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Suggest Treatment For Laryngopharyngeal Reflux
Question: I have LPR (silent reflux)
I was last seen by my ENT two weeks ago Monday. He used an endoscope to look at my throat. By that time I had been on the Dr. K dropping acid diet about 3 or 4 days and was already feeling a little better. He indicated that my voice box was slightly red, but that I was quite swollen (he said I was a 3+ on a scale of 1 to 4).
Generally speaking, how long can it generally take on a good diet, taking meds, and not eating before bed for the hoarsness to clear-up? Is there any rule of thumb or general guideline? I am committed to getting better, but exhausted by alwaysd being hoarse.
BTW, the hoarsenss started in Dec. I had an upper GI (because I was feelign full and bloated a lot) and was told I has a touch of gastritis and "moderate" reflux. My PPI was increased but I did not make the lifestyle changes I needed. THEN, in Feb/March I had multiple sinus infections and finally a viral bronchities which ended about three weeks ago. The hoarsness got much worse after that.
Sorry for all the questions....this is an issue that involves multiple systems and I know is hard to get at.
I was last seen by my ENT two weeks ago Monday. He used an endoscope to look at my throat. By that time I had been on the Dr. K dropping acid diet about 3 or 4 days and was already feeling a little better. He indicated that my voice box was slightly red, but that I was quite swollen (he said I was a 3+ on a scale of 1 to 4).
Generally speaking, how long can it generally take on a good diet, taking meds, and not eating before bed for the hoarsness to clear-up? Is there any rule of thumb or general guideline? I am committed to getting better, but exhausted by alwaysd being hoarse.
BTW, the hoarsenss started in Dec. I had an upper GI (because I was feelign full and bloated a lot) and was told I has a touch of gastritis and "moderate" reflux. My PPI was increased but I did not make the lifestyle changes I needed. THEN, in Feb/March I had multiple sinus infections and finally a viral bronchities which ended about three weeks ago. The hoarsness got much worse after that.
Sorry for all the questions....this is an issue that involves multiple systems and I know is hard to get at.
Brief Answer:
about 2 weeks..
Detailed Answer:
Hello,
If there is no other cause creating reflux or irritation : then the irritation , redness , hoarsness etc changes in throat gets cleared up in 2 weeks. Since it is more than 2 weeks now, I would suggest you discuss the following two aspects with the treating doctor.
1. I would add anti reflux medicine (prokinetic) like domperidone in addition to proton pump inhibitor. Domperidone is very important as will not allow the food to go up the food pipe from stomach by tightening the lower sphincter between food pipe and stomach.
2. secondly , since you had history of sinus infection in the recent past, the possibility of infected mucus from the nose trickling at the back of nose in the throat needs to be excluded. So when such cause of irritation is present then taking PPI will not solve the problem. You need to take medicines for sinus disease like antibiotic course, then antihistaminics and nasal steroid sprays etc . You get an ENT consultation for that.
And in addition when there are sinus problems then the person does snore in night and snoring itself creates a negative pressure in the food pipe causing more of reflux.
Discuss about my views with the treating doctor.
I hope have answered the query in doubt do reply.
about 2 weeks..
Detailed Answer:
Hello,
If there is no other cause creating reflux or irritation : then the irritation , redness , hoarsness etc changes in throat gets cleared up in 2 weeks. Since it is more than 2 weeks now, I would suggest you discuss the following two aspects with the treating doctor.
1. I would add anti reflux medicine (prokinetic) like domperidone in addition to proton pump inhibitor. Domperidone is very important as will not allow the food to go up the food pipe from stomach by tightening the lower sphincter between food pipe and stomach.
2. secondly , since you had history of sinus infection in the recent past, the possibility of infected mucus from the nose trickling at the back of nose in the throat needs to be excluded. So when such cause of irritation is present then taking PPI will not solve the problem. You need to take medicines for sinus disease like antibiotic course, then antihistaminics and nasal steroid sprays etc . You get an ENT consultation for that.
And in addition when there are sinus problems then the person does snore in night and snoring itself creates a negative pressure in the food pipe causing more of reflux.
Discuss about my views with the treating doctor.
I hope have answered the query in doubt do reply.
Above answer was peer-reviewed by :
Dr. Prasad
Thank you for your response.
Just to be clear, I did take multiple rounds of antibiotics to clear up the sinus infection and everything seemed to be fine in my sinsuses during the last endoscope I had (almost two weeks ago).
I do have a GI apt on Monday so I will bring up the issue of domperidone. For situations like this, how long would I generally need to be on this medication?
Just to be clear, I did take multiple rounds of antibiotics to clear up the sinus infection and everything seemed to be fine in my sinsuses during the last endoscope I had (almost two weeks ago).
I do have a GI apt on Monday so I will bring up the issue of domperidone. For situations like this, how long would I generally need to be on this medication?
Brief Answer:
take antihistaminics also
Detailed Answer:
Hello again,
It is good that you have completed your antibiotic course , but are you taking antihistaminics , decongestants and , steroid and saline nasal sprays ?
