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LPR

Extra-Oesophageal Reflux / LaryngoPharyngeal Reflux / Silent reflux

If reflux persists, it can traverse the entire column of the oesophagus and breach the upper oesophageal sphincter, a group of muscles including the cricopharyngeus that open when swallowing to permit food to enter the oesophagus rather than the trachea (windpipe).

Reflux occurring here is correctly termed extra-oesophageal reflux but is often referred to as Laryngo-Pharyngeal Reflux (LPR for short) or "silent reflux". (The term 'silent reflux' is also often applied to lower oesophageal reflux where heartburn is not experienced.)

Even if the acid has been reduced or neutralised with acid suppressants or antacids, regurgitation of stomach contents and extra-oesophageal reflux (known as Non-Erosive Reflux Disorder, or NERD) can still cause damage.

From the top of the oesophagus it enters the respiratory system where it can aspirate into the throat, lungs, mouth and nose.

Irritating the lining of the throat and bronchi, inducing the production of excess mucous, sufferers frequently have the need to clear their throats and aspiration deeper into the lungs can result in chronic cough as the lungs attempt to expel the foreign matter.

In the lungs, it can cause asthma like symptoms. It can even build up resulting in pneumonia or bronchiectasis.

Causing irritation to the voice box, it can result in hoarseness and sore throat.

Attempting to prevent extra-oesophageal reflux, the cricopharyngeus may tighten or spasm producing a feeling of a lump in the throat known as Globus.

At night, in attempting to prevent reflux, the cricopharyngeus may be responsible for restricting breathing causing obstructive sleep apnoea. 

Entering the mouth, reflux produces bad taste and bad breath. It can also cause dental erosion resulting in tooth decay or sharp edges to the teeth.

From the back of the throat, refluxate can travel via the eustachian tube to the ears where it may stimulate excessive wax production. This is more common in the right ear as lying on the right side results in more reflux than lying on the left. It can also result in tinnitus and peripheral vertigo (dizziness).

Rising into the nasal chambers, excess mucous produced here can cause post nasal drip producing cough and result in the sufferer sniffing frequently to constrain it. This may also give rise to a poor sense of smell (hyposmia), a distortion of smell (parosmia) or even fool the senses to imagine smells that aren't there (phantosmia).

From the nasal passages, it can pass to the eyes via the tear ducts resulting in dry eye syndrome.

A 2014 poll of 100 reflux sufferers [r-i] revealed 70% reported experiencing Hoarseness, 64% constant throat clearing, 58% post nasal drip, 58% chronic cough, 53% sinusitis, 53% bad taste in mouth, 50% Globus (lump in throat), 42% Asthma-like symptoms (shortness of breath), 41% tooth decay or sharp edges to teeth, 35% Catarrhal symptoms (blocked nose), 35% Loss of voice, 35% dry or gritty eyes, 30% nocturnal ear waxing.

In other responses, the following symptoms were also highly indicated: Bad breath, Tinnitus, Hyposmia (poor sense of smell), Sore throat.