Myth Busting Series Part VI
This week we take on busting the vocal myth of silent reflux.
True or false?
Even if you don’t have heartburn, you might have silent reflux which can harm your voice.
The answer is...false!
Here’s a scenario that happens all the time: A singer is having problems with their voice. They go to see their primary care doctor or a general ear, nose, and throat (ENT) doctor and are told, “Your voice problem is because of reflux,” and they’re put on a reflux medication. The singer takes the reflux medication faithfully, but their voice problem doesn’t get better. That’s because the problem wasn’t reflux to start with.
Let’s begin with what “reflux” means. Your stomach produces acid to help with digestion. There is a circular band of muscle (sphincter) at the bottom of your esophagus that relaxes when you swallow to let food into your stomach and then tightens to keep acid from leaving the stomach and flowing back into the esophagus. If the sphincter isn’t working well, acid can wash into the esophagus creating irritation. Sometimes we experience this as heartburn. If the acid travels into the esophagus, that’s called gastroesophageal reflux disease or “GERD.” Your larynx (or voicebox) shares a common wall with the esophagus. If the acid travels all the way up the esophagus and spills over into the voice box, that’s called laryngopharyngeal reflux or “LPR.” When LPR happens, stomach acid can irritate the delicate tissues of the voice box and vocal folds, and this can lead to voice problems.
Now, let’s be clear, LPR (when the acid gets all the way up to your larynx) CAN cause voice problems and SHOULD be treated with lifestyle changes and an appropriate medication (see link below). However, people with reflux almost always have some symptoms, even if they don’t have outright heartburn. You might feel a gurgling sensation in your throat, or a burning sensation, or a sour/acidic taste in your mouth. But “silent reflux” with absolutely no symptoms is highly unlikely. And unfortunately, a lot of people receive that diagnosis and don’t get an accurate assessment of what’s causing their voice problem.
Cohen et al. (2008) looked at patients who had hoarseness and were given a PPI (proton pump inhibitor, a reflux medicine such as Prilosec, Nexium, or Prevacid) to treat the hoarseness and who subsequently went to a voice specialty medical clinic. Of the study participants, 70% still had hoarseness despite taking reflux medications. Some of the patients had stopped taking their reflux medicine because their voices weren’t getting any better. Among those patients, 79.5% had never had heartburn or other reflux symptoms in the first place. Most patients in the study got improvement in their voice with correct diagnosis and voice therapy.
Similarly, Holcomb et al. (2018) also looked at patients with voice problems who were referred to a specialty voice clinic after being diagnosed with reflux as the primary cause of their voice problem. Of those treated with PPIs, 65% had no symptoms of reflux. For 86% of the patients, their diagnosis was changed when they saw the voice specialist ENT doctor (laryngologist) and different treatment was recommended. The authors concluded that treating voice problems with reflux medications in the absence of any reflux symptoms can delay the correct diagnosis and appropriate treatment.
So, if you’ve been diagnosed with acid reflux as a cause of your voice problem and your voice isn’t getting better, seek further diagnosis with a laryngologist (ENT doctor who specializes in voice) and a medical voice care team.
For more info on diagnosis and treatment of reflux disease, see Gastroesophageal reflux disease (GERD) - Diagnosis and treatment - Mayo Clinic.
Next time on Vocal Fitness Friday, we uncover the truth about a new myth:
True or False:
Lozenges and throat sprays are good for your voice.
Tune in next week to find the answer…
Until next time,
Your SonoVoice Team
Resources:
Cohen, S. M., & Garrett, C. G. (2008). Hoarseness: is it really laryngopharyngeal reflux?. The Laryngoscope, 118(2), 363–366. https://doi.org/10.1097/MLG.0b013e318158f72d
Holcomb, A. J., Hamill, C. S., Irwin, T., Sykes, K., Garnett, J. D., & Kraft, S. (2018). Practice Patterns of Referring Physicians in Management of the Dysphonic Patient. Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 158(6), 1072–1078. https://doi.org/10.1177/0194599818758958
Next Week: Myth Busting Part VII
You are a vocal athlete!
Athletes put superhuman demands on the human body. They practice to stay in shape, get better and prepare for the event. No athlete expects to perform at their best without working on their technique, practicing skills, and preparing for the game.
The same goes for you as a vocal athlete. Practice will help you be prepared for your event: performance. Unfortunately, there’s no shortcut! If you want to be at your best as a singer, you’ll need to establish a regular vocal exercise and practice regimen.
In our weekly Vocal Fitness Friday email, SonoVoice's team of experts in science-based voice training will be sharing information about how the voice works, tips on keeping your voice healthy, and ideas for vocal exercises for peak vocal fitness.
