Laryngitis, reflux

Inflammation of the voice box (the larynx) caused by stomach acid backing up into the esophagus.

Reflux laryngitis is associated with chronic hoarseness and symptoms of esophageal irritation such as heartburn.

Reflux is caused by a weakness in the muscle at the junction of the esophagus (food tube) and the stomach.

Normally, this sphincter muscle opens to allow food to go down to the stomach and closes to keep the stomach's contents from coming back up.

The backward movement of stomach contents up into the esophagus is gastroesophageal reflux.

The refluxed stomach acid irritates the lining of the esophagus, larynx and throat.

This can lead to erosion of the lining of the esophagus (erosive esophagitis), narrowing of the esophagus (stricture), chronic hoarseness, chronic throat clearing, difficulty swallowing, cough, spasms of the vocal cords and growths on the vocal cords (granulomas).

Reflux also increases the risk of cancer of the esophagus and larynx.</P> Heartburn is the most common symptom of reflux.

Other symptoms include non-cardiac chest pain, chronic hoarseness, asthma, or the feeling of a foreign body in the throat (the globus phenomenon).

Treatment includes: > >Antacids neutralize stomach acid and give immediate relief.

Popular choices include sodium bicarbonate (Alka Seltzer), calcium carbonate (Tums, Rolaids, Alka-Mints), and aluminum and magnesium antacids (Maalox, Mylanta, Riopan, Gavisconl), all best used 30-60 minutes after each meal and at bedtime.

>Try to have your largest meal of the day at noon.

>Give the stomach several hours to empty before you go to bed.

Try not to eat after your evening meal.

>Avoid spicy or fried foods, peppermint, citrus, tomatoes, onions, and chocolate, especially if these foods increase symptoms.

>Try eating a diet that is high-protein, high-carbohydrate, and low-fat.

>Avoid lying down after you eat.

It is often helpful to elevate the head of your bed with wooden blocks under the bedposts to allow gravity to keep the acid in the stomach.

Pillows under the head are of negligible benefit.

>Avoid alcohol, caffeinated beverages, and tobacco.

>Weight loss, if indicated.

>Avoid drugs such as nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, etc.), theophylline (in tea, too), anticholinergics, and calcium channel blockers.</LI></UL> Medications available over the counter or by prescription for reflux also include the acid-blocking drugs (Pepcid, Tagamet, Axid, Zantac), now available without a prescription.

Other valuable medications include Propulsid or Reglan which help empty the stomach; the proton pump inhibitors such as Prilosec and Pevacid; and Carafate to increase the resistance of the lining tissue of the stomach to acid.</P> If conservative therapy fails, a surgical procedure (fundoplication) is done to strengthen the muscle valve (lower esophageal sphincter).