What is acid reflux?
At the top and bottom of the esophagus there are sphincter muscles that contract strongly to keep food and acid from traveling upward. When the lower esophageal sphincter (LES) relaxes, acid can flow into the esophagus (the persistent form of this is called GER, Gastroesophageal Reflux) or it can flow all the way up the esophagus and if the upper esophageal sphincter (UES) is relaxed, acid can spill over in the larynx (this is called LPR, Laryngopharyngeal Reflux). It is important to know that everyone experiences some acid reflux. Our esophagi are built to withstand a certain number of reflux episodes every day. When the number of episodes escalates, problems arise. The tissue in the larynx is easily irritated meaning it only takes a few episodes of LPR for the voice to be affected. It takes a larger number of episodes for the esophagus to be irritated (GERD). Very recent research shows that the damage caused by reflux comes from an inflammatory process, not the acid itself.
It is possible that you have LPR or GER and you don’t know it. Many people with GER experience the sensation of heartburn, but those with LPR are less likely too. Dr. Jamie Koufman, a pioneer in the research of LPR, indicates that up to half of those who have LPR have no symptoms. Koufman and others believe that reflux can be an underlying factor in other voice problems like nodules and polyps. You can read more about Dr. Koufman at www.voiceinstituteofnewyork.com
What causes Acid Reflux?
Persistent reflux can be caused by a hiatal hernia, obesity, diet, food sensitivities and certain behaviors such as bending over, lying down or singing immediately after eating. There are also theories that acid reflux is caused by under-production of stomach acid. Never underestimate the role stress and anxiety play in your health as well.
Why should you care about Acid Reflux?
If you need your voice to do your job reflux can keep you from succeeding. You simply can’t access the full range of your voice’s potential if you are dealing with reflux. If you are singing your lifestyle and singing habits can put you at particular risk for reflux problems. To avoid having to eat before a performance singers often eat late at night, eat on the go, running from job to job or job to rehearsals. When you sing we contract the stomach muscles, putting pressure on the LES, which is why singing on a full stomach is never a good idea.
What are the symptoms of Acid Reflux?
* Scratchy throat/ feeling of something stuck in the throat
* Bitter taste in your mouth, especially in the morning
* Bad voice quality in the morning
* Prolonged warm up time needed for the voice
* Reduced pitch range
* Chronic throat clearing
* Sinus problems – post-nasal drip
* Chronic cough and/or sore throat
* Feel as though there is something stuck in your throat
What the Doctor looks for:
To be diagnosed with acid reflux you will also want to see a laryngologist who will examine your vocal cords looking for swelling, redness and possible contact ulcers on the vocal process of the arytenoids (where the cords attach to the cartilage). In cases of extreme reflux, the skin in the back of the throat can be gray and is referred to as pachydermia, because it looks like an elephant’s skin! The doctor may also see swelling of the vocal cords. Once treatment has begun, doctors rely on a visual exam to see if symptoms have resolved and the voice user’s indication of any change in the quality of the voice; i.e. the effort required to produce a sound is less.
Lifestyle shifts:
*Assess your diet and cut out trigger foods, processed and sugary foods. Elimination diets can be very helpful
* Develop strategies for managing/reducing stress
* Lose weight if needed
* Wear clothing that is looser around the waist
* Minimize heavy lifting
* Don’t lie down, bend over or sing immediately after eating
* Eat smaller meals
* Chew your food well – saliva has enzymes to break down food, aiding in digestion.
* Avoid eating less than three hours before bed
* Don’t smoke (hopefully you don’t do this for a whole host of reasons!)
* Raise the head of your bed 6 inches
You may be prescribed a medication to get your reflux under control. There are several kinds of medications – some suppress acid production triggered by H2 receptors in the stomach. Some medications inhibit the proton pumps in the stomach. These medications are generally more effective at allowing the esophagus to heal and keeping reflux in control. There is some recent concern that proton pump inhibitors can cause bone loss and vitamin B12 deficiency.
It is important to remember that these medications are treating the symptoms without getting to the root of the cause. You, as the owner of your body, need to do your own work to help your body heal. I strongly encourage you to address your diet and stress levels. Many have found resolution to their reflux through programs like the Whole30, where you clean up your eating and see how your body responds. Visit whole30.com to learn more.
If you change your eating habits and take medicines and still don’t see a change in your reflux, the final option is to have a surgical procedure called fundoplication. This involves wrapping one part of the stomach around the lower portion of the stomach to create a tight sphincter to keep acid from traveling upward into the esophagus. As with all surgeries you will want to thoroughly weigh the risks versus benefits of the procedure.