In adults and children, irritating acidic juices may back up from the stomach into the esophagus (swallowing passage) and throat. It is frequently called gastroesophageal reflux disease or GERD. This may occur at any time, but happens more often when laying down. A common anatomic condition known as a hiatal hernia predisposes people to acid reflux. The most commonly recognized symptom of acid reflux is “heartburn” due to irritation of the lining of the esophagus.
Most people do not know that acid reflux can also cause voice problems or symptoms in the pharynx (back of throat). This can happen to someone even if they are not aware of any heartburn, and is sometimes called silent reflux, atypical reflux, or laryngopharyngeal reflux.
Symptoms of acid reflux may include: hoarseness, excessive mucous or phlegm, throat clearing, a sensation of a lump in the throat, sore throat, choking spells, wheezing, or a sense of post-nasal drip. Singers will often notice an increased warm-up time, a sluggish voice (particularly early in the day), or a sense of a “coating” on the vocal folds. In a small percentage of people, more serious problems result, including: pneumonia, ulcers or granulomas of the larynx, vocal fold scarring, or a pouch (diverticulum) of the upper esophagus. There is also a small chance of developing cancer in the esophagus or throat due to long-term acid reflux. In children, the symptoms can be a little different and may include persistent vomiting, bleeding from the esophagus, respiratory symptoms, choking spells, recurrent pneumonia, asthma, swallowing problems, or anemia. In some cases, unexplained fussiness and crying in children is due to acid reflux.
The following information is intended to help you understand acid reflux and the steps you may take to reduce this problem. It is important to realize, however, that the healing of the irritated vocal folds, throat, or esophagus will take time, and one should not expect immediate results.
Dietary factors often contribute to acid reflux. Certain foods are acids or irritants themselves; others will bring out stomach acid in large amounts. Both should be avoided. The following list of foods are especially known to be troublesome: coffee, tea, chocolate, carbonated beverages, alcoholic beverages, citrus beverages, or highly spiced foods. Hard candies, gum, breath fresheners, throat lozenges, cough drops, mouthwashes, gargles, etc. may actually irritate the throat directly (many cough drops and lozenges contain irritants such as menthol and oil of eucalyptus), and will also stimulate the stomach to pour out acid.
Being overweight also contributes to acid reflux; if you are overweight, it would help to lose weight. Large meals at one time are troublesome, and so three or four equally small feedings are preferable to one or two large meals. One should not eat for two or three hours before bedtime; it is advisable not to lie down right after eating.
Behavioral and Other Factors
As mentioned above, body weight is a significant factor in promoting reflux of stomach acid, and weight reduction is helpful. Pregnancy will markedly increase symptoms of heartburn and sometimes throat symptoms as well. This is partly due to the space taken up by the growing infant. One should avoid clothing that fits tightly across the midsection of the body. It is helpful to practice abdominal or diaphragmatic breathing. This means you should concentrate on pushing out the stomach with each breath instead of expanding the chest. Avoid slumping when sitting down. Avoid bending or stooping as much as you can.
For many people, reflux occurs most often at night and sets up the irritation which continues to bother during the daytime. One of the most important things you can do is to sleep on a bed which is elevated at the head end. To do this, use blocks, books, or bricks underneath the legs at the head of the bed. The elevation should be 4-6 inches or so, but not high enough that you will slide down when sleeping. Professional singers with acid reflux should consider traveling with blocks in their suitcase for use in hotel rooms. The use of multiple pillows to get the head up is not effective because it causes the body to curl unless the pillows are maintained under the shoulders in addition to the head. Wedge-shaped pillows can be helpful in this regard.
In addition to dietary and behavioral adjustments, medications are often part of an anti-reflux program. Some are available without a prescription, while others require a prescription. Antacids are commonly used for this problem, and they work by neutralizing stomach acid. Other medications work to decrease stomach acid secretion before it happens, and are more effective at controlling symptoms. Medications should be discussed with your physician.
Several different medications which you might be taking for other medical problems may actually increase stomach acid. These include progesterone (Provera, Ortho Novum, Orval, and other birth control pills), theophyllin (Theodur and other products), anticholinergics (Donnatol, Scopolamine, Probanthine, Bentil, and others), beta blockers (Inderal, Tenormin, Corgard), alpha blockers (Dibenzyline), dopamine, or calcium channel blockers (Procardia, Cardizem, Isotin, Calan). Aspirin or aspirin-containing compounds and other drugs used for pain or arthritis, especially the group called “non-steroidal anti-inflammatory” drugs or NSAID’s, are especially prone to aggravating this problem in some people. Vitamin C is also an acid and can cause stomach symptoms.