The Reflux Dilemma

Many people are all-too familiar with acid reflux and how it can potentially affect us. We know the classic symptoms of indigestion and “heartburn” (GERD, or gastroesophageal reflux disease). Some of us experience less common symptoms that affect the throat, such as chronic cough, throat clearing, hoarseness, a feeling of a lump in the throat, and post-nasal drip (LPR or laryngopharyngeal reflux disease). Read more

What is Sleep Apnea?

Sleep apnea is a nighttime event during which a person will repeatedly stop and start breathing while asleep, causing the level of oxygen in the blood to drop, as well as waking the body and disturbing healthy sleep. Severity of the condition varies from mild to severe, depending on how many times and how low the oxygen level goes down.

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What Is Chronic Sinusitis?

Located over the forehead, between the eyes, over the cheeks and behind the nose, the sinuses are air cavities in the skull that are surrounded by bone and lined with mucous membranes, the “skin” that covers the inside of the nose and sinuses. This membrane has glands that produce mucous, and hair cells (“cilia”) that move the mucous and filter the air. The sinuses and the nasal cavity—whose job it is to warm and filter the air as it passes through the nose during breathing—produce 1 liter of mucous daily, which naturally moistens the nose and throat and helps in the initial process of food digestion. When the mucous gets trapped in the sinuses and/or the sinuses are not breathing well, sinus pressure and possibly sinus infections will occur. Read more

The Q-Tip Dilemma: Safe to Use in Ears?

When purchasing a box of cotton swabs (Q-Tips), we usually have one use in mind—cleaning our ears—even though the box provides no instructions on how to do so. Instructions for the use of cotton swabs range from cleaning the grout between your tiles to make up-removal and the cleaning of electronics. In today’s litigious society, ear trauma with a cotton swab is considered the “fault of the user, not the supplier.” Read more

What Is Deviated Nasal Septum?

What is a deviated septum, and do I have one?

The septum is the cartilage and bone that divide the right side of the nose from the left—it is the “tent pole” that holds the nose up. When this structure is deviated, it simply means it is shifted to one side, the other or both. Everyone has a deviated septum to some extent; even after septal surgery, the septum will never be perfectly strait. It may be very mild and not noticeable or severe enough to compromise the nasal breathing. Read more

Chronic Cough: Why Am I Always Coughing?


Why am I always coughing? Is it allergy? Is it asthma? Do I have an infection? I took 2 courses of antibiotics but my chronic cough did not go away, so I had a chest X-ray, which was normal. I took allergy medication, and it still did not go away. My doctor gave me inhalers to treat asthma and the cough is still there. The only thing that helps is cough syrup, but I am tired of taking that. Some days I feel better and I think the problem has resolved, but the next day the cough is back. Read more

Chronic Throat Clearing and Silent Reflux

Chronic throat clearing is a symptom of many different conditions ranging from post-nasal drip to chronic sinusitis to acid reflux. Gastric reflux is the back flow of stomach contents and gastric acid up from the stomach into the esophagus, the tube that connects the throat to the stomach. Gastric acid can damage the esophagus and cause irritation. With chronic exposure to stomach acid, sufferers feel symptoms of indigestion and heartburn. These symptoms are from a common disorder known as GERD, or gastroesophageal reflux disease.

Beyond GERD and Up to the Throat

Sometimes, the back flow of stomach acids goes beyond the esophagus, reaching up into the voice box and throat and sometimes even go into the nose and sinuses. As the reflux progresses, there are many associated symptoms, including hoarseness, post-nasal drip, a lump in the throat, pain, shortness of breath, difficulty swallowing, a chronic cough and, the most common, excessive throat clearing.

This syndrome is called laryngopharyngeal reflux or LPR. People who suffer from LPR may not experience heartburn and indigestion because the stomach acid is going higher than the esophagus. Sufferers of LPR may experience a range of symptoms, only a few or many. Because these symptoms can be masked, LPR is often called “silent reflux.”

Diagnosing Silent Reflux/LPR

Since there are many causes of throat clearing, silent reflux may sometimes go undiagnosed. If you experience any of the symptoms, especially throat clearing, see an ear, nose, throat (ENT) doctor. Making a diagnosis of LPR is not painful. Usually, a flexible endoscope is inserted through the nose into the throat, which allows the ENT to see the lining of the throat. The stomach acid causes the irritated lining to become red and sometimes there is evidence of damage. The throat is much more sensitive to stomach acid than the esophagus, so even a small amount of acid may cause irritation and chronic throat clearing.

Relieving Symptoms

The most effective way to lessen symptoms and help treat LPR is a modifying the diet. Many foods cause reflux, including citrus, tomatoes, onions, fatty foods and caffeinated foods. Alcohol, particularly red wine, and nicotine also increase symptoms.

Losing weight and easing stress can be helpful, too. The timing of meals is also important. Patients are recommended to avoid eating two to three hours before bedtime to reduce nighttime symptoms.

Some patients may need to take a proton pump inhibitor (PPI), like Nexium, Aciphex, Protonix, a half hour before breakfast every morning. Other patients may be required to take an additional medication like an H2 blocker (Zantac). In some cases, treatment is required for several weeks, and in others, long-term therapy is needed to control symptoms.

As time progresses, with the right, tailored treatment, symptoms may lessen. It is always important to keep your physician up to date on all of your symptoms, so that treatments can be tweaked as necessary.  Be especially careful to alert your doctor to all your symptoms and their severity, even if you feel it may not be related. For instance, some LPR cases cause ear pain and nasal congestion.