Ear, Nose, Throat, & Allergy

What is Silent Reflux?

Silent reflux, also known as laryngopharyngeal reflux (LPR), is a type of acid reflux that does not produce heartburn or indigestion. Often overlooked and misdiagnosed, silent reflux produces a variety of bothersome throat symptoms not associated with traditional reflux.

Silent reflux is characterized by the backflow of stomach acid into the esophagus/lower throat (laryngopharynx). Under normal circumstances, swallowed food travels down the esophagus (food pipe) towards the stomach. Between the stomach and esophagus is a small muscle which opens and closes, allowing food to pass. For patients with acid reflux, this muscle opens at inappropriate times, causing acid to “back up” into the esophagus and upper throat.

Common complaints of silent reflux include hoarseness, chronic cough, throat clearing, postnasal drip, sore or burning throat, acidic taste in mouth, or difficulty swallowing. Various risk factors can worsen symptoms. Some of which include eating spicy/acidic foods, not hydrating well, and eating meals right before bedtime.

Silent reflux can be diagnosed via a routine visit with an Ears, Nose, & Throat physician (otolaryngologist). To evaluate throat complaints, a quick and painless in-office procedure called a fiberoptic laryngoscopy is performed. This involves the physician guiding a thin, flexible tube with a light and camera attached to it into the nasal passages and down the back of the throat to visualize the upper airway. Patients with silent reflux may also be recommended to follow up with a gastroenterologist. Gastroenterologists can better evaluate the esophagus with an upper endoscopy, or EGD.

Acid reflux can be treated with both lifestyle modifications and reflux inhibiting medications. Symptoms that are mild and intermittent can be treated with; avoiding spicy/acidic foods, avoiding meals before bedtime, limiting exercise immediately after eating, sleeping with head elevated, and eating moderate amounts of food during one sitting. If symptoms are more persistent, reflux medications can be considered. Reflux medications are broken into two major classes, Proton pump inhibitors (Prilosec) and H2 antagonists (Zantac). Both are proven to be safe and effective ways in managing silent reflux.

If you or family members have concerns regarding silent reflux, please do not hesitate to contact Colden and Seymour Ears, Nose, Throat, and Allergy to set up and appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. They are not intended as medical advice and cannot substitute for the advice of your personal physician.