What is silent reflux?

Silent reflux is a condition where acid from your stomach passes up into the larynx (voice box) and throat. It is an extra oesophageal disorder of Gastroesophageal Reflux (GERD) with symptoms affecting the larynx and throat, not the chest.

What are the symptoms of silent reflux?

Globus sensation, chronic throat clearing and gravelly voice are the three most common presenting symptoms of silent reflux. Chronic throat pain, the sensation of choking as well as chronic cough, may also be frequently experienced.

Symptoms of silent reflux include:

  • Dysphonia
  • Sensation of a lump in the throat
  • Throat clearing
  • Sensation of excess mucus stuck in the throat and/or postnasal drip
  • Chronic cough, choking and laryngospasm
  • Difficulty swallowing
  • Sore throat
  • Feeling of something caught in the throat (sometimes a tickling sensation)
  • Halitosis
  • Dry throat and altered (metallic) taste

These symptoms were previously thought to constitute part of the spectrum of GERD, however silent reflux is now thought to be a distinct entity and should be managed differently.

How is silent reflux treated?

Silent reflux can be treated by a combination of anti-reflux medications, as well as behaviour and dietary changes. Recent studies suggest that anti-reflux medication will have little effect if the diet is not carefully controlled. 

Many foods and drinks can make symptoms worse, and it is important that these be reduced. In particular, caffeinated or carbonated beverages, dairy products, acidic foods such as tomatoes, all citrus fruits and their juices should be reduced.

Changes in behaviour and habits including weight loss, quitting smoking, avoiding alcohol and not eating immediately before bedtime are all factors that aim to reduce reflux disease. Nicotine and alcohol relax the sphincters of the oesophagus, allowing acid to reflux more easily.

Untreated silent reflux can lead to other laryngeal pathologies (vocal cord ulcer and granulomas) and worsening of coexisting asthma and COPD. Untreated silent reflux may also place a role in exacerbating chronic sinusitis and contribute to the development of laryngeal cancer.