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Silent Threat

July 6, 2012

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Large meals taken late in the evening and excessive cups of coffee can lead to hearing loss caused by severe acid reflux, writes Kasmiah Mustapha

EVERY night for over three years, Lavin John had a chronic cough, the dry heaving kind that made it difficult to sleep. He also felt as if something was stuck in his throat and he had to clear it often.

The 28-year-old visited the physician and each time he was given some cough mixture. However, the cough remained.

“I had short-term relief from the coughing when I took the medication. But then the coughing would start again. After a while, I thought it was because I smoked.”

Last month, John began to lose his hearing. He could make out sounds but could not understand them. Afraid that he was becoming deaf, he consulted an ear, nose and throat (ENT) specialist who told him he was suffering from laryngopharyngeal reflux (LPR).

The backward flow of acid — from his stomach into his throat — had caused the coughing and irritation. Since his condition was not diagnosed properly, over time, the liquid moved up to his upper respiratory tract and blocked his middle ear, causing hearing loss.

The cause was John’s unhealthy lifestyle. As he worked in customer service, he did not take meals on time and often ate heavy meals late in the day. He was also drinking too much coffee, he admits.

To add to that, he was a heavy smoker and was overweight.

“The acid in my stomach was moving up to my throat especially since my upper sphincter was not working properly. However, I did not feel any burning sensation. The only symptoms were the coughing and irritation in my throat,” he says.

John underwent minor surgery to drain the liquid in his eardrum. In addition, he had to take medication before meals to control acid reflux. He was also told to avoid ice-cream, chocolate, tomato, acidic fruit and oily, spicy food.

“The doctor told me I had to modify my lifestyle — that I must reduce the amount of coffee and the smoking, that I should not skip meals but have frequent light ones instead,” he says.

“I am slowly trying to change my lifestyle. It is difficult especially giving up coffee and smoking. Previously, I smoked one packet of cigarettes a day. Now I’m trying to stretch a packet to two days. I’m also drinking only one cup of coffee a day.”
If his condition persists, John will need surgery to tighten the upper sphincter but this is the last resort.

Another LPR sufferer, Siti Salmah Sheikh Abod, used to feel that something was perpetually stuck in her throat. While she did not feel pain, it was difficult to swallow. She also felt a burning sensation near her throat. Siti Salmah tried various methods including gurgling with tamarind juice and salt water, but they did not work.

“I was afraid to go to the doctor. I ignored the discomfort because I wanted to believe it would go away. But it didn’t and I went to the doctor who did an endoscopy. She found red spots in my throat due to LPR which had caused the irritation.”

Siti Salmah’s unbalanced diet — missing meals and drinking coffee — had contributed to the problem. She took only coffee for breakfast, had fruit and crackers for lunch and a heavy dinner. The lack of proper food was causing acid in her stomach to flow up her upper sphincter into her throat.

Fortunately, the condition was caught early before further damage was done. She was given medication to control the acid reflux and was advised to modify her eating habits.

“Now I have proper meals and have reduced coffee intake. I have either toast or oats for breakfast and I eat my meals on time. I’m also eating more vegetables and fruit.”

Tropicana Medical Centre consultant ENT, Head and Neck surgeon Dr Mallina Sivarajasingam says as many people do not practise a healthy lifestyle, LPR is becoming more common although many don’t realise they are suffering from it.

The structures in the throat (pharynx and larynx) are much more sensitive to acid and digestive enzymes, so small amounts of reflux into this area can result in more damage. The reflux causes a burning sensation in the throat which then leads to frequent throat clearing, chronic cough, difficulty in swallowing and voice change.

“People who suffer from these symptoms think it is a normal sore throat. They go to a general physician who treats it with antibiotics as they are unaware of the underlying cause of the illness.

“Antibiotics offer short-term relief but eventually they develop the symptoms again. Eventually, it affects their productivity and lifestyle.”

Misdiagnosis often leads the patient to ignore their condition. They think that they will eventually recover. However, Dr Mallina says, recurrent episodes of sore throat and discomfort without fever, need to be checked.

Some LPR patients won’t feel the burning sensation because acid from the stomach will spurt up like a fountain into the throat. This may last only a few seconds and the patient may not even realise it’s happening. Hence, the term silent reflux.

“Usually, by the time I see the patient, he or she has been suffering from these symptoms for quite some time. The diagnosis is made by taking a detailed history from the patient and performing an outpatient endoscopy of the larynx. This will reveal a red, irritated, swollen larynx and in more severe cases, ulcers and granulomas.

“Acid reflux can also reach the nasopharynx which causes post-nasal drip and middle ear effusion, which leads to hearing loss.”
The cause of LPR is mainly related to unhealthy lifestyles. People who are stressed and have an unhealthy diet, the obese and those who smoke and drink are at risk.

“Oily, spicy food, skipping meals, having heavy meals late at night and a high intake of caffeine are also among the causes. I have seen an increasing number of people with this condition over the years. This is due to the fact that many of us lead busy, unhealthy lifestyles. Women too seem more prone to this condition.”

Treatment for LPR reduces risks through lifestyle modifications. It involves keeping a balance between injury and repair such as taking medications and, most importantly, educating the patient regarding eating habits as well as lifestyle alterations. Eventually, the goal is to wean off medications and to keep the effects of acid reflux under control through behavioural and dietary modifications.

“If patients do not change their lifestyle, they will suffer from LPR again. Two episodes of reflux in a week can cause significant damage to the upper aerodigestive tract. Studies have also found that long-term consequences of LPR include severe degradation of voice and even laryngeal cancer. Although it may not be the primary cause of laryngeal cancer, it is certainly a precipitating factor.”

Lump that won’t go away

IN laryngopharyngeal reflux, stomach acid backs up into the throat (pharynx) or voice box (larynx), or even into the back of the nasal airway because the sphincters don’t work properly.

Unlike gastroesophageal reflux disease, patients won’t feel the burning sensation in their lower chest. Instead they have excessive throat clearing, persistent cough, hoarseness, a “lump” in the throat that doesn’t go away with repeated swallowing, a sensation of postnasal drip or excess throat mucus, trouble swallowing, trouble breathing and sore throat.

Some patients respond well to lifestyle modification and medication. However, others need more aggressive and lengthy treatment including surgery.

Managing acid reflux
1. Have small meals more frequently.
2. Nibbling is good.
3. Have dinner three hours before bedtime and avoid heavy meals before you sleep.
4. If you must eat, have a light supper.
5. Avoid processed meat.
6. Stop smoking.
7. Drink alcohol in moderation.
8. Manage your stress.
9. Avoid painkillers.
10. Be very careful with traditional medication, aspirin and steroids.
11. Calcium, iron tablets and glucosamine can sometimes irritate the stomach.

Read more: Silent threat – Health – New Straits Times

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