Acid reflux is when stomach acid comes back up the esophagus and possibly up into the throat. The most common symptom associated with reflux is heartburn. On the other hand, many throat and voice problems can also be related to reflux. For example, acid in the throat can cause the sensation of excess throat mucus, need for frequent throat clearing, sensation of a lump in the throat, difficulty swallowing, intermittent hoarseness and chronic nonproductive cough. Interestingly, 50% of patients with throat and voice symptoms related to reflux do not actually have heartburn. Based on your history and exam, we suspect some of your symptoms may be due to the reflux of stomach acid into your throat.
You can do some lifestyle changes that may help reduce the amount of your reflux. One option is to allow two to three hours to pass between eating and then lying down. Eating simulates acid production in your stomach. That acid can more easily move up into your throat if you then lie down. The same reasoning applies to avoiding vigorous exercise immediately after eating.
Another helpful measure is to elevate the head of your bed six inches. In doing so, the stomach acid has to fight gravity in order to reach your throat while you are sleeping. Do not attempt a short cut method of simply using extra pillows underneath your head. Using extra pillows causes bending at your waist which simply puts more pressure on your stomach and makes your reflux problem worse. The safest way of elevating the head of your bed is to get an eight inch by eight inch block of wood from your hardware store. Then drill a two inch deep hole which is wide enough to allow the leg of your bed to fit into it. With the head of your bed elevated, you may initially get the sensation that you will slide out of bed. Most people overcome this sensation in due time.
In addition to these bedtime issues, there are dietary modifications that can help reduce your reflux. Certain substances cause the valve at the top of the stomach to relax and, therefore, increase the chance of reflux. These foods include mints, chocolate, fatty foods, caffeine and alcohol. We are not saying that you have to give up all these products, but realize that they may be aggravating your problem. While acidic foods and spicy foods may irritate your stomach and esophagus, they do not lead to reflux and will not worsen your throat symptoms. Finally, smoking may make the problem worse, which is just one of numerous reasons why you should stop smoking.
In addition to these lifestyle changes, medications that reduce the amount of acid produced by your stomach often help with reflux symptoms. Zantac is one such product and no longer requires a prescription. The non-prescription strength of Zantac is 75 mg, but the required dosage to help with reflux is 150 mg twice a day. Prevacid, Prilosec, Nexium, Protonix and Aciphex are prescription medications that are more effective than Zantac at reducing the amount of acid made by your stomach, especially if taken in the morning before breakfast. Unfortunately, they are expensive, costing over $100 a month.
Even with these lifestyle changes and medications, relief of your symptoms may not happen right away. If you are having no improvement after two months, we may increase your use of Prevacid or similar products to twice a day instead of once a day. If you do get improvement, then trial and error will determine if you need to continue to use the medication every day or else only as needed.
Since it is often difficult to know for certain that acid reflux is contributing to your throat and voice symptoms, we encourage you to pay close attention to your various symptoms and update us on your progress. Please do not hesitate to call us with any questions or problems with the treatment regimen.