What is LPR?
Laryngopharyngeal reflux (LPR) — also known as silent reflux — occurs when stomach contents travel upward and irritate the throat, voice box, and airway. Unlike classic acid reflux or GERD, LPR can occur without heartburn, making it easy to miss. But acid coming up is only part of the story. Current evidence suggests that pepsin — a digestive enzyme from the stomach — can deposit in the tissues of the larynx and throat, where it becomes activated by acidic foods and beverages consumed later. This means that both upward reflux and the foods and drinks we ingest may contribute to LPR symptoms, which has important implications for how the condition is best managed.
LPR is a real and common condition — but it is also one of the most over-attributed diagnoses in ENT and primary care. Many patients are placed on reflux medications for months or years without meaningful improvement, because their symptoms actually stem from a different cause entirely, such as muscle tension dysphonia or laryngeal sensory neuropathy. Accurate diagnosis is essential before committing to long-term treatment.
Common Symptoms of LPR
- Persistent throat clearing or dry cough
- A sensation of something stuck in the throat (globus)
- Excess mucus or post-nasal drip sensation
- Throat irritation or burning without heartburn
- Difficulty swallowing
- Chronic hoarseness or voice changes
Diagnosis & Treatment
Evaluating LPR requires a careful clinical history and flexible laryngoscopy — both to confirm signs of laryngeal irritation and inflammation and to rule out other conditions that can mimic LPR symptoms. When the diagnosis remains unclear, additional testing such as pH monitoring or hypopharyngeal impedance testing may be recommended to objectively measure reflux activity.
Treatment is individualized and may include dietary and lifestyle modifications, proton pump inhibitors (PPIs) or H2 blockers, alginate-based therapies to create a physical barrier against reflux, and voice therapy when vocal symptoms are prominent. Dr. Benjamin Rafii works closely with gastroenterology colleagues when further evaluation or management is needed.
Related Conditions: Hoarseness & Voice Disorders | Chronic Cough & Throat Sensitivity | Muscle Tension Dysphonia | Swallowing Disorders / Dysphagia
Related Treatments: Voice Therapy & Care Team Coordination
Related Services: Comprehensive Voice Evaluation | High-Definition Videostroboscopy
If you are experiencing throat symptoms that may be related to LPR / silent reflux, Dr. Rafii and his team are here to help. Contact us today to schedule a consultation at The Laryngology & Voice Center of Beverly Hills — same- and next-day appointments are available.