Steroid nasal sprays are very important for those having allergic disease and they do not have systemic absorption or absorption in the body so can be used safely.
Saline nasal sprays are important as they give a wash inside the nose and do not allow dust and discharge to accumulate and so does clean the mucus which otherwise would have got infected and trickled down the throat.
As i said before if your nasal problem settle down then recovery will be faster .
The use of anti reflux medicines should be used at least for 1 month , in addition to life style modification like----
Keep head end of bed elevated.
Avoid alcohol, Smoking
Do brisk walking daily
Go for walk after dinner
Avoid spicy food
Avoid meat
Avoid late night coffee
etc.
Further you should see that the vegetables you buy are clean .
I have i have made my point clear.
In doubt do reply.
Regards
take antihistaminics also
Detailed Answer:
Hello again,
It is good that you have completed your antibiotic course , but are you taking antihistaminics , decongestants and , steroid and saline nasal sprays ?
Steroid nasal sprays are very important for those having allergic disease and they do not have systemic absorption or absorption in the body so can be used safely.
Saline nasal sprays are important as they give a wash inside the nose and do not allow dust and discharge to accumulate and so does clean the mucus which otherwise would have got infected and trickled down the throat.
As i said before if your nasal problem settle down then recovery will be faster .
The use of anti reflux medicines should be used at least for 1 month , in addition to life style modification like----
Keep head end of bed elevated.
Avoid alcohol, Smoking
Do brisk walking daily
Go for walk after dinner
Avoid spicy food
Avoid meat
Avoid late night coffee
etc.
Further you should see that the vegetables you buy are clean .
I have i have made my point clear.
In doubt do reply.
Regards
Above answer was peer-reviewed by :
Dr. Yogesh D
I am doign all of those lifestyle changes. I am also using a netti pot flush 1 to 2 times per day, BUT I am not using a nasal steroid spray or using any antihistamines. My nose seems pretty clear, so i stopped the nasal spray. Maybe I should start back up. I do not thnk I have allergies as I have been tested for them. I have been warned a bit by using benedryl because it might make me too dry. It can also loosen up the XXXXXXX above my stomach which can lead to more reflux. So, I am confused.
If am pretty sure that I do not have allergies, will a steroid spray still be helpful?
If am pretty sure that I do not have allergies, will a steroid spray still be helpful?
Brief Answer:
steroid nasal sprays are suggested
Detailed Answer:
Hello,
Benedryl is not recommended. Plain Loratidine or fexofenadine is good enough.
In addition if phenylepherine (decongestant tablet) if available in your area should be used.
Decongestant will decrease the congestion (or increased blood flow in nose ) and would cause decrease in mucus production .
Steroid nasal sprays are anti inflammatory nasal sprays and decrease the congestion and mucus production whether allergic or not.
I would suggest that you use steroid nasal sprays for few months like 2-3 months , as they are safe and as you still have throat problem (grade 3 problem as told by your doctor, mentioned by you previously).
At least for the time being your throat problem settles sprays can be used.
Secondly i do not prefer to advice for netti pot.It is better to use saline nasal sprays .Netti pot took origin in india and now followed world wide . But it is not easy for every one to do it properly . What happens is the water goes waste and does not reach to the area in nose where it is supposed to reach. Saline nasal Sprays are a good option as the jet will help in maintaining cleanliness in nose.
If any further query please to ask,
Regards
steroid nasal sprays are suggested
Detailed Answer:
Hello,
Benedryl is not recommended. Plain Loratidine or fexofenadine is good enough.
In addition if phenylepherine (decongestant tablet) if available in your area should be used.
Decongestant will decrease the congestion (or increased blood flow in nose ) and would cause decrease in mucus production .
Steroid nasal sprays are anti inflammatory nasal sprays and decrease the congestion and mucus production whether allergic or not.
I would suggest that you use steroid nasal sprays for few months like 2-3 months , as they are safe and as you still have throat problem (grade 3 problem as told by your doctor, mentioned by you previously).
At least for the time being your throat problem settles sprays can be used.
Secondly i do not prefer to advice for netti pot.It is better to use saline nasal sprays .Netti pot took origin in india and now followed world wide . But it is not easy for every one to do it properly . What happens is the water goes waste and does not reach to the area in nose where it is supposed to reach. Saline nasal Sprays are a good option as the jet will help in maintaining cleanliness in nose.
If any further query please to ask,
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
As to the netti pot, I use the squeeze bottle style and squeeze gently. I sniff slightly so I get some saline in my throat.
Is that the correct method?
As to steroid sprays I have been advised that improper use can irritate the vocal cords. Any thoughts on that?
Otherwise, I like your advise.
Two other questions....I am using flo nase as the nasal spray. One puff in each side twice a day. Is this your advice?
Also, what can I do to help reduce inflammation as get my voice back sooner? I avoid ibuprofen as it is not recommended if I have reflux.
Lastly, my mouth is dry a lot...especially at night. Sometimes I know I sleep with mouth open but my nose is clear. Mouth is very dry when I wake up.
