When Acid Reflux Travels to Your Throat

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Under some circumstances, heartburn can create throat ulcers.
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Acid reflux is a common condition that afflicts up to 20 percent of adults, according to the National Library of Medicine. Its hallmark is the discomfort known as heartburn — the pain you feel as stomach acids creep back up into your esophagus, often causing a burning sensation.

If this happens a lot, you may have gastroesophageal reflux disease (GERD). But if those acids travel farther north and reach the back of your throat and larynx (your voice box), you're likely dealing with laryngopharyngeal reflux (LPR), says Cleveland Clinic. LPR can leave you with a sore throat, plus a raspy voice, dry cough and more. Here's how to handle it.

Read more: The Do's and Don'ts of Eating With GERD

What Is a Throat Ulcer?

Areas of irritation in the lining of your larynx and pharynx (the area that connects your mouth and nose to your larynx) can start as throat ulcers, just as irritation from acid can lead to similar sores in your stomach. However, if they aren't caught and treated, they can develop into masses called granulomas, according to the University of Pittsburgh otolaryngology department. These are small- to medium-sized growths that occur on the vocal cords or arytenoid cartilage (translation: flaps just above the vocal cords).

While overusing your voice can cause these growths, another trigger is the LPR type of acid reflux, says Jesse P. Houghton, MD, senior medical director of gastroenterology at the Southern Ohio Medical Center in Portsmouth.

Granulomas are a sign of chronic irritation. As Dr. Houghton explains, they're often diagnosed during a procedure called a laryngoscopy, during which a very small, thin tube with a camera is passed into the nose and guided toward the back of the throat, where the vocal cords are located.

What Does It Feel Like?

Interestingly, you may not even feel these growths as they're developing, but the symptoms of vocal cord granulomas are similar to the symptoms of LPR itself — think chronic cough, hoarseness, frequent clearing of the throat and the potential to have difficulty speaking or singing, known as voice fatigue, says Dr. Houghton. And there's one differentiation that has yet to be determined: "We don't know for sure whether it is the granulomas causing these symptoms or the LPR itself," he says.

Treating Throat Granulomas

If LPR rather than overusing your voice is the root cause, it's important to treat the LPR, which can be done with medication, says Dr. Houghton. Specifically, proton pump inhibitors (PPIs), which can be over-the-counter or by prescription, such as esomeprazole (Nexium), omeprazole (Prilosec), lansoprazole (Prevacid), pantoprazole (Protonix) and omeprazole/sodium bicarbonate (Zegerid), generally work well for those who suffer from LPR as well as those with GERD.

However, treatment needs to be a bit more intensive for LPR, requiring twice daily PPI for several months to be successful, he notes. These drugs do have side effects, so be sure to discuss them with your doctor.

It may also be helpful to streamline your diet and sleep with your head elevated — both common treatments for GERD. Start by eliminating acid-causing foods from your plate, like highly spicy, fried or fatty dishes, citrus and caffeine, suggests the Mayo Clinic.

What Else Should I Know?

Also still left to be determined is who develops LPR as opposed to the more common GERD and whether LPR is a result or a furthering of a case of reflux itself.

"In some specific and objective tests for acid reflux, LPR patients don't always show that acid is in fact entering the upper esophagus," says Dr. Houghton. He also notes that the vagus nerve, which plays a critical role in the involuntary nervous system and is the longest in the body, may be behind LPR.

Likewise, it's not always clear why some people with LPR develop granulomas and others don't. "It may be due to an exaggerated inflammatory response or related to genetics," he notes.

Read more: The 10 Worst Foods for Acid Reflux

Is This an Emergency?

To reduce the risk of spreading COVID-19 infections, it is best to call your doctor before leaving the house if you are experiencing a high fever, shortness of breath or another, more serious symptom.
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