Symptoms include facial pain, headaches, nasal drainage, cough, postnasal drip, bad breath, upper jaw pain, sore throat, sensitive eyes, swelling of the eyelids, general fatigue, and fever. Even after treatment of a sinus infection, inflammation can persist. Chronic sinusitis refers to inflammation of the sinuses that continues for at least a few weeks, but often continues for months or even years. A gastroenterologist may decide to order some additional tests to evaluate your GERD. A Barium swallow is a series of x-ray films that monitor dye as it travels through the stomach.
A variety of findings in the larynx can be nonspecific, such as erythema, edema, swelling, and cobblestoning. These findings can be induced by other conditions, such as postnasal drip, allergies, asthma, voice abuse, and even by repetitive behaviors such as throat clearing. Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat). This can happen to someone even if they are not aware of any heartburn and is sometimes called silent reflux, atypical reflux or laryngopharyngeal reflux. In adults and children, irritating acidic juices may back up from the stomach into the esophagus (swallowing passage) and throat.
Silent acid reflux, like normal gastroesophageal reflux (GERD), occurs when food or acid from the stomach backflows up into the esophagus, causing irritation, coughing, difficulty swallowing and heartburn. Unlike GERD, silent acid reflux usually does not induce heartburn – which is one of the more recognizable symptoms of reflux. Therefore, silent acid reflux can be easily overlooked or misdiagnosed. In some cases, patients with a history of silent acid reflux may believe they have longstanding sinus issues and even take unnecessary or incorrect medications. If not properly treated, silent acid reflux can lead to vocal fatigue or scarring, breathing problems (such as asthma or bronchitis) and, in rare cases, an increased risk of lung, throat or esophageal cancer.
Sometimes, there can be more than one cause that needs to be addressed. Sinusitis occurs when viruses or bacteria infect the sinus cavities, usually due to blockage of the small drainage pathways that lead to the nasal passages. This causes an inflammation of the sinuses, which stops proper drainage.
Laryngopharyngeal Reflux: What Does It Mean?
I have them swallow rather than cough or repetitively clear their throats. I emphasize the importance of fluids, because if their secretions become viscous, it creates a noxious effect. You want to prevent that by having them be well hydrated so the secretions don’t get thick. What do we do with these patients?
Coughing may be provoked by reflux via a number of mechanisms. The regurgitation of gastric contents into the laryngopharynx can cause mechanical or pH-sensitive stimulation, with chronic inflammation leading to the sensitisation of peripheral nerves mediating cough . This may have an acid or nonacid (namely, bile and pepsin) basis. Adhami et al.  demonstrated that bile can injure the laryngeal epithelium but only in an acidic environment, and furthermore, Sasaki et al.  were able to demonstrate histological laryngeal injury in a rat model following bile exposure in neutral environments. Pepsin, the principal proteolytic enzyme of the stomach, is predominantly active in acidic pH and has been shown to cause laryngeal injury in this state ; however proteolytic activity is still present up to pH 7 and can be reactivated .
That is to say, the acid can travel all the way up to your nose and sinuses (for instance, while you are lying down asleep), and this acid can inflame the nose and sinus linings. This problem is more common in children – but it may also be seen in adults. Sometimes, the symptoms of GERD can mimic some of the symptoms of sinusitis. The sensation of post nasal draining and the need to clear your throat constantly may be due to post nasal drip – but may also be due to GERD.
Tell me about medical treatment.
The idea of “silent GERD” causing these symptoms as a “tip of the iceberg” phenomenon is not likely in most patients. In the meantime, treating acid reflux in patients with chronic sinus trouble remains a good idea, experts say, since it may lower symptoms in a subset of patients plagued by both conditions. Acid reflux disease “is probably not the cause of sinusitis, but it may be participating in some cases,” said Dr. Timothy Smith, a professor of otolaryngology and chief of rhinology and sinus surgery at the Medical College of Wisconsin in Milwaukee. Laryngopharyngeal reflux is a condition in which acid that is made in the stomach travels up the esophagus (swallowing tube) and gets to the throat.
A PH monitoring test is a 24-hour test to record the back flow of acid from the stomach into the esophagus and even the throat. A small flexible tube is placed in the stomach through the nose and is connected to a small computer to record 24-hour acid reflux. Endoscopy is sometimes performed to evaluate the esophagus for damage from acid burns and to examine the stomach for irritation and ulceration. Furthermore, we don’t have a validated instrument to define GERD in patients with laryngopharyngeal reflux.
When to see your doctor
Associated symptoms and negative outcomes with this condition include loss of sleep, exhaustion, irritability, urinary incontinence, cough syncope, social disability, and inability to perform daily activities. Many patients experience chronic cough secondary to another medical condition, such as COPD, asthma, rhinosinusitis, Gastroesophageal reflux syndrome (GERD), postnasal drip syndrome (PNDS), or unknown etiology. GERD is thought to be the most common cause of chronic cough in a nonsmoker nonasthmatic individual. A sore throat that doesnâ€™t go away and isnâ€™t accompanied by typical cold symptoms (like a runny nose) may in fact be a symptom of acid reflux.
That’s why it can be difficult to diagnose and why it is sometimes called silent reflux. Over-the-counter medications and home remedies are often successful treatments. People who experience persistent postnasal drip or postnasal drip accompanied by additional symptoms should see their doctor for diagnosis and treatment.
In silent reflux, stomach acid flows back up the esophagus and causes throat problems. A reflux action causes these uncomfortable sensations. Reflux refers to a backward or return flow.
Gastrooesophageal reflux and postnasal drip syndrome account for a significant number of cases of chronic nonproductive cough seen in otolaryngology practice. Each may, alone or in combinationcontribute to cough even when clinically silent, and failure to recognise their contribution may lead to unsuccessful treatment. Many of these patients are notoriously difficult to diagnose and treat but the literature suggests that a systematic and thorough approach in a multidisciplinary setting can lead to successful diagnosis and treatment in the majority of patients.