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Reflux Laryngitis

Updated : May 27, 2024





Background

Reflux laryngitis is characterized by irritation and inflammation of the larynx due to the backflow of stomach acid or stomach contents into the throat and voice box.

It is one of the many manifestations of gastroesophageal reflux disease (GERD), in which stomach acid flows back into the esophagus, leading to various symptoms and potential complications.

Epidemiology

Reflux laryngitis is a relatively common condition, but its exact prevalence can vary. Estimates suggest that it affects approximately 10% to 20% of the population in the United States. It may be underdiagnosed or misdiagnosed, as the symptoms can overlap with other throat and voice-related disorders. Reflux laryngitis can occur at any age but is more commonly seen in adults.

It tends to affect both males and females, but some studies have suggested a slightly higher prevalence in females. The prevalence of reflux laryngitis may vary by geographic region. Dietary habits, lifestyle, and genetic predisposition can influence its occurrence.

Epidemiological trends related to reflux laryngitis may evolve due to changes in lifestyle, dietary habits, and medical management. The prevalence of GERD, which is closely associated with reflux laryngitis, may also influence its epidemiology.

Anatomy

Pathophysiology

Under normal circumstances, the lower esophageal sphincter (LES), serves as a barrier to prevent the stomach’s contents, including stomach acid, from moving back into the esophagus. The esophagus has protective mechanisms, such as mucosal lining and peristaltic contractions, to handle occasional exposure to gastric acid. In individuals with GERD, the LES may weaken or relax abnormally, allowing stomach acid to flow back into the esophagus.

Several factors can contribute to this dysfunction, including obesity, hiatal hernias, smoking, and certain medications. When stomach acid overcomes the weakened LES, it can reach the upper esophagus, the throat, and even the larynx. The larynx, which houses the vocal cords and plays a critical role in speech and breathing, is sensitive to irritants. The larynx may respond to this irritation by trying to protect itself.

This can lead to throat clearing, coughing, and changes in voice quality as the vocal cords become swollen and inflamed. Over time, repeated exposure to stomach acid can lead to chronic inflammation in the larynx and throat. This chronic inflammation can contribute to persistent symptoms and may even lead to more severe conditions, such as vocal cord nodules or polyps.

Etiology

Obesity: Excess body weight, particularly abdominal obesity, can increase intra-abdominal pressure, which can push stomach contents upward and weaken the LES. Obesity is a significant risk factor for GERD and reflux laryngitis.

Smoking: Smoking has been shown to weaken the LES and decrease salivary flow, which can reduce the esophagus’s ability to clear acid. Smokers are at a higher risk of developing GERD and related conditions, including reflux laryngitis.

Anatomical Abnormalities: In rare cases, structural abnormalities in the esophagus or throat may contribute to reflux laryngitis.

Dietary Factors: Certain foods and beverages can relax the LES or increase stomach acid production, making reflux more likely. These include spicy foods, acidic foods and drinks, fatty foods, caffeine, alcohol, and chocolate.

Genetics

Prognostic Factors

Clinical History

Individuals with reflux laryngitis often have a history of gastroesophageal reflux disease (GERD) or frequent heartburn and acid reflux episodes. Past or current use of medications to manage acid reflux, such as proton pump inhibitors (PPIs) or H2 blockers, should be inquired. Changes in the voice, often described as hoarseness, are a common symptom of reflux laryngitis.

Individuals may notice that their voice becomes rough, raspy, or strained. A chronic, dry cough is a frequent complaint of reflux laryngitis. The cough may be persistent and worsen at night. Frequent throat clearing is a reflex response to the irritation in the throat caused by acid reflux.

Some individuals may feel a lump or a “globus” sensation in the throat as if something is stuck. Reflux laryngitis can sometimes lead to difficulty swallowing or a sensation of food getting stuck in the throat. The onset of reflux laryngitis can be gradual or sudden, depending on individual factors and the underlying cause of GERD.

Physical Examination

One of the most common physical findings is hoarseness or changes in the quality of the voice. The voice may sound rough, raspy, or strained. The patient may exhibit signs of persistent throat irritation, including a reddened or irritated throat lining. This can contribute to a sore throat or discomfort. Postnasal drip, characterized by excess mucus draining from the nasal passages into the throat, may be visible during the examination.

Frequent throat clearing or a persistent dry cough may be elicited during the examination as a reflex response to the throat’s irritation. In some cases, the provider may identify vocal cord nodules or polyps, which can develop as a result of chronic irritation and inflammation. These growths can affect voice quality and may require further evaluation.

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Allergic Rhinitis

Chronic Sinusitis

Gastroesophageal Reflux Disease

Infectious Laryngitis

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Lifestyle Modifications

  • Dietary Changes: Avoiding trigger foods and beverages, such as spicy foods, acidic foods and drinks, fatty foods, caffeine, alcohol, and chocolate, can reduce reflux episodes.
  • Weight Management: If you are overweight or obese, losing weight can reduce abdominal pressure and lessen the severity of GERD symptoms.
  • Smoking Cessation: Quitting smoking is crucial, as smoking can weaken the lower esophageal sphincter (LES) and contribute to reflux.

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

A surgical procedure called fundoplication may be considered in severe cases of GERD that do not respond to other treatments. It involves wrapping the top of the stomach around the lower esophagus to strengthen the LES and prevent acid reflux.

