From the Guidelines
Laryngopharyngeal reflux (LPR) symptoms include chronic throat clearing, persistent cough, hoarseness, sensation of a lump in the throat (globus pharyngeus), excessive throat mucus, difficulty swallowing, and a bitter taste in the mouth. These symptoms are based on the latest evidence from the clinical practice guideline on hoarseness (dysphonia) update 1.
Key Symptoms of LPR
- Chronic throat clearing
- Persistent cough
- Hoarseness
- Sensation of a lump in the throat (globus pharyngeus)
- Excessive throat mucus
- Difficulty swallowing
- Bitter taste in the mouth
- Postnasal drip
- Voice fatigue
- Throat pain
- Breathing difficulties, particularly at night
According to the guideline, the diagnosis of LPR is often made based on symptoms and laryngoscopic examination showing redness and swelling of throat tissues, though pH monitoring may be used in some cases to confirm acid exposure 1. The guideline also notes that antireflux treatment is more likely to reduce dysphonia in patients with a diagnosis of GERD, but the evidence for antireflux therapy in patients with LPR symptoms alone is limited and inconclusive 1.
Important Considerations
- LPR often doesn't cause heartburn because stomach acid affects the throat directly
- Morning symptoms are typically worse as acid can reflux during sleep when lying flat
- Some patients report worsening symptoms after consuming acidic foods, alcohol, caffeine, or spicy meals
- The upper esophageal sphincter fails to prevent stomach acid from reaching the throat and larynx, causing inflammation and irritation of these sensitive tissues 1
From the Research
Symptoms of Laryngopharyngeal Reflux (LPR)
- Throat clearing 2, 3, 4, 5, 6
- Hoarseness 2, 3, 4, 5, 6
- Pain 2, 3, 4, 5, 6
- Globus sensation 2, 3, 4, 5, 6
- Cough 2, 3, 4, 5, 6
- Excess mucus production in the throat 2, 3, 4, 5, 6
- Dysphonia 2, 3, 4, 5, 6
- Laryngeal irritation symptoms such as throat clearing, coughing, and hoarseness 6
Diagnosis and Treatment
- Laryngoscopy and pH monitoring are currently used diagnostic methods, but their reliability is controversial 6
- A therapeutic trial with proton pump inhibitors (PPIs) is suggested to be cost-effective and useful for the diagnosis of LPR 6
- Empirical therapy with PPIs is widely accepted as a diagnostic test and for the treatment of LPR 6
- Dietary modifications, H2-antagonists, alginates, and fundoplication are other possible LPR treatments 5
- Objective reflux testing, such as pH testing with/without impedance, should be considered if empiric treatment is unsuccessful 5