Reflux in the Throat


A patient goes to the doctor. The doctor says, "you're fat". The patient says, "I want a second opinion". The doctor says, "OK, you're ugly, too." The old joke has a point. Just because you have one ailment does not mean you can't have another going on at the same time.

We often see patients with complaints of sore throat, the frequent need to clear their throat, and chronic cough. Many have allergies. The allergic rhinitis (literally, inflammation of the nose) causes excess mucus to be produced in the nose. Gravity drains the mucus down the throat, where it irritates cough receptors, and the coughing starts. Constantly clearing your throat is not only bothersome, it also worsens your sore throat. Delicate muscles designed to swallow are not built to clear mucus all day long, so you can literally "pull a muscle" in your throat. Treatment of the allergy usually helps, but doesn't always improve things 100 percent.

Why not? Many people also have some reflux of stomach acid going on. Maybe it's just a teeny, tiny bit of acid, not even enough to cause symptoms of heartburn. Even so, if the acid reaches up to the throat, the exact same symptoms can occur: sore throat, too much mucus in the throat, a continual need to clear the throat, and cough, cough, cough. Believe it or not, treating Laryngo-Pharygeal Reflux (LPR) is more difficult than treating Gastroesophageal Reflux Disease (GERD). Those acid blocking medicines, like Nexium, Prevacid and Aciphex, do a great job at relieving GERD when taken once a day, with or without meals.

Frequently, though, they need to be taken twice a day to work for LPR, and often only work if taken 60 minutes before meals. Why is that? I guess that a moderate degree of acid reduction makes your esophagus feel better; it lives next door to the stomach and is built for heavy duty use. But your throat is very delicate, and can tolerate only a very small amount of acid before crying out for help. Also, Nexium makes your heartburn feel better within a few days, but twice daily Nexium can take months of regular use before LPR symptoms of constant throat clearing, cough, and sore throat improve. 

Here are some tips from the American Academy of Otolaryngology's website on reducing reflux:

  • Avoid eating and drinking within two to three hours prior to bedtime
  • Do not drink alcohol
  • Eat small meals and slowly
  • Limit problem foods:
    • Caffeine
    • Carbonated drinks
    • Chocolate
    • Peppermint
    • Tomato and citrus foods
    • Fatty and fried foods
  • Lose weight
  • Quit smoking
  • Wear loose clothing

Table Courtesy of American Academy of Otolaryngology – Head and Neck Surgery

Note: Information contained in this article should not be considered a substitute for consultation with a board-certified allergist to address individual medical needs.

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