Laryngopharynx Acid Reflux Disease (LPRD)

A constellation of symptoms and findings caused by reflux (backwards flow) of stomach acid into the throat or larynx, typically during sleep. Laryngopharynx acid reflux disease (LPRD) may be seen with or without the heartburn, acid belching, etc., commonly associated with gastroesophageal reflux disease (GERD). The classic symptoms of LPRD may be exaggerated in the morning and include one or more of the following: dry throat, rawness or scratchy sensation, increased mucus production and attendant throat clearing, husky voice quality or low-pitched morning voice, irritative cough, and, if one is a singer, the need for prolonged warm-up. For appropriate treatment measures, see GERD.

Sometimes acid reflux is diagnosed when it isn’t the real problem. The do-it-yourself trials in this downloadable article can help a person and his or her personal physician verify if acid reflux is the appropriate diagnosis: When Acid Reflux Treatment Takes You Down a Rabbit Trail

1. Originally published in Classical Singer, April 2009. Posted with permission.


Photos:

Acid Reflux

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Open phase of vibration

Acid reflux (1 of 2)

Open phase of vibration, strobe light, with white mucus sometimes but not always suggestive of acid reflux laryngitis.
Closed phase of vibration

Acid reflux (2 of 2)

Closed phase of vibration, strobe light, with same mucus findings.
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Phonation under strobe light

Acid reflux (1 of 2)

Phonation under strobe light. Mild capillary prominence.
Acid Reflux during phonation

Acid reflux (2 of 2)

As phonation proceeds, appearance of large amounts of viscous white mucus.

Acid Reflux Laryngitis

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interarytenoid pachyderma

Acid reflux laryngitis (1 of 2)

Panoramic view, shows interarytenoid pachyderma (“elephant skin”) at upper blue arrow; arytenoid redness at green arrows; and mucus retention cyst at lower blue arrow.
interarytenoid pachyderma

Acid reflux laryngitis (2 of 2)

During phonation, interarytenoid pachyderma and mucus retention cyst are typically obscured.

Acid Reflux and Sicca Syndrome

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Acid reflux (1 of 4)

This man has obvious clinical symptoms of acid reflux such as heartburn, excessive morning mucus, husky morning voice. Note classic interarytenoid pachyderma, diffuse pinkness.

Prominent capillaries and mucus (2 of 4)

Here we see loss of color differential between true and false cords. Capillaries are prominent (like bloodshot eyes) on the true cords. There is also adherent mucus.

Closer view (3 of 4)

Closer view of the prominent capillaries.

Redness and inflammation (4 of 4)

Even the upper trachea shows evidence of redness and inflammation. This is not seen that often except with truly severe nocturnal acid reflux/ LPR.