ENT MANIFESTATIONS OF A REFLUX DISEASE

Symptoms of GERD have been discussed in my previous post like heartburn, dyspepsia, waterbrash and central type of chest pain. Aspiration symptoms appear if GERD is associated with LPR ( laryngopharyngeal reflux). Both the conditions are associated with laxity of lower esophageal sphincter, so gastric ( stomach) secretions enter esophagus and some enter respiratory tract ( nose, nasopharynx, larynx,trachea and bronchus) 

WHAT ARE THE SYMPTOMS OF LPR? 

Patient will have difficulty in swallowing, feeling of a lump in the throat, frequent throat clearing, sore throat,  bad breath, coughing or choking. Breathing may be difficult due to constant  mucus trickling . These are worsened by smoking, alcohol consumption, allergies and GERD. 

WHAT HAPPENS TO THE AFFECTED STRUCTURES? 

The gastric secretions (contain acid and pepsin,) can cause inflammatory changes in the larynx resulting in acidic laryngitis and patient will have voice changes or tiring of voice, and can lead on to swelling, granulations, stricture on the posterior( back)  part of the larynx. Reflux contents can reach nose, nasopharynx and eustachian tube resulting in sinusitis, nasopharyngitis, and fluid in the middle ear( pain or burning sensation  and ear block), aspiration symptoms and infections ( pneumonia especially in immunocompromised) 

COMPLICATIONS

Chronic laryngitis, frequent sore throat, vocal cords edema, ulcer or granulations, worsening of asthma, bronchitis or other respiratory ailments, aspiration pnuemonia and or ear infections. 

HOW TO MANAGE IT? 

Life style  and dietary changes like quit  or decrease alcohol consumption, carbonated drinks, caffeine, fatty  and spicy food and smoking. Weight reduction, frequent small meals, sleeping with head end elevation also can be done. 

Medical management with anti acid and antireflux   medicines. Resistant or complicated cases can be treated with antireflux surgeries. 

LIFE STYLE AND DIETARY CHANGES CAN CONTROL REFLUX TO SOME EXTENT.