Laryngopharyngeal Reflux & Granuloma. By Isabel C. Bula Presented to Rebecca L. Gould, MSC, CCC-SLP. Overview. Rationale Definition Etiology & Mechanisms of LPR Symptoms Diagnosis Clinical Findings Associated with LPR Associated Vocal Pathologies Treatment Conclusions. Why LPR?.
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By Isabel C. Bula
Presented to Rebecca L. Gould, MSC, CCC-SLP
Backflow of food and stomach acids into the back of the throat and onto the larynx.
b. Lifestyles Factors
Improper functioning of esophageal sphincters.
Abnormal esophageal contractions.
Slow emptying of the stomach.
Irritants: chocolate, caffeine, citrus, fatty foods, spices.
Alcohol consumptionLPR: Etiology
Irritation from reflux of stomach fluids into the voice box causes: redness and swelling (indicated with white arrows) in vocal folds (vf) and false vocal folds (f vf); pachydermia (indicated with yellow arrow) or thickening of tissue in between the focal folds.
Antacids (Tums, Mylanta)
H2 Blockers (Tagament, Zantac,
Proton Pump Inhibitors (Prevacid,
Nexium, Prilosec, Aciphex)
Recommended dose: 2x/day
If you are interested in understanding how PPIs work, visit this website: http://arbl.cvmbs.colostate.edu/hbooks/pathphys/digestion/stomach/parietal.html
-Low fat diet
-Avoid coffee, tea, chocolate : (, tomato-based products,citrus fruits, carbonated drinks, cheese, eggs & onions.
-Avoid alcohol, especially in the evening.
-Avoid eating/drinking within 3 hour of bedtime.
-Avoid tight-fitting clothes.
-If you are a smoker, QUIT!
-Elevate the head of the bed (esp. if reflux at night).
-Don’t exercise or sing too soon after eating
-Lose weight-if necessary
1. Behavioral: anti-reflux therapy.
Vocal Hygiene - -reduce/eliminate throat clearing and coughing.
-encourage conservative voice use
-initiate new functioning voicing behaviors.
-production of voice with an extreme
Resonant voice therapy (RVT): most often
employed for LPR/granulomas (Stemple et
Surgery is not the treatment of choice for granulomas,
due to their tendency to recur. However, surgery is
indicated in certain cases:
Granulomas respond well to ART + meds.
Voice therapy focused on reducing medial compression of vocal folds, such as RVT are effective.
PPIs are effective in reducing acid production in the stomach.
Belafsky, P. (2003). Abnormal endoscopic pharyngeal and laryngeal findings attributable to reflux. American Journal of Medicine, 115 (3A): 90S-96S.
Garnett, J.D. (2005, May). Contact granulomas. Emedicine specialties. Retrieved on July 5, 2005,
Koufman JA, Cummins MM. (1995) Reflux and early laryngeal carcinoma. Visible Voice, 4:2-5, 19-23.
Koufman, J.A. (1994) Laryngopharyngeal Reflux and Voice Disorders. Visible Voice, 3:2-7.
Koufman, J.A., Aviv, J.E., Casiano, R.R. and Shaw, G.Y. (2002) Laryngopharyngeal reflux: position statement of the committee on speech, voice, and swallowing disorders of the American Academy of Otolaryngology-Head and Neck Surgery. American Journal of Otolaryngology – Head and Neck Medicine and Surgery, 127, 32-35.
Leonard, R. & Kendall, K. (2005) Effects of voice therapy on vocal process granuloma: a phonoscopic approach. American Journal of Otolaryngology – Head and Neck Medicine and Surgery. 26. 101-107.
Stemple, J.C. & Glaze, L.E. (2000). Clinical Voice Pathology: Theory and Management. San Diego: Singular Publishing Group, Inc.
Voice Disorders.org (n.d.). Voice Disorders: Reflux Laryngitis. Retrieved on July 5, 2005, from http://www.voiceproblem.org/pdfs/reflux_laryngitis.pdf