A raspy, breathy voice may be sexy in the movies, but chronic hoarseness, perhaps along with postnasal drip or a dry cough, could signal a problem known as laryngopharyngeal reflux, or LPR. Acid reflux that reaches your throat and larynx, or voice box, can cause inflammation and ulcers known as vocal cord granulomas. Healing these granulomas may require dealing with the reflux itself -- the upward movement of acidic stomach juices that occurs when the anti-reflux valve between the stomach and esophagus is compromised.
Throat ulcers in the area of the vocal cords may result from a number of different factors. Although stomach acid has more distance to travel to reach the larynx, the tissue there is more sensitive to acidic injury. Granulomas commonly appear near or on the back area of the vocal cords closest to the esophageal opening. Doctors diagnose granulomas using a device with a mirror or a thin, flexible viewing tube called a laryngoscope. In a small number of cases, a biopsy may be taken to make sure the involved tissue is not cancerous.
Avoiding Aggravating Factors
Granulomas are thought to reflect the vocal cords' response to injury and chronic inflammation. Acid reflux and vocal stress are two factors commonly associated with laryngeal injury -- and both factors may be in play in the same person. Treatment calls for ending the aggravating factors. Talking loudly over noise all day long and excessive throat clearing are examples vocal stresses that could injure the larynx. Healing may also require reducing the exposure of these sensitive laryngeal tissues to acidic digestive juices. If acid reflux is clearly to blame for your ulcers, your doctor may recommend that you begin acid-suppression therapy.
Acid Suppression and Lifestyle Changes
While there is no single standard treatment for laryngeal granulomas, acid-suppression therapy may be effective when the ulcers are definitely caused by reflux. Drugs called proton pump inhibitors, or PPIs, are often used to reduce the secretion of stomach acid that injures the voice box during episodes of reflux. Common PPIs, available both over the counter and by prescription, are omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid). Reflux affecting the larynx may be more difficult to treat than reflux that only impacts the esophagus, and your doctor may prescribe higher doses and longer-duration therapies than are available over the counter. Your doctor may also encourage you to take steps that are recommended for gastroesophageal reflux disease, or GERD. These might include weight loss or elevating the head of the bed to help acid reflux at night.
Warnings and Precautions
Whether or not you have heartburn, the symptoms of hoarseness, mild pain when talking, trouble swallowing or the sensation of having a lump in your throat are all things that should be discussed with your doctor. Chronic untreated LPR can be just as serious as untreated GERD. Most laryngeal granulomas heal without issue, but complications of LPR include malfunctioning vocal cords and potential obstruction of your airflow, the precancerous esophageal condition called Barrett esophagus and -- in rare cases -- cancer involving the esophagus or larynx.
Medical advisor: Jonathan E. Aviv, M.D., FACS
Is This an Emergency?
- GI Motility Online: Laryngeal and Pharyngeal Complications of Gastroesophageal Reflux Disease
- American Gastroenterological Association Treatment Guidelines: Gastroesophageal Reflux Disease (GERD)
- Merck Manuals Professional Edition: Laryngeal Disorders
- Curbside Consultation in GERD: 49 Clinical Questions; Philip O. Katz