Q: My wife is sick of me clearing my throat. This post-nasal drip is just annoying beyond belief. I’ve tried sinus medicines and been prescribed nasal sprays, all to no avail. I also feel like I’m swallowing past a lump, I’ve lost my high notes when I sing, and the drainage makes my throat sore in the morning. Help.
A: It’s not post-nasal drip! What you have is epidemic of over-indulgence late at night. It’s called laryngopharyngeal reflux. Acids from your stomach are travelling all the way up into your throat. Your throat gets burned, the irritated mucosa secretes mucous in response, and the thick mucous in your throat feels exactly like something draining from above. 40% of people with this problem have no heartburn, so it can be hard to diagnose. In addition, treatment requires a more aggressive regimen than plain gastroesophageal reflux. We used to call this problem “globus hystericus”. Yep, we thought that it was all in your head. Turns out it’s not.
Q: Reflux?!? How can that be? I don’t taste acid, I don’t get heartburn very often, and I’ve always had an “iron stomach.”
A: Join the crowd. Laryngopharyngeal reflux, LPR, is more and more common as we eat more, eat later, and eat reflux-inducing foods. Acids coming up cause more than just the sense of mucous hanging in the throat. The circular muscle at the top of the esophagus, the upper esophageal sphincter, will involuntarily tighten, or constrict, to protect the voicebox, the larynx. Since swallowing involves this muscle relaxing, if it is tight because of reflux, it feels like you are swallowing past a lump. Irritation causes vocal cord swelling. Swollen vocal cords can’t hit high notes. The morning sore throats are because of the acids.
Often, I’ll find that there has been a recent change in schedule of a throat clearing patient. Work has been going later than normal, or the kids have gone from T-Ball to Little League. Either way, they’re eating later than normal and going to bed soon after. This exacerbates reflux.