Patient information · ENT
Silent reflux
reflux that never causes heartburn
Laryngopharyngeal reflux is stomach contents reaching the throat and voice box. Unlike ordinary reflux it often causes no heartburn at all, which is why it is called silent — and why people spend months being treated for infections, allergy or asthma before anyone considers it.
Seek urgent assessment if you have
- a hoarse voice lasting more than three weeks
- difficulty or pain swallowing, or food sticking
- unexplained weight loss, or coughing up blood
- a lump in the neck, or persistent one-sided earache with a normal ear
- noisy breathing or breathlessness
- symptoms in a smoker or heavy drinker over 45
These symptoms overlap with those of throat and voice box cancer, which is far more treatable when found early. Three weeks of hoarseness is the threshold for examining the larynx, regardless of how likely reflux seems. In an emergency call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
The symptoms
- Persistent throat clearing — the most common symptom of all
- a lump or tightness in the throat that is not there when swallowing food (globus)
- hoarseness, particularly in the morning, and voice fatigue
- chronic cough, worse on lying down or after meals
- excess mucus or postnasal drip sensation
- sore throat, difficulty swallowing, and a bitter taste
- and often no heartburn whatsoever
Why the throat is more sensitive than the gullet
The oesophagus has a protective lining and clears acid within seconds. The throat and voice box have neither, so even small amounts of refluxed material — and importantly the enzyme pepsin, which remains active on the tissue — cause inflammation. That is why you can have significant throat symptoms without any of the chest burning that would make the diagnosis obvious, and why the treatment needs longer than for ordinary reflux.
Treatment takes months, not weeks
The commonest reason treatment appears to fail is judging it at three weeks. Throat tissue heals far more slowly than the gullet, and symptoms improve gradually.
What to change
Helps
- Nothing to eat or drink for three hours before lying down — the single most effective change
- Raising the head of the bed on blocks by 10–20cm (not extra pillows)
- Smaller meals; avoiding large evening meals
- Losing excess weight, especially around the middle
- Stopping smoking, which relaxes the valve and irritates the throat directly
Common triggers
- Alcohol, especially in the evening
- Coffee, fizzy drinks, chocolate and mint
- Fatty and fried food, tomatoes and citrus
- Tight waistbands, and bending after eating
- Throat clearing itself, which further irritates the vocal cords
Medication
- Alginate preparations — Gaviscon Advance in particular — form a raft over the stomach contents. Take after meals and at bedtime, which is when they work. These are often more effective than acid suppression for throat symptoms.
- Proton pump inhibitors may be used, typically for two to three months, taken 30 to 60 minutes before food on an empty stomach. Taken with food they are far less effective.
- Evidence for acid suppression in silent reflux is weaker than for classic heartburn, which is why lifestyle and alginates carry more weight here.
- Stop clearing your throat. Sip water, swallow hard or hum instead — throat clearing is a mechanical irritant that perpetuates the whole cycle.
- Speech and language therapy helps voice symptoms and breaks the throat-clearing habit.
Why come to us. Silent reflux is a diagnosis of pattern, and the important step is looking at the larynx to exclude what else causes these symptoms. Our ENT team can perform flexible nasendoscopy in clinic, usually within the same week, confirm the diagnosis, and rule out the causes that must not be missed — rather than treating for months on assumption. We prescribe, arrange speech and language therapy, and refer for pH studies or endoscopy through our CQC-registered partners where needed.
Larynx examined in clinic, usually the same week
ENT nasendoscopy without a referral. Seven days a week.
Tower Bridge Hospital London
97–99 Whitechapel Road, London E1 1DT
WhatsApp 07903 284 189
info@mhwclinic.co.uk
Open Mon–Sat, 9am–7pm (closed Sundays until September)
In an emergency
Call 999, or go to the Royal London Hospital Emergency Department, Whitechapel Road, London E1 1FR.
When we are closed and it is not an emergency
Call NHS 111 or visit 111.nhs.uk.