Three out of ten people suffer from what we call gastro-laryngeal reflux. This is the same reflux that occurs when gastric juices rise from the stomach into the larynx and pharynx. Some causes of gastro-laryngeal reflux are:
- A large production of acid: linked or not to a pathology.
- A problem in the function of the esophageal sphincter: the cardia is the space that communicates the esophagus with the stomach. The latter contracts normally to avoid regurgitation, but if it does not work properly, it reproduces a reflux that rises from the esophagus upwards.
- Certain inadequate eating habits : not eating early, consuming spicy foods, drinking alcoholic beverages….
And its associated symptoms are :
- Heartburn
- Burning sensation in the trachea and throat.
- Dysphonia
- Hoarseness
- Excessive secretion of mucus and phlegm in the throat.
When a person presents the above mentioned symptoms, an otolaryngologist is usually consulted in order to perform an examination of the larynx to determine the following:
- Redness in the area of the arytenoids.
- Irritation of the mucosa (pink or red larynx).
In these two cases, the otolaryngologist recommends the patient to visit a specialized digestive doctor to perform: –
- A gastroscopy in order to explore the esophagus, stomach and duodenum.
- A manometry and pH metry of the esophagus.
Reflux and voice
Regarding the voice, alterations in vocal quality are frequent in patients with reflux, and can be severe in some cases. However, unlike other organs, the vocal cords are usually able to recover within a very short period of time. The treatments that the otolaryngologist usually advises in case of reflux are the following:
- Medication to control acidity and regulate gastric acid production, such as through the use of gastric protectors.
- Change the hygiene of life: do not eat anything three hours before going to bed or sleep with the head up.
- Change dietary hygiene: avoid fatty foods, eliminate condiments, coffee and tea, and above all drink plenty of water so that the acid does not reach the throat….
My advice for patients with reflux:
- Modification of eating habits.
- Elevate the head when sleeping
- See an otolaryngologist (who will prescribe a series of medications to control the production of gastric acids).
In specific cases, surgery is also an option.
Silent reflux: the worst enemy for the voice.
The enemy of the vocal cords is called silent reflux. This reflux is a laryngopharyngeal reflux that mainly affects the throat and voice and sharply affects the larynx and pharynx. In fact, its effects affect vocal production and voice quality. This reflux appears when stomach acid and other contents rise upwards, in some cases reaching the nostrils.
The following is a list of symptoms of laryngopharyngeal reflux:
- Sensation of excess mucus with the need to clear the throat in the morning.
- Hoarse or dysphonic voice
- Sensation of bitter or dry mouth
- Halitosis
- Hypersalivation
- Chronic cough
- Laryngeal spasms
- Dysphagia
Hygiene of life, nutrition and medication
Treatment with medication usually greatly attenuates the symptoms of this reflux. The so-called proton pump inhibitor is usually the most effective since it reduces the amount of acid considerably. The best known is omeprazole. Other drugs such as antacids or histamine antagonists are also used. As well as, in certain cases, prokinetic drugs are used.
Diet is usually the best way to reduce reflux symptoms. Therefore, it is important to follow a low-acid diet. Foods such as melon, celery, bananas and green leafy vegetables are recommended. Spicy or fried food, too fatty foods, citrus fruits, tomatoes, chocolate, cheese, garlic or mint should be avoided. Coffee, carbonated beverages and alcohol can also aggravate symptoms and are therefore also discouraged. It is important to eat slowly, chew food well, eat in the morning and at noon, and try to eat as early as possible. As stress is another aggravating factor of reflux, people suffering from laryngopharyngeal reflux are advised to try to maintain a healthy lifestyle, without stress, to maintain a healthy weight, not to smoke….
There are other alternative therapies that can be beneficial to reduce the symptoms of laryngopharyngeal reflux. One example may be acupuncture. Probiotics are also often beneficial in soothing symptoms.
The effects of reflux on voice feminization
In terms of voice feminization, it is often noted that the patient’s voice is not clean. In other words, her vocal quality is altered. Here a dirty voice is appreciated, and a hypersecretion at the mucus level is noted. This causes the patient to throat clear often, preventing her from producing clear sounds. In these cases, when I detect these signs in the first sessions, the first thing I do is to recommend the patient to consult an otolaryngologist if I have not already done so (at the beginning of each vocal training, patients are always advised to visit an otolaryngologist to make sure that there is no pathology, trauma or injury to the vocal cords before starting feminization training or voice and speech harmonization).
Normally, when the patient starts taking the medication, improves her dietary and lifestyle hygiene, and follows a series of tips I give her to clean the voice, results begin to be seen after two or three days. The voice is cleaner, clearer, the patient notices the decrease of mucus in the throat, so vocal training can be performed more effectively. If the patient takes care of herself and respects the hygiene guidelines and advice of the otolaryngologist and speech therapist, the voice is usually clearer and the results of feminization will not be altered.
After more than 15 years of experience as a voice professional specializing in vocal feminization, I must say that I have seen many cases of patients presenting silent reflux. And since most of them presented the same symptoms, it was easy for me to detect them. I have seen very altered vocal gestures caused by this reflux, since, most of the time, since the patient does not feel burning or burning sensation, she does not suspect reflux. Patients who had complained for years about the sensation of having a foreign body in the throat and a hypersecretion of mucus.
When trained, it is amazing to see the self-healing capacity of the vocal cords. In just a few weeks the vocal gesture recovers normally, and if the effect on the voice has not become a functional problem, the voice recovers all its splendor quickly. However, I advise all patients not to delay in going to the ENT doctor if they feel any of the symptoms mentioned throughout the article.