Acid reflux, especially the form known as laryngopharyngeal reflux, can wreak havoc on the delicate vocal cords. 

There are several things we know about laryngopharyngeal reflux:

1. It’s on the rise, perhaps due to stress, diet, or some combination of the two.

2. It can burn the vocal cords. Not all reflux reaches the level of the larynx, but LPR does and can cause sore throat, hoarseness, and chronic cough.

3. You may never feel it. Just because you don’t have pain after eating doesn’t mean you don’t have LPR. Some reflux is “silent,“ meaning that it doesn’t cause uncomfortable heartburn.

4. It can lead to severe vocal impairment. The inflammation caused by LPR can cause the vocal cords to swell, giving the speaking voice a raspy quality and lowering the pitch. Singers may experience vocal fatigue and loss of range. Some laryngologist believe that LPR also puts patients at greater risk for nodules, polyps, and other vocal cord disorders.

How LPR is diagnosed:

An otolaryngologist can diagnose LPR by viewing the vocal cords via laryngoscopy. Additional tests (such as a 24-hour pH test) can confirm the diagnosis, if needed.

How LPR is treated:

The standard medical treatment for LPR is:

• a proton pump inhibitor (PPI), like Protonix (available by prescription) or Prilosec (available over the counter), taken in the morning

• antacids (like Tums, Gaviscon) taken after meals

• an H2 antagonist, like Pepcid (available over the counter), taken in the evening

However, lifestyle changes, which can be equally important, include:

• Finishing any meals or snacks 3-4 hours before bedtime

• Avoiding trigger foods (spicy foods, tomato sauces, peppermint, high fat or fried foods, sugar, and - for some people - gluten)

• Avoiding alcohol, tobacco, caffeine, and carbonated beverages (including seltzer)

• Raising the head of the bed 6-8 inches (There are many ways to do this. I use a full length wedge pillow.)

• Avoiding clothing that restricts the waist

• Reducing stress (mindfulness meditation can help)

Recommended reading:

It can be quite daunting to switch to a reflux-friendly diet. My doctor, a leading laryngologist based in Philadelphia, recommends the books of Dr. Jamie Koufman. In her books, Dr. Koufman explains how modern diets contribute to LPR and what we can eat to help us heal. She emphasizes that reflux triggers often vary between individuals, and her tells patients how to discover and avoid their triggers. Both books include recipes. (I own the book that includes gluten-free recipes, as gluten is one of my triggers.)

A word of caution:

When you tell people (including Dr. Google) that you have acid reflux, you will receive a lot of advice about how to treat it. (For example, apple cider vinegar is commonly mentioned as an all-natural remedy.) I strongly recommend that you ignore well-meaning but uninformed anecdotal advice and seek out evidence-based treatment from medical doctors. This is especially important with silent reflux in singers. It is easy to assume that the reflux has gone away and that any vocal problems are due to some other cause. Please do not make assumptions about your vocal health. The best person to give you medical advice on your voice is a fellowship-trained laryngologist. (Read my post on how to find a voice doctor.)

Where to find more information:

• Stanford Medicine’s Voice & Swallowing Center has a concise description of LPR and its treatment.

• Dr. Koufman’s blog includes helpful, up-to-date information about reflux and diet

Disclaimer: This blog post does not constitute medical advice, professional diagnosis, opinion, treatment, or services. It simply provides general information for educational purposes only. This information is not a substitute for medical or professional care, and you should not consider it a substitute for a consultation with a physician or other healthcare provider.