Laryngopharyngeal reflux (LPR), often referred to as “silent reflux,” is a condition that occurs when stomach acid travels up the oesophagus and reaches the back of the throat and voice box. Unlike classic acid reflux or gastroesophageal reflux disease (GORD), which typically causes heartburn, LPR often presents without any burning sensation at all, making it harder to identify and diagnose.

At London ENT, we frequently see patients with throat symptoms that turn out to be caused by reflux, rather than infection or inflammation. Understanding the signs of LPR and how it differs from common acid reflux is key to getting the right treatment.

How Is LPR Different from Acid Reflux?

While both LPR and GORD involve stomach acid flowing upwards, the key differences lie in the symptoms and the areas affected:

  • GORD primarily affects the lower oesophagus and often causes:
  • Heartburn
  • Chest discomfort
  • Regurgitation
  • A sour taste in the mouth
    • LPR, on the other hand, affects the throat, voice box (larynx), and pharynx, and is more likely to cause:
  • Persistent throat clearing
  • Hoarseness or voice changes
  • A sensation of something stuck in the throat (globus)
  • Chronic cough
  • Sore throat
  • Difficulty swallowing
  • Excess mucus or postnasal drip

Notably, many LPR patients do not experience heartburn, which is why the condition is sometimes missed or mistaken for allergies, sinus problems, or throat infections.

What Causes LPR?

LPR is usually the result of the lower oesophageal sphincter and upper oesophageal sphincter not functioning properly, allowing stomach acid to travel all the way up to the throat and larynx. This area is far more sensitive than the lower oesophagus, and even small amounts of acid can cause significant irritation.

Triggers can include:

  • Eating too late at night
  • High-fat or spicy foods
  • Caffeine and alcohol
  • Carbonated drinks
  • Smoking
  • Stress

How Is LPR Diagnosed?

Diagnosing LPR involves a detailed history and examination. At London ENT, we may recommend:

  • Fibreoptic laryngoscopy to assess irritation of the throat and voice box
  • 24-hour pH monitoring to measure acid levels in the throat and oesophagus
  • LPR symptom questionnaire to evaluate the pattern and severity of symptoms

Because LPR symptoms overlap with many other ENT conditions, it’s important to see a specialist who can differentiate between them.

Treatment Options for LPR

Most cases of LPR can be managed with lifestyle adjustments and medical treatment. Recommendations may include:

  • Dietary changes– avoiding reflux-triggering foods
  • Elevating the head of the bed– to prevent acid movement during sleep
  • Eating smaller meals and not eating late at night
  • Medications, such as:
  • Proton pump inhibitors (PPIs)
  • H2 blockers
  • Alginates to coat the oesophagus and throat
    • Voice therapy– in cases where LPR is affecting vocal performance

Latest medical evidence suggests that it may not be just the stomach acid that is causing the symptoms, but also enzymes present within the stomach liquid, which can be irritative to the lining of the throat and voice box. This is one of the reasons why anti-acid medications are not always effective and further advice or an opinion from a gastroenterologist may also be needed.

In severe or persistent cases, surgical intervention may be considered, especially when medication fails to control symptoms.

When to See an ENT Specialist

If you have ongoing throat symptoms such as hoarseness, chronic cough, or a sensation of something in your throat, and traditional treatments haven’t helped, it may be time to consult an ENT specialist. LPR is often misdiagnosed, but with the right assessment, targeted treatment can provide lasting relief.

At London ENT, our team is experienced in identifying and managing laryngopharyngeal reflux, using the latest diagnostic tools and evidence-based therapies to restore comfort and voice quality.

To book a consultation, call London ENT on 0203 865 7225.