Laryngopharyngeal reflux is nobody’s friend

My last post discussed my own issue with LPR that I faced just last week, so I thought I’d write a little more on the topic since it is such a prevalent problem. 

Many, many singers, and just people in the general population, suffer from this condition.  As a singer, though, I know I was personally very quick to blame my “symptoms” on something else instead of facing up to the fact I have LPR.  The first thing that put me in denial was the fact that I never experienced heartburn (unless I ate greasy Chinese food…but who doesn’t get heartburn in that situation.)  The other more insidious issue is that I suffer from allergies.  I have always had allergies which were no small problem back on the east coast where I grew up.  I always attributed any excess mucus in the morning and/or irritated feeling in my throat to my allergies rather than reflux.  How did I climb out of this area of total denial?  My voice teacher took the time to ask thorough questions that led her to suspect reflux.  While I was still questioning her conclusion, I went through a few up and down vocal days that led me to think she was probably right.

Here’s a pretty generic list of the symptoms of LPR:

• Continual throat clearing
• Chronic throat irritation
• Chronic cough
• Hoarseness
• Excessive phlegm the throat
• Constant sensation of something in the throat
• Post nasal drainage
• Weak voice
• Cracking voice

Now, prior to the talk with my voice teacher, I had seen lists like this before.  I never connected it to reflux, however, because so many of the things on this list match up with the symptom list for allergies, asthma, or any number of other things.  So here’s what solidified the reflux issue for me:  I had very distinct “good” voice days and “bad” voice days.  In fact, singing would feel great for one day and then the very next day I would find myself thinking something like, “What’s going on with my voice today?  Yesterday was great and today feels like complete crap.  I just can’t seem to clear it up!”  Or I would have so much “junk” in there it would take me a couple of hours after waking up to feel like my throat had cleared enough to sing and warming up on those days took at least 30 minutes, which is much longer than it should take.  Also, singing itself would bring on more and more mucus to the point where I would be clearing my throat excessively either after a performance or during lessons.   Although this could have been caused by allergies, my allergies never struck that badly over the course of one day unless I had done some spring cleaning that caused me to inhale a lot of dust the day before.  And I did not have asthma at all.  So the fact that my “bad voice days” would come on so suddenly seemingly without cause and the mucus production was so excessive were a big red flag that something else beyond allergies was going on.

I will admit that the prevalence of reflux for me was MUCH more obvious after I was treated for my paresis, but this up and down pattern was there even before the paresis diagnosis.  The biggest trigger for there being something wrong was the presence of excessive mucus in my throat that got much worse on the days where my voice was burned.  Now, excessive mucus alone is not a diagnostic factor of anything, but vocally speaking, excessive mucus is just a sign that the tissue of the larynx is irritated.  And if you experience excessive mucus during or after singing, it is either a sign that singing on that irritation increased the level of irritation or that the act of excessive voice use is bringing about irritation.  (The later is more common in cases where there is an asymmetry on the vocal folds, usually due to excess pressure being called upon in an attempt to “clarify” the sound.)  So I had a double-whammy of mucosal production on those days when I had some burning from my reflux that made singing on those days a nearly impossible task. 

I did go on Nexium for a while which worked very well, but due to financial constraints I was unable to continue on that.  Since then, I have elevated the head of my bed at least five inches, I don’t eat anything four hours before bed, I monitor my dinners very carefully for anything that might cause reflux, and I take an OTC proton pump inhibitor for a couple of weeks before a singing gig to ensure I don’t have reflux prior to the event.  (Obviously, getting the stomach flu a week before a singing gig didn’t let me stick to this lovely schedule of PPIs I have invented for myself.)

The main take-home message for anyone out there who suspects they, or their student, might be suffering from LPR:  Go to the doctor.  They are the only ones who can really diagnosis this issue and treat it effectively if it is too severe to be controlled by OTC medication.  But truly, anytime there is any sign of excess irritation in the larynx via mucosal production that cannot be explained, a trip to the doctor is warranted, especially if the issue seems to be chronic.