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

Reflux Laryngitis

Updated : May 27, 2024




Reflux laryngitis is characterized by irritation and inflammation of the larynx due to the backflow of stomach acid or stomach contents into the throat and voice box.

It is one of the many manifestations of gastroesophageal reflux disease (GERD), in which stomach acid flows back into the esophagus, leading to various symptoms and potential complications.

Reflux laryngitis is a relatively common condition, but its exact prevalence can vary. Estimates suggest that it affects approximately 10% to 20% of the population in the United States. It may be underdiagnosed or misdiagnosed, as the symptoms can overlap with other throat and voice-related disorders. Reflux laryngitis can occur at any age but is more commonly seen in adults.

It tends to affect both males and females, but some studies have suggested a slightly higher prevalence in females. The prevalence of reflux laryngitis may vary by geographic region. Dietary habits, lifestyle, and genetic predisposition can influence its occurrence.

Epidemiological trends related to reflux laryngitis may evolve due to changes in lifestyle, dietary habits, and medical management. The prevalence of GERD, which is closely associated with reflux laryngitis, may also influence its epidemiology.

Under normal circumstances, the lower esophageal sphincter (LES), serves as a barrier to prevent the stomach’s contents, including stomach acid, from moving back into the esophagus. The esophagus has protective mechanisms, such as mucosal lining and peristaltic contractions, to handle occasional exposure to gastric acid. In individuals with GERD, the LES may weaken or relax abnormally, allowing stomach acid to flow back into the esophagus.

Several factors can contribute to this dysfunction, including obesity, hiatal hernias, smoking, and certain medications. When stomach acid overcomes the weakened LES, it can reach the upper esophagus, the throat, and even the larynx. The larynx, which houses the vocal cords and plays a critical role in speech and breathing, is sensitive to irritants. The larynx may respond to this irritation by trying to protect itself.

This can lead to throat clearing, coughing, and changes in voice quality as the vocal cords become swollen and inflamed. Over time, repeated exposure to stomach acid can lead to chronic inflammation in the larynx and throat. This chronic inflammation can contribute to persistent symptoms and may even lead to more severe conditions, such as vocal cord nodules or polyps.

Obesity: Excess body weight, particularly abdominal obesity, can increase intra-abdominal pressure, which can push stomach contents upward and weaken the LES. Obesity is a significant risk factor for GERD and reflux laryngitis.

Smoking: Smoking has been shown to weaken the LES and decrease salivary flow, which can reduce the esophagus’s ability to clear acid. Smokers are at a higher risk of developing GERD and related conditions, including reflux laryngitis.

Anatomical Abnormalities: In rare cases, structural abnormalities in the esophagus or throat may contribute to reflux laryngitis.

Dietary Factors: Certain foods and beverages can relax the LES or increase stomach acid production, making reflux more likely. These include spicy foods, acidic foods and drinks, fatty foods, caffeine, alcohol, and chocolate.

Individuals with reflux laryngitis often have a history of gastroesophageal reflux disease (GERD) or frequent heartburn and acid reflux episodes. Past or current use of medications to manage acid reflux, such as proton pump inhibitors (PPIs) or H2 blockers, should be inquired. Changes in the voice, often described as hoarseness, are a common symptom of reflux laryngitis.

Individuals may notice that their voice becomes rough, raspy, or strained. A chronic, dry cough is a frequent complaint of reflux laryngitis. The cough may be persistent and worsen at night. Frequent throat clearing is a reflex response to the irritation in the throat caused by acid reflux.

Some individuals may feel a lump or a “globus” sensation in the throat as if something is stuck. Reflux laryngitis can sometimes lead to difficulty swallowing or a sensation of food getting stuck in the throat. The onset of reflux laryngitis can be gradual or sudden, depending on individual factors and the underlying cause of GERD.

One of the most common physical findings is hoarseness or changes in the quality of the voice. The voice may sound rough, raspy, or strained. The patient may exhibit signs of persistent throat irritation, including a reddened or irritated throat lining. This can contribute to a sore throat or discomfort. Postnasal drip, characterized by excess mucus draining from the nasal passages into the throat, may be visible during the examination.

Frequent throat clearing or a persistent dry cough may be elicited during the examination as a reflex response to the throat’s irritation. In some cases, the provider may identify vocal cord nodules or polyps, which can develop as a result of chronic irritation and inflammation. These growths can affect voice quality and may require further evaluation.

Allergic Rhinitis

Chronic Sinusitis

Gastroesophageal Reflux Disease

Infectious Laryngitis

Lifestyle Modifications

  • Dietary Changes: Avoiding trigger foods and beverages, such as spicy foods, acidic foods and drinks, fatty foods, caffeine, alcohol, and chocolate, can reduce reflux episodes.
  • Weight Management: If you are overweight or obese, losing weight can reduce abdominal pressure and lessen the severity of GERD symptoms.
  • Smoking Cessation: Quitting smoking is crucial, as smoking can weaken the lower esophageal sphincter (LES) and contribute to reflux.

A surgical procedure called fundoplication may be considered in severe cases of GERD that do not respond to other treatments. It involves wrapping the top of the stomach around the lower esophagus to strengthen the LES and prevent acid reflux.