As a relatively short (acute) problem that responds well to treatment and never returns again;
As a long-term (chronic) condition that requires treatment for the rest of your life;
Or, as a long term problem that occurs in short bouts–from several weeks to months–improves with treatment and goes away, and then returns again–even several months to years later (chronic intermittent).
The reason why reflux laryngitis behaves in so many different ways is not well understood.
Key Information: The Heartburn Puzzle
"Why don't I have 'heartburn' if my voice problem is from backflow of stomach acids?"
A Puzzle
For unclear reasons, patients with LPR do not commonly experience heartburn (a burning sensation in the chest that is not due to a heart problem but due to irritation and/or inflammation of the esophagus or esophagitis caused by backflow of stomach fluids into the esophagus or GERD).
This is unexpected especially since acid that affects the voice box must first pass through the esophagus.
Different Reactions to Stomach Fluid
Physicians believe that the esophagus may be better able to resist the effects of stomach fluids (acid and enzymes) than the voice box.
When exposed to the same stomach fluid, the voice box is more sensitive or susceptible than the food pipe.
If only small amounts of stomach acid backflow into both the esophagus and voice box (larynx)–swelling and irritation may occur only in the voice box without affecting the "tougher" more resistant lining cover (mucosa) of the esophagus.
A Different Puzzle
Some patients with reflux laryngitis do experience heartburn (a burning sensation in the chest that is not due to a heart problem but due to irritation and/or inflammation of the esophagus or esophagitis).
Right Action Plan
Therefore, physicians need to perform a full evaluation to determine whether backflow of stomach fluids affects both the voice box and esophagus.
What do patients feel when they have reflux laryngitis?
Swelling and irritation of the voice box caused by stomach fluid backflow into the larynx is associated with a number of common complaints listed below.
Swelling and irritation prevents full closure of the vocal folds in the voice box and prevents normal vibration (For more information, see Anatomy and Physiology of Voice Disorders.)
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"Feeling of Nasal Drip" [post-nasal drip] Note: Reflux laryngitis is not the only cause of "post-nasal drip".
A feeling of mucus dripping down the throat, "nasal drip"
More mucus is produced as a form of "self-protection" by the lining of the throat and voice box exposed to stomach contents
This mucus is commonly thicker and travels down the throat causing the feeling of the "nasal drip"
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Frequent Throat Clearing
Needing to repeatedly clear the throat due to excess mucus production
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Sore Throat
Soreness in the back of the throat from irritation and swelling caused by contact with stomach fluids
Sudden inability to breathe due to closing off of the airway
Instead of vocal folds opening and closing with ease, prolonged closure of the vocal folds may occur as the body reflexly tries to protect the air pipe from the stomach fluids
May sometimes be accompanied by severe throat tightening and coughing
+/- Uncommon
Red Flag
Noisy breathing (stridor) is a sign of obstruction or narrowing of the laryngeal or tracheal parts of the airway.
Stridor is a sign of difficulty passing air.
Any breathing difficulty needs immediate medical attention.
Key Information
Scary but Short-Lived
Sudden difficulty breathing and throat tightness caused by closing off of the airway as a reflex reaction to stomach fluid backflow (laryngospasm) may wake the patient at night.
Although frightening, this type of breathing difficulty is short lived, and normal breathing should resume again soon.
Red Flag
There are other causes of breathing difficulties which may wake the patient at night–such as heart problems. You should contact your doctor immediately.
How do "reflux laryngitis patient complaints" usually begin?
Scene 1
"Slow creep" (gradual): Many patients report that they first notice their complaints from reflux laryngitis slowly, over the course of several weeks or months.
Significant changes: On hindsight, patient complaints often started during one or more of the following events:
change in dietary habits
experienced increased stress levels
change in lifestyle habits
fluctuations in weight
Increased acid and/or pressure: These events are associated with backflow of stomach fluids because they are commonly associated with:
increase in the levels of acid production by the stomach, or
increased backflow pressure on the muscular sphincter between the food pipe and the throat (UES, upper esophageal sphincter), and/or
increased backflow pressure on the muscular sphincter between the food pipe and the stomach (LES, lower esophageal sphincter)
Key clue: Patients often report that the "cold complaints" such as aches and pains may disappear, but a nagging hoarseness, cough, or throat clearing remains.
Key Information
What a Cold Does
The cold did not cause your reflux laryngitis–it added inflammation and swelling to already swollen vocal folds, intensifying symptoms, and bringing the reflux laryngitis to your attention.
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