Laryngopharyngeal Reflux Specialist in Singapore

Laryngopharyngeal reflux (LPR) occurs when stomach acid flows back into the throat and voice box (larynx), affecting the upper airway. This condition can cause throat irritation, persistent coughing, and voice changes.

Unlike other reflux disorders, LPR often presents without heartburn, making it harder to diagnose. It is commonly triggered by dietary habits, lifestyle factors, or anatomical issues that allow acid to travel upward.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

Symptoms Causes Diagnosis Treatment Prevention FAQ

Common Symptoms of Laryngopharyngeal Reflux

LPR frequently presents with a variety of symptoms, particularly in the throat and voice. Recognising these symptoms at the clinic can help identify the condition and guide appropriate treatment.

Throat Irritation: This includes recurring sore throat, burning sensations, frequent throat clearing, and excess throat mucus as the body responds to acid exposure.
Chronic Cough: A persistent cough, often worse at night or after meals, occurs when stomach acid irritates the throat and triggers the cough reflex.
Hoarseness and Voice Changes: Especially noticeable in the morning, these changes result from acid irritation affecting the vocal cords.
Swallowing Difficulties: Acid reflux can cause inflammation, making swallowing uncomfortable or creating the sensation of a lump in the throat.
Post-Nasal Drip: Increased mucus production caused by irritation can lead to the sensation of mucus dripping down the throat.

Causes and Risk Factors

Several factors increase the risk of developing or worsening LPR symptoms. These factors may be related to dietary habits, lifestyle choices, or underlying medical conditions.

Dietary Habits: Consuming acidic foods, caffeine, or large meals close to bedtime can increase acid production and reflux risk.
Body Position: Lying down soon after eating makes it easier for stomach contents to flow back into the throat.
Anatomical Factors: A weakened upper oesophageal sphincter allows acid to travel upwards more freely.
Lifestyle Factors: Smoking, alcohol consumption, and high stress levels can weaken sphincter muscles and stimulate acid production.
Medical Conditions: Obesity, pregnancy, and hiatal hernias increase abdominal pressure, promoting acid reflux.

Dr. Gan examining throat with laryngoscope

Diagnostic Approaches for Laryngopharyngeal Reflux

Laryngoscopy: A small, flexible camera is used to visually examine the throat and larynx. This procedure helps identify signs of irritation, such as redness, swelling, or tissue damage caused by acid reflux. It provides a clear view of the upper airway to confirm the presence of LPR-related changes.
pH Monitoring: A specialised device measures acid levels in the throat over a 24-hour period. This test tracks the frequency and timing of reflux episodes, allowing ENT doctors to link symptoms directly to acid exposure. It is a reliable way to confirm acid reflux as the cause of discomfort.
Impedance Testing: This diagnostic test measures the movement of both acidic and non-acidic stomach contents into the oesophagus and throat. It is particularly useful for cases where symptoms persist despite normal pH levels, helping identify reflux that does not involve acid.
Barium Swallow Study: This imaging test involves drinking a liquid contrast material that highlights the throat and oesophagus on X-rays. The test provides detailed images of how liquids flow, making it easier to identify structural abnormalities or functional issues, such as a hiatal hernia or swallowing difficulties.

Treatment Options for Laryngopharyngeal Reflux

Managing LPR involves reducing reflux and healing throat tissues. Treatment options include medications, lifestyle changes, and surgical procedures.

Non-Surgical Treatment

Proton Pump Inhibitors (PPIs): These medications significantly reduce stomach acid production, giving tissues time to heal. PPIs are typically used daily for several months, offering relief for severe LPR symptoms. Long-term use requires monitoring to avoid potential side effects.
H2 Blockers: These medications lower acid production by targeting histamine receptors in the stomach lining. They are often used alongside PPIs or as a standalone treatment for milder symptoms, particularly for managing reflux at night.
Alginate Therapy: This treatment creates a floating barrier on stomach contents, preventing acid from reaching the throat. It is effective for immediate relief after meals or at bedtime and works well in combination with other medications.

Surgical Treatment

Fundoplication: This procedure reinforces the barrier between the stomach and oesophagus by wrapping the upper part of the stomach around the lower oesophagus. It is generally recommended for patients with structural abnormalities or those whose symptoms persist despite medication.
LINX Device Implantation: This minimally invasive procedure involves placing a magnetic ring around the lower oesophagus. The ring allows normal swallowing but closes tightly afterward to prevent reflux. LINX is a reversible option for patients seeking an alternative to fundoplication.

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Prevention and Management

Preventing LPR involves practical lifestyle adjustments. Eating smaller, more frequent meals and avoiding acidic foods or large portions before bedtime can help reduce reflux episodes. Elevating the head of the bed or using wedge pillows can minimise acid backflow during sleep. Maintaining a healthy weight reduces abdominal pressure that contributes to reflux. Keeping a diary to track symptoms and triggers, such as specific foods or habits, allows for more effective self-management.

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Frequently Asked Questions (FAQ)

Can untreated LPR lead to other complications?

Yes, untreated LPR can result in complications such as chronic throat irritation, vocal cord nodules, or even oesophageal damage. Long-term exposure to acid can increase the risk of conditions like laryngeal granulomas or, in rare cases, precancerous changes. Early treatment helps mitigate these risks.

Can LPR be misdiagnosed as other conditions?

Yes, LPR symptoms can mimic those of other conditions, such as asthma, chronic sinusitis, or allergies. A thorough evaluation, including diagnostic tests like laryngoscopy or pH monitoring, helps ensure an accurate diagnosis and appropriate treatment plan.

Does LPR worsen with age?

Ageing can decrease the muscle tone of the sphincters responsible for preventing reflux, potentially increasing the likelihood of LPR. Nevertheless, with appropriate interventions, including lifestyle adjustments and medical or surgical treatments, symptoms can be effectively controlled at any age.

Dr Gan Eng Cern

Ear, nose and throat specialist

MBBS

MRCS (Edin)

mmed (orl)

FAMS

With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.

Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.

2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
2016 – Best Educator Award (Eastern Health Alliance)
2016 – “Wow” Award (Patient Compliment)

2014 – Eastern Health Alliance Caring Award – Silver
2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
2012 – Human Manpower Development Award (Ministry of Health, Singapore)
2007 – Singhealth Best Doctor Award

Qualifications

MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
FAMS – Fellow of the Academy of Medicine Singapore

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Our Location

A Specialist Clinic for Sinus, Snoring & ENT

38 Irrawaddy Road #08-45
Mount Elizabeth Novena Hospital
Singapore 329563

enquiry@drganent.com

+65‎ 6253‎ 7296

+65 9058 2480

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