Microsoft word - ent laryngitis and sore throats from acid reflux.doc


As many as 30% of people have a hiatal hernia or malfunctioning lower esophageal sphincter (LES). The
LES is a muscular valve between the stomach and the esophagus which keeps acidic stomach contents
from refluxing (going backwards) up the esophagus. When a person with acid reflux reclines for sleep,
acid may travel up to the level of the throat and come into contact with the pharynx and larynx. Because
acid reflux occurs during sleep, the person may be unaware that this is happening. Persons with acid
reflux may experience symptoms which are direct, indirect, or both.
Acid belching
Scratchy, raw, dry or irritated throat, often worse in the morning and improving throughout the day
Excessive morning mucus
Throat clearing
Chronic irritative cough
Husky, or low pitched morning voice often requiring prolonged singing voice warm-up
TREATMENT MEASURES (Do all of these):
Avoid caffeine, alcohol, spicy foods, mint, citrus, carbonated beverages, vinegar-based salad dressings
and chocolate, particularly after 2:00 p.m. These substances may increase stomach acidity and/or may
make the LES function poorly.
Eat the last meal/snack of the day no fewer than three hours before going to sleep. In addition, try to eat
the heavier meal of the day at noon and a lighter one in the evening. The idea here is that the stomach be
relatively empty when one lies down so that there is not a lot of “back pressure” to push stomach contents
up the esophagus and into the throat, and also that the stomach has returned to baseline acidity before
Use four to six inch bed blocks under the head posts of the bed. Old books or wooden blocks work well
for this purpose. This procedure puts the entire bed on a slight downward slant from head to foot. During
sleep, gravity now assists in keeping stomach acid where it belongs. Some persons prefer instead to
sleep with a large foam wedge under the entire upper body. These wedges are available from medical
equipment supply stores.
Use one of the following medical regimens. They, from strongest to weakest:
Prilosec or Prevacid, taken one hour before dinner.
Zantac, Pepcid, Axid, or Tagamet. Double the does if an over-the-counter preparation is used. Take one
hour before bed.
Antacids such as Gaviscon, taken at bedtime.
(Occasionally, various combinations of 2, 3 and 4 are also utilized.)
It is recommended that a trial of the above measures be continued for a minimum of two weeks and that
none of the treatments outlined be omitted. If you have further questions, do not hesitate to call your
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