PAGE 02/11 Ei'1T 02/11/2010 10:52 7084500005 Centllry Head In ti e and Throat k Surgery ella, M.D. M.D. er, M.D. • M .D. tiO-0007 \(l.fI(}f)5 L ARYNGOPH ana Wt at is Reflu x? Wh en we e at something the aches the stomach by traveling down a mu 5cular tube called the esoph 3g uS On f od reaches the stomach, the stomach adcls acid and pepsin (a digesti 'te en ) so that the food can be digested. Th e e sc phagus has two sphincters (band ' mu fibers th at close off the tube) that help keE p the contents of the stoma(;h wt One sphincter is at the top of the esc phagus (at the junction with the u r ' ) and one is at the bottom of the esc phagus (at the junction with th e The term REFLUX means "a backward or return flow," and it usually ref ers t th ..vard flow of stomach contents up thrc lugh the sphincters and ,nto th e e 0 u or th roat. Wh at is GERD and what is LP Some people have an ab norr I I .. I ' f reflux of stomach acid up through the low sphincter and into the eso ph a referred to as GERD or Ga: ,troesophageal Reflux Disea se. I I makes it all the way up through the Upf:er sphincter and into the ba( k of IS ca ll ed LPRD or Laryngopharyngeal Ref ux Disease. The structures in th arynx, larynx, and lungs) are much mOl e sensitive to stomach acid imd d zymes, so smaller amounts of reflux into this area can result in more dam. Wh' , don't I have heartb um or stom c lems? , This is a question that is often ask y patients with LPRD. The fact is that very few patients with LPRD experier'ce SI nJ r nt heartburn. Heartburn occurs when the tisslle in the esophagus becomes irrit d of the reflux events that can damage the hroat happen wi thout the pa tie nt vcr kno ;ing that they are occurring. Con ,mon Symptoms of LPRD: o Hoarseness o Chronic (ongoing) Cough o Frequent Throat Clearing o Pain or Sensation in Thro at o Feeling of Lump in Throat o Problems while Swallowin 9 o Bad/bitter taste in mouth ( espec all In m rning) o Asthma-like symptoms o Referred ear pain o Post-nasal Drip o Singing: Difficulty with higll not Dial! nosis of LPRD: The 'allowing signs seen by the t ng indicators of LPRO.
e and Throat k Surgery ella, M.D. l~ M.D. er, M.D . • M.D.
tiO-0007 \(l.fI(}f)5
LARYNGOPH ana Recom.,.~e~n~~~~-.or.~~~~~i"i-::'i~
Wt at is Reflux? When we eat something the aches the stomach by traveling down a
mu 5cular tube ca lled the esoph 3guS On f od reaches the stomach, the stomach adcls acid and pepsin (a digesti'te en ) so that the food can be digested. The esc phagus has two sphincters (band ' mu cl ~ fibers that close off the tube) that help keE p the contents of the stoma(;h wt ~long. One sphincter is at the top of the esc phagus (at the junction with the u r ' ) and one is at the bottom of the esc phagus (at the junction with the The term REFLUX means "a backward or return flow," and it usually ref ers t th ..vard flow of stomach contents up thrc lugh the sphincters and ,nto the e 0 u or throat.
Wh at is GERD and what is LP ~D? Some people have an ab norr
I I
.. I
' f reflux of stomach acid up through the low ~r sphincter and into the esopha referred to as GERD or Ga: ,troesophageal Reflux Disea se. I I makes it all the way up through the Upf:er sphincter and into the ba( k of IS called LPRD or Laryngopharyngeal Ref ux Disease. The structures in th arynx, larynx, and lungs) are much mOl e sensitive to stomach acid imd d "vO>\lV~ zymes, so smaller amounts of reflux into this area can result in more dam.
Wh' , don't I have heartbum or stom c lems? , This is a question that is often ask y patients with LPRD. The fact is that very
few patients with LPRD experier 'ce SI nJ r nt heartburn. Heartburn occurs when the tisslle in the esophagus becomes irrit d of the reflux events that can damage the hroat happen without the pa tient vcr kno ;ing that they are occurring.
Con ,mon Symptoms of LPRD: o Hoarseness o Chronic (ongoing) Cough o Frequent Throat Clearing o Pain or Sensation in Thro at o Feeling of Lump in Throat o Problems while Swallowin 9 o Bad/bitter taste in mouth (espec all In m rning) o Asthma-like symptoms o Referred ear pain o Post-nasal Drip o Singing: Difficulty with higll not
Dial! nosis of LPRD: The 'allowing signs seen by the ~ Ihys t ng indicators of LPRO.
1. Red, irritated arytenoid:: (str he back of the vocal folds). 2. Red, irritated larynx. 3. Sma'll laryngeal ulcers. 4, Swelling of the vocal folds . 5. Granulomas in the laryr lx. 6. Evidence of hiatal herni:! (m ot be associated with reflux). 7. Significant laryngeal pa' :holo vpe.
Ollfln itive diagnostic testing for L The 24-hour Pharyngo-I: sop monitoring is the gold standard for
m mitoring reflux events assoc iated it L r. A small tube is passed throu~h the nc se into the esophagus in ore er to m r e amount and type of reflux dUring a tYI ,ical day. One of the bigges': adva tag I hat It allows the testing of the patient's sy 3tem while performing his/he r dal ro tine. In LPRD patients, it is important that the u~ per channel is placed at the level l f e laryngeal (voice box) Inlet.
Tr ~atm9nt for LPRD: 1, Stress: Take significant step. uc stress! Make time in your schedule to
do activities that lower y)ur s I vel. Even moderate stress can dramatically increase the amount of 1'eflux.
2. Foods: You should pay clos . n ohow your system reacts to various foods. Each person will disC'" oods cause an increase in reflux. The following foods have benn sho se reflux in many people. It may be necessary to avoid or m niml:z: the following foods.
a. Spicy, acic ic ar sed foods like Mexican or Italian food. b. Acidic fruit juic orange juice, grapefru it juice, cranberry
juice, etc. c. Fast foods and toods.
nee, tea, soft drinks) and chocolate.d. Caffeinatel t be e. Peppermin t.
3. Mealtime: a. Don\t gorgu YOUi el 1m .altime . . b. Eat sensib y (me ra ounts of food). c. Eat meals ~evel I h urs efore bedtime. d. Avoid bedt me s c s e. Don't exercise I m di el after eating.
4. Body Weight: Try to rna intain ~ h alth body weight. Being overweight can dramatically increase refux.
5. Nighttime Reflux: If the 24·h I H m nrroring demonstrates nocturnal reflux, elevate the head of your bed ..a I h Jith books, bricks, or a block of wood to achieve a 10 degree sla/lt. D n e body up with extra pillows. This may increase reflux by kinkinu th acent studies have shown that reflux occurs much more often duri 9 '''len 'upright. Therefore, this suggestion may be much less impor :ant lieved.
6. Tight ~Iothlng: Avoid ti~ ht L ~r restrictive clothing. ',7. Smoking: If you smoke, STC natically causes reflux and many other
evils to your body!
Me :iications for LPRD: 1. Take one dose (as recommel
a abel) at meals and at bedtime of an
over-the-counter antacid suet aviscon, or Mylanta. Turns has the added benefit of containi,lg c'
2. Medications such as H2 t lock pcid, Tagamet, Zantac) and proton pump inhibitors (Prilosec Pre Protonix, or Nexium) may be prescribed or recommended ciano
