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Chronic Cough, Reflux, Postnasal Drip Syndrome, and the Otolaryngologist

It causes significant impairment to quality of life, and can predict serious oesophageal and laryngeal pathology, yet it remains under-treated and under-diagnosed. Surgery QuestionsSurgery is the branch of medicine that employs operations in the treatment of injury or disease.

In the meantime, I’m listening to these people, and what you often hear is that these patients are coughing repetitively or speaking in a gravelly voice, or the tenor of their speech may be more rapid, or the pitch of their speech might be a little squeaky. Ask the patient what their day-to-day job is. Many of these patients spend a lot of time on the telephone or are singers. I had 2 patients who were school teachers and had ongoing voice overutilization. Gastroesophageal reflux disease (GERD), or acid reflux, can cause post-nasal drip.

post nasal drip and gerd symptoms

These findings can be induced by other conditions, such as postnasal drip, allergies, asthma, voice abuse, and by repetitive behaviors such as throat clearing even. The classic symptom of GERD is heartburn. Many people have LPR without any associated heartburn and instead they experience chest pain, hoarseness, difficulty swallowing, excessive mucous, throat clearing, a sensation of a lump in the throat, sore throat, choking spells, wheezing, post-nasal drip, dry cough, or bad breath. A gastroenterologist might decide to order some additional tests to evaluate your GERD.

One of the most common characteristics of chronic rhinitis is post-nasal drip. Post-nasal drip may lead to chronic sore throat, chronic cough, or throat clearing. Post-nasal drip can be caused by excessive or thick mucus secretions or impairment in the normal clearance of mucus from the nose and throat.

Silent reflux, or laryngeal-pharyngeal reflux (LPR), is similar, but without the indigestion and heartburn. Coughing may be provoked by reflux via a number of mechanisms. The regurgitation of gastric contents into the laryngopharynx can cause pH-sensitive or mechanical stimulation, with chronic inflammation leading to the sensitisation of peripheral nerves mediating cough [5].

post nasal drip and gerd symptoms

  • Thanks for listening.
  • You want to prevent that by having them be well hydrated so the secretions don’t get thick.
  • It has been suggested that coughing can also be induced by “micro” or “silent” aspiration, caused by the direct activation of tracheo-bronchial receptors by reflux entering the airway.
  • GERD is worse at night because gravity makes it easier for acid to “backwash” into the esophagus and back of the throat.
  • So, how do I take a GERD history in the patient with suspected laryngopharyngeal reflux disease?

Non-allergic rhinitis with nasal eosinophilia syndrome (NARES) is characterized by a clear nasal discharge. The nasal discharge is found to have eosinophils (allergic cell type), although the patient may not have any other evidence of allergy by skin testing or history or symptoms. Discover what foods are causing your acid reflux.A proven association between certain foods and acid reflux is the key to discovering what causes GORD. show that in patients with nasal obstruction, LPR may have a causative role and that in these patients, comorbid LPR should be investigated for and treated with a PPI as a component of management for nasal obstruction.

Despite this, few studies have objectively examined the effect of treatment of LPR on sinonasal symptoms. Links between sinusitis and reflux become much clearer in cases involving children. In fact, reflux in children “commonly presents as respiratory-type problems,” Matthews said. He explained that in children, the distance between the lower esophagus and the nasal passages is much shorter, so that when reflux occurs it is more likely that acids shall reach the nasal area.

Tips for children

The idea of “silent GERD” causing these symptoms as a “tip of the iceberg” phenomenon is not likely in most patients. We still agree that this can occur, but the train has accelerated to the fast track. Of new patient referrals to otolaryngologists, 1 in 10 receives a diagnosis of laryngopharyngeal reflux disease. It is believed that anything that refluxes into the larynx is attributable to gastroesophageal reflux disease (GERD), but that’s not the case. Certainly when patients are referred to us for a reddened larynx (having been told “you have GERD; go see your gastroenterologist and he or she will make you better”), they come to us, the final end of the road, and we are supposed to cure them.

To start with, there’s a lot of anatomical distance to cover between the two areas. In GERD, reflux splashes into the lower esophagus as it breaches a sphincter separating the esophagus from the upper stomach. But to reach the throat, reflux has to break through another sphincter located at the very top of the esophagus. If you’re a dedicated brusher and flosser but your dentist is still filling cavities, tells you your tooth enamel is eroding, or notices discoloration, acid reflux may be to blame. “Even a small amount of acid reflux making its way up from the esophagus to your throat or mouth while lying down can impact tooth enamel,” says Dr. Dellon.

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