Hoarse whisperers: Unmasking the vocal sabotage of silent reflux
Key takeaways:
- Silent reflux is an extension of typical reflux with different symptoms: a hoarse voice, a cough and damage to teeth.
- Tips to avoid reflux include: don't eat late at night; avoid excess fatty food, nicotine, caffeine and alcohol; exercise regularly and sleep with your head above your body.
- Treatment includes medicine and surgery to recreate the valve that's not working.
- Untreated reflux can lead to swallowing and breathing problems and a pre-cancerous condition.
In November, Today host Savannah Guthrie told the world about her bout with laryngopharyngeal reflux, better known as silent reflux.
“My voice has been getting hoarser and hoarser, and I thought it was old age,” Guthrie said.
The bad news: silent reflux is a pain.
The good news: it’s not a new condition to memorize. Rather, it’s an extension of typical reflux when acidic contents of your stomach get all the way up into your voice box. And treatment for silent reflux is like that for typical reflux.
Do I have silent reflux?
Greg Ward, MD, an OSF HealthCare general surgeon, says the condition is called silent reflux because it typically doesn’t bring the usual reflux symptoms – notably pain or a burning feeling in the chest. Rather, symptoms of silent reflux include a hoarse voice, a cough and even damage to teeth. You may have those symptoms and think you have a cold, allergies or asthma when you really have silent reflux, making the ailment even more difficult to diagnose and treat.
“You have these chronic voice changes or chronic cough. It’s new to you. You didn’t have it when you were 20. Now you’re 35 or 55, and you have it. That’s something that should be considered” Dr. Ward gives as an example. “You need to seek care and talk about it.”
Diagnosis and treatment
Dr. Ward says a provider would perform an endoscopy, where a tube and camera are sent down your throat to look at the extent of the problem. The first treatment is lifestyle changes.
- Don’t eat after 6 p.m. Eating then quickly laying down to sleep is a recipe for disaster.
“When you eat, your stomach releases acid to help digest. Some of it goes forward. Some of it goes back up, especially when you’re laying down,” Dr. Ward says.
The alternative is to eat early then resume normal activities.
“If you’re standing up and are moving around, you don’t have the problem,” Dr. Ward says. Gravity isn’t taking acid the wrong way.
- Avoid excess fatty food, nicotine, caffeine and alcohol. This is one of the big changes Guthrie made.
- Exercise regularly.
- Sleep on an incline with your head above the rest of your body. Again, this uses gravity to help keep the stomach fluid in place. Don’t just do this with pillows, Dr. Ward warns. That can pinch the stomach. Instead, put the head of your bed frame on six-inch blocks.
If those changes aren’t helping, Dr. Ward says the person can try medications like Protonix, Prevacid or Tagamet. However, even if medicine helps, younger people may consider minimally invasive surgery because the medication may have side effects. There, Dr. Ward says a surgeon will wrap the stomach a bit around the esophagus to keep food from going up.
“We recreate the valve that’s no longer working,” he explains.
He says the surgery is usually a one-night stay in the hospital, and some dietary restrictions will follow. Notably: no carbonated beverages. Burping can loosen the repair.
Long term impacts
Talk to a health care provider right away if you have signs of reflux. Left untreated, it can lead to swallowing and breathing problems and Barrett’s esophagus, a condition that can lead to esophageal cancer.