Reflux & Swallowing
ACid REflux
Do you constantly clear your throat? Is there persistent mucus in the throat? What about voice changes or a sense of a lump in the throat? These symptoms may mean you are suffering from a particular form of reflux called laryngopharyngeal reflux or LPR.
TYPES OF REFLUX
Reflux refers to the backflow of acid and enzymes from the stomach towards your throat, as opposed to towards the intestines. A certain amount is normal in adults but the precise extent and frequency of this reflux determines two conditions:
1) The more common gastroesophageal reflux disease (GORD), where excessive reflux enters the oesophagus but travels no further than the upper oesophageal sphincter. People with GORD often experience heartburn or indigestion.
2) Laryngopharyngeal reflux (LPR), where reflux breaches the upper oesophageal sphincter and passes into the throat and voice box. This is sometimes termed ‘silent reflux’ as the backflow itself is frequently not felt and there is typically no heartburn or indigestion.
The internal lining of the pharynx and voice box is extremely sensitive to stomach contents and LPR can quickly cause irritation that can lead to throat discomfort or burning, mucus build up, an irritable cough or voice changes. Often these symptoms are worse during the day, in an upright position, and can follow ingestion of certain foods that trigger an episode of reflux.
TREATMENT
Speech pathologists treat LPR via careful diet and lifestyle modifications. Your doctor may administer acid-supressing medications; however they do not work for everybody and they will not necessarily stop the reflux events from occurring. Treatment can last from 6 weeks to as long as 3 months, as it takes time for the damaged lining to heal whilst acid suppression commences. This normally follows endoscopic visualisation of the larynx by a Laryngologist. Further studies may be ordered by doctors, including oesophageal pH testing, Barium swallow or gastroscopy.
As a further note, there is controversy over the existence of non-acidic reflux, a phenomenon whereby stomach contents that do NOT contain acid travel up from the stomach or oesophagus and into the throat area. This may be difficult to differentially diagnose without proper oesophageal pH testing. Other conditions must also be ruled out, such as Zenkers Diverticulum, oesophageal stricture or dysmotility, and Nutcracker or hypertensive oesophagus. Treatment is not too dissimilar from LPR and centres around diet and lifestyle modifications, as well as potential stomach acid reduction medications.
Swallowing therapy
Does food get stuck on the way down? Do you find yourself coughing during meals? Swallowing difficulty or ‘dysphagia’ can present in a number of ways and range from mild annoyances and embarrassment to serious disability and risk to health. Dysphagia may indicate underlying disease, neurological disturbances and/or normal age-related changes.
Swallow evaluation and treatment may be important if you experience the following:
- drooling of food or saliva
- difficulty chewing or taking a long time to eat
- pooling of food in the oral cavity
- difficulty initiating a swallow
- needing to swallow multiple times to get food down
- pain or discomfort with swallowing
- coughing or choking when eating or drinking
- shortness of breath during meals
- a gurgly or wet voice during meals
- food or fluid coming out of the nose
TREATMENT
Speech pathologists use exercises that directly or indirectly rehabilitate the swallow mechanisms where possible. Strategies can also be implemented that significantly reduce risks associated with dysphagia. If necessary, compensatory adjustments may be advised, such as modifications to food and fluid consistency, as well as rate and method of feeding.
