The stomach naturally produces acid to digest food. Sometimes this acid flows upwards into the esophagus. When this occurs frequently, it is called Gastroesophageal Reflux Disease (GERD), which commonly causes heartburn and indigestion.
Acid can also make its way through the esophagus and into the throat, over the voice box, and into the back of the nose. This is called Laryngopharyngeal Reflux (LPR), or “silent reflux”, and often occurs WITHOUT heartburn or indigestion, making it difficult to diagnose. It is difficult to tell when LPR is causing symptoms, which may include:
- Hoarseness, especially in the morning
- Chronic throat clearing or persistent cough
- Chronic sore throat
- A feeling of something caught in the throat or foreign body sensation
- Excess mucous /post nasal drip
- Difficulty swallowing
- Restless sleep
- Nasal obstruction
- Chronic sinusitis
- Pneumonia that recurs frequently
- Chronic tonsillitis
- Bad Breath
How serious is reflux? While a small amount of reflux is normal, excessive amounts can lead to:
- Vocal cord nodules
- Chronic sinusitis requiring surgery
- Asthma requiring inhalers
- Laryngeal granulomas
- Cancer of the esophagus, larynx, and upper airway
In the past, we would make an educated “guess” that you might have reflux. We would recommend dietary precautions and medications like Nexium /Protonix/Prilosec for several months to see if there was any positive effect. While this approach would be effective occasionally, it also exposed patients to the recently identified side effects of these medications. It also was difficult to distinguish between a patient that had severe reflux that would never respond to medications versus the patient with no reflux but severe throat symptoms due to another cause.
Finally, we have a highly accurate test that can distinguish between patients who have reflux from patients that don’t. We started using the Restec pH probe in our office in May, 2017. The Restech pH probe is placed into the back of the nose (not the throat) for 18-24 hours. This is gently placed in our office by our medical assistants and removed in our office the next day. Placement of the probe is a two-minute procedure and removal is similarly quick and easy. Remarkably, having the probe in place is not uncomfortable and doesn’t cause any issues with swallowing or talking. The probe does not induce gagging even in patients with the worst gag reflexes.
Once we have identified the presence of reflux, we can treat you. Most of the time, LPR can be managed with lifestyle changes as the probe allows us to identify your reflux triggers. We can also identify patients that will never get better with medications and would benefit from a general surgery procedure to restrict acid from entering the esophagus. We would refer this patient to a general surgeon who specializes in this type of surgery.
Restec ph probe testing is simple, comfortable, and accurate. It is almost always covered by insurance.