Voice Problems: Your Stomach is Connected to Your Throat

Would you consider yourself someone who uses their voice a great deal? Whether it's at work, at home, as a singer, or as a professional voice artist, do you depend on your voice more than the average individual? If so, you know when something is abnormal in your voice function. Symptoms can include hoarseness, throat clearing, thick mucus in the throat, cough, post nasal drip, a lump-like feeling in the throat and trouble swallowing, and they all greatly affect your quality of life.

Posted on | Jonathan E. Aviv, MD, FACS | Comments ()

Would you consider yourself someone who uses their voice a great deal? Whether it's at work, at home, as a singer, or as a professional voice artist, do you depend on your voice more than the average individual? If so, you know when something is abnormal in your voice function. Symptoms can include hoarseness, throat clearing, thick mucus in the throat, cough, post nasal drip, a lump-like feeling in the throat and trouble swallowing, and they all greatly affect your quality of life.

Your voice abnormality may be a change in pitch, voice fatigue, cracks or breaks when speaking or singing, or difficulty being heard in noisy environments (restaurants, bars, talking on cell phone outdoors). Do any of these symptoms and scenarios sound familiar? If so, what may be causing these annoying and sometimes debilitating symptoms?

While there are a variety of causes for throat and voice-related problems, one of the most common causes of these issues is stomach acid traveling the wrong way, up towards the throat and vocal cords. The most common response I hear from my voice patients when I tell them their voice problems result from acid reflux is, "Well I don't have heartburn, so this couldn't possibly be the cause of my problems."  What many people are not aware of is that heartburn (acid reflux) is more common than you think because there are types of acid reflux that don't cause the classic symptoms we all tend to think of, the sensation of burning or irritation in the chest and/or stomach, or food regurgitation.

The fact is normally we all reflux acid from the stomach into the esophagus (the organ that connects the throat to the stomach). Reflux is the term for material that goes in reverse or the wrong way.  It is normal to reflux acid into the esophagus an average of 50 times per day. We usually don’t feel those regular reflux incidents because the esophagus is adapted to handle the stomach acid.

However, if even one of these 50 normal acid reflux events climbs beyond the esophagus and up into the throat, damage is immediately caused to the throat tissues. This is called silent reflux or reflux laryngitis or LPR (LaryngoPharyngeal Reflux). The stomach acid causes a burn, and the burn in turn causes swelling. When sensitive throat tissues start to swell, hoarseness, throat clearing, alterations in voice pitch can all take place.

So now that we understand why our stomach activity can affect our voice, what does one do when they begin experiencing throat and/or voice symptoms? The first thing to do is to check your lifestyle and diet. Are you smoking? Do you consume a diet high in caffeine, chocolate, alcohol, mint, acidic foods (citrus), or high fat content? If the answer is yes, these items increase acid production from the stomach. Nicotine, caffeine and alcohol are the worst offenders on this list as they not only increase acid production but also disrupt the normal muscular separation between the stomach and the esophagus, thereby making those substances a 1-2 punch as far as acid production and anatomically making it easier for acid to travel the wrong way.

For further information on diet alterations to treat acid reflux see my previous blog, Treating Acid Reflux with Your Diet.

If changes in lifestyle and diet are not enough to control your symptoms then additional treatment in the form of daily antacid medication may be necessary. Since the throat related symptoms from acid reflux are so varied, if you are experiencing persistent throat symptoms for more than 2 weeks, please see your doctor.

Blog written by Jonathan E. Aviv, MD, FACS
Author of over 60 scientific papers in peer-reviewed journals and Flexible Endoscopic Evaluation of Swallowing with Sensory...