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Reflux
Reflux occurs when stomach juice (acid) is released back up into the esophagus (feeding tube) between the throat and stomach, sometimes as high as the larynx (voice box), pharynx (throat), or even higher – causing heartburn, sore throat, phlegm, post-nasal drip, cough, choking, and/or hoarseness.

There are two major types of reflux: GERD (gastroesophageal reflux) and LTR (laryngotracheal reflux), which is sometimes referred to as Extra Esophageal Reflux Disease (EERD). EERD differs from GERD in the following ways:
  • EERD may not be associated with the typical heartburn symptoms that are seen with GERD.

  • With EERD, patients frequently complain of post-nasal drainage, but are unable to cough productively. This is because acid irritation makes the patient feel that there is phlegm on the vocal cords – when in actuality, the vocal cords are merely irritated. For this reason, EERD may mimic sinusitis and the drainage associated with it.

  • Other common EERD symptoms include hoarseness, throat clearing, dysphagia (pain on swallowing) or a feeling of fullness in the lower throat below the Adam's apple.

  • Rarely, EERD may cause sphenoid sinusitis.

  • In children, EERD can both mimic and cause otitis media (inflammation of the middle ear) and sinusitis.

The treatment for EERD may require behavioral changes such as not eating before bedtime or raising the head of the bed, coupled with medical therapy like proton pump inhibitors or H2-blockers. In extreme cases, surgery to tighten the lower esophageal sphincter, a muscle that controls reflux, can cure the condition.

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