Is that the correct method?
As to steroid sprays I have been advised that improper use can irritate the vocal cords. Any thoughts on that?
Otherwise, I like your advise.
Two other questions....I am using flo nase as the nasal spray. One puff in each side twice a day. Is this your advice?
Also, what can I do to help reduce inflammation as get my voice back sooner? I avoid ibuprofen as it is not recommended if I have reflux.
Lastly, my mouth is dry a lot...especially at night. Sometimes I know I sleep with mouth open but my nose is clear. Mouth is very dry when I wake up.
Brief Answer:
flonase is to be used
Detailed Answer:
Hello,
Yes the squeeze method for the saline wash is good enough.
Flonase is good nasal spray , yes i was writing for that spray.
steroid nasal sprays would not irritate the cords , they act at the nose . The way to use them is bend forward and then spray inside the nose.and do not try to inhale it.
Ibuprofen should be avoided. In place of anti inflammtory like ibuprofen you could use anti inflammatory enzymes like trypsin , chymotrypsin or serratiopeptidase. They will not cause harm to the cords instead would help in decreasing the inflammation and will give a faster recovery.
You could also use acetyl cystine which comes in brand name of mucinac or mucotab .
Do you snore in night , dry mouth could be because of that.and vocal cords will obviously get affected if the dry air (not conditioned in the nose ie not humidified in nose ) enters in the throat.
You could try to sleep in lateral position and not straight . In addition make the head end of bed elevated. These things will help to decrease the snoring, and would increase nasal breathing.
I hope to have answered and hope my suggestions would help.
In doubt do reply.
flonase is to be used
Detailed Answer:
Hello,
Yes the squeeze method for the saline wash is good enough.
Flonase is good nasal spray , yes i was writing for that spray.
steroid nasal sprays would not irritate the cords , they act at the nose . The way to use them is bend forward and then spray inside the nose.and do not try to inhale it.
Ibuprofen should be avoided. In place of anti inflammtory like ibuprofen you could use anti inflammatory enzymes like trypsin , chymotrypsin or serratiopeptidase. They will not cause harm to the cords instead would help in decreasing the inflammation and will give a faster recovery.
You could also use acetyl cystine which comes in brand name of mucinac or mucotab .
Do you snore in night , dry mouth could be because of that.and vocal cords will obviously get affected if the dry air (not conditioned in the nose ie not humidified in nose ) enters in the throat.
You could try to sleep in lateral position and not straight . In addition make the head end of bed elevated. These things will help to decrease the snoring, and would increase nasal breathing.
I hope to have answered and hope my suggestions would help.
In doubt do reply.
Above answer was peer-reviewed by :
Dr. Raju A.T
Hello Doctor
That was very fascinating. I have never heard of enzymes used in that fashion. I have been avoiding any ibuprofen. However, it is a product that works well for me when I have a fever. Long term it will be hard to avoid.
I don't snore and my bead is elevated by about 4 inches. I probably could raise it higher.
I have been drinking turmeric root tea. About a cup or two a day. I sometimes add honey and slippery elm.
What are your thoughts on this tea?
I will look into those enzymes. Any side affects of my ingestion if I take them?
That was very fascinating. I have never heard of enzymes used in that fashion. I have been avoiding any ibuprofen. However, it is a product that works well for me when I have a fever. Long term it will be hard to avoid.
I don't snore and my bead is elevated by about 4 inches. I probably could raise it higher.
I have been drinking turmeric root tea. About a cup or two a day. I sometimes add honey and slippery elm.
What are your thoughts on this tea?
I will look into those enzymes. Any side affects of my ingestion if I take them?
Brief Answer:
Avoid long term use of ibuprofen
Detailed Answer:
Hello,
The medicines i wrote earlier must be easily available at your place.
There are no side effects of the anti inflammatory enzymes.
I usually avoid ibuprofen as it causes more of stomach problems and should not be used for long time as these medicines are toxic to kidneys " when used for long time" . There is a separate disease called as analgesic nephropathy caused by the analgesics in kidneys.
Turmeric is very helpful for increasing the immunity of body , since childhood we have been taught this in the family , not in the medical school ; so thats all i know about it. Its good for health.
Keeping head end of the bed elevated is good to prevent snoring . Head end can be elevated upto 30 degrees .
For any other query do reply.
Avoid long term use of ibuprofen
Detailed Answer:
Hello,
The medicines i wrote earlier must be easily available at your place.
There are no side effects of the anti inflammatory enzymes.
I usually avoid ibuprofen as it causes more of stomach problems and should not be used for long time as these medicines are toxic to kidneys " when used for long time" . There is a separate disease called as analgesic nephropathy caused by the analgesics in kidneys.
Turmeric is very helpful for increasing the immunity of body , since childhood we have been taught this in the family , not in the medical school ; so thats all i know about it. Its good for health.
Keeping head end of the bed elevated is good to prevent snoring . Head end can be elevated upto 30 degrees .
For any other query do reply.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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