LPR is a common condition effecting a singers voice.
LPR means Laryngealpharygeal reflux. It is a condition commonly know as Gastroesophageal reflux or Gerd. LPR Presents with more symptoms of the upper airway such as the throat and vocal cords.
Did you know that 50% of people with acid reflux do not have heartburn?
This means that you could have acid, bile and mucous chronically going into your throat and you do not know it. The symptoms you may have include frequent clearing of your throat, hoarseness of your voice, problems swallowing, sore throat, cough and a feeling of a lump in your throat. All of these symptoms could be happening without you having any heartburn or indigestion.
Ear, Nose and Throat (ENT) Physicians such as myself will see this condition frequently. If you have these symptoms chronically it is important to see your Physician. Your Physician may recommend an ENT specialist. An ENT doctor could examine your throat and vocal cords with a special fiberoptic scope. The exam is especially important if you are having changes in the quality of your voice for more than a few weeks. The exam is easily done in the office and is not uncomfortable.
It is estimated that 20% of the population has reflux on a weekly basis.
Acid reflux is more likely to happen as you get older especially if you gain weight. Diet and lifestyle play a major role. Eating late at night as well as smoking, consuming fatty foods, alcohol, an excess of coffee, chocolate or overly spicy foods can make it worse.
Musicians who play late at night could easily develop poor dietary habits.
The singer’s voice is particularly vulnerable to this problem. Even minor irritation could dramatically affect voice quality.
The treatment involves changes in lifestyle and diet. The most important change is to not eat significant amounts of food within 3 hours of going to sleep. If this is impossible you should elevate the back/headboard of the bed 5 inches with blocks. You could also sleep with a wedge which props up your back and head. Adding extra pillows can potentially increase your intra-abdominal pressure and make things worse as well as strain your neck.
Some people need to be on medications to reduce the amount of acid their stomach produces. The common medicines used for this condition include antacids such as Tums, Prilosec and Zantac. These medications are very effective and do not have significant side effects if used short term such as a few months. If you need to be on them long term you should be seen by a Gastroenterologist who can look into your esophagus and stomach to confirm the diagnosis as well as rule out other conditions.
Besides effecting your singing voice, untreated reflux has the potential to cause esophageal cancer. Anyone with difficulty swallowing foods or liquids, unexplained weight loss, bloody or black stools should be seen by their primary care Physician as soon as possible.
The main sign of vocal cord cancer is changes in voice quality for more than a couple of months. No other symptoms may exist. Smokers should be extremely aware of these warning signs.
In summary you may have LPR and not know it. Most musicians are “in tune” with their body. If you noticing any of the symptoms you should not ignore them and seek medical attention.
Dr. Mark Andreozzi
Dr. Andreozzi is a board certified otolaryngologist with more than 20 years of experience. In 2016, he was the recipient of a top doctor designation from Rhode Island Monthly’s “Top Docs” issue. Dr. Andreozzi has a special interest in the management of sinonasal disorders.