Voice and reflux
Acid Reflux and My Voice: My Experience with LPR
A persistent cough, throat clearing and voice changes can sometimes be linked with laryngopharyngeal reflux, even when there is no obvious heartburn.
Just before I was due to go on holiday, I developed a bad sore throat and a dry cough. I expected it to settle within a week or so, but it kept hanging around.
While I was away, I did what many people do on holiday. I ate out more often, had richer meals, drank more alcohol than usual and generally relaxed my normal routine. I enjoyed the break, but the cough stayed with me.
At first, I thought it was simply the end of an infection. But over the next two weeks, the cough did not improve. It came and went with no clear pattern. I also found myself clearing my throat often, even when I did not feel particularly unwell.
By the time I returned home, the cough was still there.
After around five weeks of persistent coughing and throat clearing, I decided to see an Ear, Nose and Throat specialist. I wondered whether post-nasal drip might be causing the irritation. Instead, the ENT identified signs of laryngopharyngeal reflux, often shortened to LPR.
What Is Laryngopharyngeal Reflux?
Laryngopharyngeal reflux is a type of reflux that can affect the throat and voice box.
Many people associate reflux with heartburn. That burning feeling in the chest is commonly linked with gastro-oesophageal reflux disease, or GORD. LPR can be different. Some people with LPR do not experience obvious heartburn at all, which is why it is sometimes called silent reflux.
With LPR, stomach contents can travel back up towards the throat and larynx, or voice box. The lining of the voice box is sensitive, so even small amounts of irritation may contribute to symptoms such as coughing, throat clearing, hoarseness or a sensation of a lump in the throat.
That is one reason LPR can be confusing. It may feel like a throat problem rather than a stomach problem.
How LPR Affected My Voice and Throat
During the examination, the ENT looked at my larynx using an endoscope, a small camera used to view the throat and voice box.
The examination showed swelling around the vocal folds and increased muscle tension. These findings, together with my symptoms, were consistent with LPR.
When I thought back over the holiday, a few things made more sense. My voice had been changing towards the evening. I was waking with a sore throat. I was coughing and clearing my throat regularly. But I had not been getting heartburn, so reflux had not been the first thing I suspected.
The ENT explained that the original infection may have triggered the cough, but reflux was likely helping to keep the irritation going. Rich food, later meals and alcohol during the holiday may also have contributed.
Common Symptoms of LPR
LPR symptoms can vary from person to person. They may include:
- a persistent dry cough
- frequent throat clearing
- a dry or irritated throat
- a sour, bitter or unpleasant taste in the mouth
- a feeling of a lump in the throat
- difficulty swallowing
- hoarseness or changes in voice quality
- voice fatigue, especially later in the day
- a sore throat on waking
These symptoms can also be caused by other conditions, so it is important not to self-diagnose. If symptoms persist, worsen or keep returning, it is worth speaking with your GP. They may refer you to an ENT specialist for further assessment.
Why LPR Can Be Missed
LPR can be missed because it does not always behave like typical reflux.
You may not feel burning in your chest. You may not notice indigestion. Instead, the main signs may be throat clearing, coughing, voice changes or a feeling that something is stuck in the throat.
Those symptoms can overlap with allergies, post-nasal drip, infection, asthma, medication side effects and other throat or voice conditions. That is why assessment matters.
An ENT specialist can examine the larynx and help identify whether reflux, vocal fold changes or another issue may be contributing.
Treatment and Recovery
My treatment involved medication prescribed by the specialist, along with changes to diet and lifestyle. I also began voice therapy.
At first, I was inconsistent with the medication because work was busy. Unsurprisingly, my symptoms did not improve much. Once I followed the treatment plan more consistently, made changes to reduce reflux triggers and worked on my voice use, the cough and throat clearing gradually settled.
Over time, my voice returned to normal. I was then able to reduce and eventually stop the medication under medical guidance.
Everyone's situation is different. Some people improve with lifestyle changes and medication. Others may need a combination of medical treatment, dietary changes and voice therapy. More severe or persistent cases may require further investigation or specialist management.
How a Speech Pathologist Can Help
Medication may reduce reflux irritation, but it does not always address the voice and throat habits that develop around it.
When someone has been coughing, throat clearing or pushing their voice for weeks, the muscles around the throat and larynx can become tense. The voice may remain effortful even after the original irritation starts to improve.
A speech pathologist with experience in voice disorders can help by:
- identifying voice habits that may be adding strain
- providing strategies to reduce throat clearing
- supporting healthier voice use
- helping manage vocal fatigue
- advising on practical voice care
- working alongside your GP or ENT where appropriate
Voice therapy does not replace medical treatment for reflux. But for some people, it can be an important part of recovery, especially when voice changes, throat clearing or cough have become persistent.
When to Seek Medical Advice
You should seek medical advice if you have persistent throat clearing, coughing, hoarseness, swallowing difficulty or a sensation of a lump in the throat.
It is especially important to be assessed if symptoms last more than a few weeks, are getting worse, or are associated with pain, unexplained weight loss, coughing up blood, breathing difficulty, a neck lump or significant swallowing problems.
Persistent symptoms should be checked because they can have several possible causes. Reflux is one possibility, but it is not the only one.
Getting Help for Reflux-Related Voice Problems
If you are experiencing ongoing throat clearing, cough, hoarseness or voice changes, a good first step is to speak with your GP. If LPR or another voice-related condition is suspected, they may refer you to an ENT specialist.
Nikki Martin Speech Pathology works with adults experiencing voice, swallowing and breathing difficulties, including voice symptoms that may occur alongside reflux.
If you have questions about voice changes, persistent throat clearing or reflux-related voice symptoms, you can contact Nikki Martin Speech Pathology or call 0410 777 034 to discuss an appointment.
Clinical review required before publication. This article provides general information only and is not a substitute for individual medical advice, diagnosis or treatment.
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