Suggest Treatment For Laryngo-pharyngeal Reflux

Posted on Mon, 4 Aug 2014

Question: Hi, my name is XXXXXXX. In 2006 or 2007 I was diagosed with "REFLUX ESOPHAGITIS" as a result of an Indoscopy given to me by my GASTROENTEROLOGY DR. Prescribed 40 mg Nexium twice daily. When I went back to that "Group" for a follow up, in 2011, initiated by me, i found that my Dr. had since retired, hence, saw another Dr. Who didn't even LOOK in my throat! Because my symptoms were getting worse, THROAT CLEARING, COUGHING MORE & HOARSNESS, I decided to try an ENT in XXXXXXX 2013. who did the procedure inserting little cameras through nostrils to look at my throat & Vocal Chords (due to HOARSENESS), & scheduled me for a Cat Scan. Results, fine, continue with Nexium & scheduled me with a Voice Therapist. My condition continued to worsen, COUGHING MORE THAN EVER, EVEN THROUGH THE NIGHT. Because my intuition tells me I should b seeing a Gastroenterologist, I went back on April 22, 2014, saw a different Dr. & once again, she didn't even look at my throat, and yet her "ASSESSMENT/PLAN, "GERD without esophagitis (530.81) continue with Nexium 40 mg Bid and to take them 1/2 hr before a meal, LARYNGOPHARYNGEAL REFLUX (LPR) (478.79). I've wondered HOW she came up with that Diagnosis, when she didn't even look in my mouth, unless she was useing the previous one, which was a couple yrs prior to THIS visit!! I have, off & on for the past week, felt a lump under my jaw, (could b gland swelling?), so I called the ENT to set up an appt., 6/25/14, I was told he is taking appts. into Sept!! I could b Dead! My fear is, of course, Throat Cancer.. & I feel like if it's caught in time, your chances of survival increase. It's not like I'm imagining, or bugging these Dr's. I've been to GASTROENTEROLOGY DR.'S 3 TIMES IN 7 YRS & an ENT, ONCE! I'm still taking Nexium 40mg. twice daily, before meals. Having said all that, MY QUESTION; WHICH TYPE DR. AM I SUPPOSE TO SEE, & IS THERE SOMETHING I'M SUPPOSE TO BE DOING OTHER THAN EXPLAINING TO THEM WHATS GOING ON WITH ME (REASON FOR THE VISIT.) Should i make an appt. with my Primary PA first, see what she has to say about the swollen lump that kinda comes & goes, (She has recommended Gastroenterology before to me).I appreciate any advise u can give me. Thank You, Rita

Answered by Dr. Dr. Naveen Kumar Nanjasetty (10 days later)

Brief Answer:
First primary physician and then Gastro...

Detailed Answer:
Hi

Thanks for posting the query. I do understand your concern and will try my best to help you with this problem.

1. After going through the detailed query, I too, strongly suspect Laryngo-pharyngeal Reflux (LPR). That will be my primary suspicion. It is more unlikely to be a malignancy.

2. I would rather prefer you to see your primary physician first and let him examine your throat and neck. Depending upon the examination findings, further management can be planned accordingly.

3. In your age, acid reflux is common, due to the lax Lower Esophageal Sphincter (LES). Proton pump inhibitors alone may not suffice in treating your problems. In addition, you will require Prokinetics to increase the gastric emptying and tighten the XXXXXXX

4. Life style modifications are also equally beneficial in reducing your problems. Simple exercises, reduction of stress, consuming plenty of warm water and maintaining hydration (this will also reduce any throat congestion) will alleviate most of your symptoms.

5. Dietary modifications are also extremely important in managing the reflux and can sometimes be effective without other intervention. By this time you would know most of them, but still, I would like to reinforce the same:
Avoid or minimize reflux triggers within the diet:
• Alcohol
• Fried/Fatty Foods
• Spicy Foods
• Tomato-Based Foods
• Citrus food
• Caffeinated Beverages
• Carbonated Beverages

Hope I have answered your query. Please keep me informed about your visit to the primary physician and we can discuss further regarding this.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Prasad