Dear Sir, GERD and hoarseness are related. It seems like your patient had a vocal cord haematoma or a vocal cord nodule due to repeated coughing and constant acid reflux. Hence, surgery was recommended. It may also be possible that she had a groove on her vocal cord called sulcus vocalis which also causes hoarseness and is treated surgically. Sulcus vocalis is also precipitated by acid reflux. The repeated dry coughing without prominent chest symptoms which is very suggestive of a condition called LPRD or Laryngopharyngeal Reflux Disease. In this condition small amounts of acid from the stomach create injury and inflammation around the voice box leading to swelling in the interarytenoid region (posterior portion of the voice box). This is what causes the sticking feeling in the throat and the acid irritation leads to dry cough. It may be possible that due to LPRD and coughing she developed vocal cord nodules or a vocal cord haematoma due to which she was recommended surgery. LPRD is different from GERD or Gastroesophageal Reflux Disease and therefore may not be associated with symptoms of gastritis such as burning chest pain, stomach pain and gas. Management of this condition involves keeping the LPRD under control and allowing the voice box to heal (2-3 weeks). This is a challenge because there is more effort required from the patients in the form of lifestyle changes and little support provided by medications. Antacids and lifestyle changes may need to be followed for 6 months or more for complete cure. Here are some recommended lifestyle modifications 1. Reduce/ avoid spicy and fried food 2. Reducing intake of tea/ coffee/ carbonated drinks 3. Reducing/ stopping smoking and alcohol consumption 4. Reducing stress/ anxiety related to work or family 5. Taking plenty of fluids : 1.8 to 2.5 litres of water per day 6. Maintaining fixed or identical meal timings every day 7. Maintaining fixed or identical sleep timings every day 8. To maintain an upright posture for up to 2 hrs after meals. Avoid lying down immediately after meals. 9. Raise the head end of your bed. Avoid raising the height of the pillow. 10. Voice rest for 48 hrs