Stomach fluids contain strong acids, for the dilution and digestion of food. If these fluids travel reversely upwards, due to malfunction of the feeding tube connecting the throat with the stomach, namely the esophagus, then severe irritation can happen along the course of the reverse flow (reflux).

 

Reflux can cause burning, bitterness and foreign body sensation (lump) in the throat, as well as hoarse voice. These symptoms can be associated with heartburn and pain in the chest, which suggest esophageal involvement.

 

However, sometimes these esophageal symptoms do not exist and the symptoms in the throat can be non-specific, making the diagnosis difficult. In these cases, endoscopic examination of the throat will give the first clues. Redness and swelling in the pharynx and the voice box, especially at the posterior part, near the esophagus, irritation of the breathing tube leading to the lungs (trachea), and polyps or granulomas of the vocal cords are typical findings suggesting reflux.

What the doctor would do in such cases?

If symptoms from the esophagus exist, then the Gastroenterologist will be consulted, who in turn will examine endoscopically the esophagus and the stomach and may also test the function of the esophagus with special examinations, such as multiple level pH-metry and manometry.

 

If the esophagus is not affected, the doctor would typically prescribe a three month empirical course of drugs (called ppi’s), to reduce the acid production in the stomach. Positive response to this treatment would suggest laryngo-esophageal reflux and the Gastroenterologist will again be consulted for the optimal treatment strategy. If no response to the treatment is reported, then reflux is excluded, and other diagnostic options are investigated.

All this happened until today.

Nowadays, we do not have either to make guesses, or to give empirical medical treatments. We now have the ability to measure the exact acidity in the throat, with a simple, non-invasive, low-cost test, called the pharyngeal pH-metry.

A thin catheter is passed through the nose to the throat and is secured in place by means of a transparent tape on the cheek (picture 1). One end of the catheter is a sensitive acid sensor, which continuously monitors the throat. The other end is connected to a small transmitter, and wirelessly, to a special processor, which records the measurements of the sensor. The patient carries the usual day or night activities, keeping record of the times of sleep and meals, as well as of any possible symptoms.

 

After one or two days, the catheter is removed and the processor is connected to a computer. The measurements are transferred to the dedicated software, and a graph is drawn showing the acidity during the monitoring period (picture 2). By studying the graph and the data collected by the system, safe conclusions can be drawn on the existence of reflux disease in the throat, and the appropriate management is undertaken not by guess, but by proof. We do not anymore give our patients long treatments, unless they really need them.