue causing a chemical burn leading to a variety of medical conditions which can be treated by otolaryngologists (ENT physicians).
The role acid plays in ENT disorders now accounts for up to 10% of the patients seen in and ENT practice. The spectrum of disease is commonly termed laryngopharyngeal reflux (LPR) or supra-esophageal reflux disease. LPR is best treated by an ENT doctor and requires slightly different management than problems associated with acid-related heartburn.
Patients with disorders related to LPR require special monitoring by an ENT as they are more likely to have problems if they ever need to be intubated (a tube placed in the throat to provide mechanical breathing). The most common acid causing condition to be treated by an ENT include the frustrating and elusive condition of Globus – the feeling of having something stuck in your throat. Globus seems to respond to acid lowering medications.
Your ENT most likely will want to examine your upper airway with a laryngoscope to look for evidence of a chemical burn from the acid or if the acid has caused any other structural damage that may be explained by the acid. Your ENT may also perform specialized testing that allows measurement of the amount of acid produced in the stomach as well as a special probe which can determine if acid is actually refluxing into the throat. Newer less invasive devices are now being used which allow these tests to performed with much greater comfort to the patient.
Your ENT may want to start treatment for LPR with a powerful acid lowering medication called a proton pump inhibitor (PPI). These medications are very effective and newer more powerful formulations are coming to market. Additionally some of the older forms of these medications are being offered over the counter providing cheaper and effective alternatives for relief of symptoms.
There are also several more complementary therapies patients can pursue which will lower the risk and damage from acid to their throat. Decreasing the amount of alcohol consumption and tobacco will lower the amount of acid exposed to the upper airway. Also weight loss, smaller meal size, and elevating the head of the bed have been shown to reduce the degree of LPR. Finally, your ENT physician will have communication with your primary care physician, as well as a gastroenterologist or speech therapist if necessary, as studies have shown a team approach to LPR provides the greatest risk reduction for symptoms over all.
At last, those nagging and often unexplained throat problems have both a cause and treatment!