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The symptoms of laryngopharyngeal reflux (silent reflux), how they differ from GERD symptoms, the Reflux Symptom Index, and when to see an ENT specialist.
By Editorial Team · Updated · 3 min read
This article is awaiting review by a qualified medical professional.
Quick answer
The main symptoms of LPR (silent reflux) are hoarseness, constant throat clearing, a lump-in-the-throat feeling, a sensation of mucus or postnasal drip, chronic cough and difficulty swallowing. Unlike GERD, heartburn is often absent. See a doctor if hoarseness lasts more than 4 weeks or if you have trouble breathing, pain when swallowing, or coughing blood.
Laryngopharyngeal reflux (LPR) sends stomach contents up to the throat and voice box. The symptoms are often mistaken for a cold, allergies or a smoker's throat, and heartburn is often missing. This guide lists the symptoms to look for. For treatment, see our main guide to LPR.
The lining of the throat and voice box has less protection than the esophagus, so a small amount of reflux can cause irritation without the burning feeling of heartburn. Many people with LPR do not have any heartburn.
| LPR | GERD | |
|---|---|---|
| Heartburn | Often absent | Common |
| Regurgitation | Sometimes | Common |
| Hoarseness and throat clearing | Common | Sometimes |
| Chronic cough | Common | Sometimes |
| Lump in the throat | Common | Sometimes |
| When it is worse | Often in the daytime, upright | Often after meals, and when lying down |
See our guide to GERD symptoms.
Doctors sometimes use a questionnaire that scores nine symptoms from 0 (no problem) to 5 (severe):
A total score above 13 suggests LPR, but the score is only a guide and does not prove reflux.
Throat symptoms are not always reflux. Other causes include allergies, sinus problems and postnasal drip, asthma, infections, smoking, dry air, voice overuse, medicines (such as some blood pressure tablets that cause cough), and stress and muscle tension. Your doctor will look at these too.
See a doctor promptly, ideally an ear, nose and throat (ENT) specialist, if you have:
Difficulty breathing is an emergency. Call your local emergency number.
Track your symptoms, avoid smoking and irritants, and try the diet and lifestyle steps in our GERD diet guide. If symptoms continue, speak to your doctor about examination and tests.
Yes. Many people with laryngopharyngeal reflux never feel heartburn, which is why it is called silent reflux. Their main symptoms are in the throat and voice.
People often describe a constant need to clear the throat, a lump or tightness in the throat, mucus dripping down the back of the throat, a hoarse or tired voice, and a dry cough, particularly in the daytime and after meals.
Yes. Reflux irritating the voice box and airway is one of several causes of a long-lasting dry cough. Other common causes, such as asthma, allergies and postnasal drip, should also be considered.
A lump-in-the-throat feeling (globus) is common and is usually harmless, and reflux is a frequent cause. It needs checking if it comes with pain, difficulty swallowing, weight loss, voice changes or a neck lump.
This article is for educational purposes only and does not replace advice from a doctor or other qualified health professional. See our medical disclaimer.
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