Why do I always have bad breath?
Bad breath may be associated with several other symptoms and these include:
- Needing to clear the throat frequently
- Feeling a lump in the throat
- Chronic cough
- Chronic Hoarseness
- Excess phlegm or mucus
- Difficulty swallowing
- Burning sensation at the back of the throat
- Acidic or bitter taste in the mouth
Many of these symptoms are worse in the morning. Some peoples may also experience heartburn, chest pain or indigestion.
What does this all mean?
This may suggest that you are suffering from Laryngopharyngeal Reflux (LPR) which refers to the backflow of food or stomach acid up to the larynx (voicebox) or the pharynx (throat).
What causes LPR?
LPR can be caused by a weakness in the closure of the sphincter muscles between the stomach, esophagus (food channel between the throat and stomach) and pharynx (throat).
Often, it is related to the lifestyle and eating habits. Caffeine, spicy foods, chocolates, citrus foods, alcohol and smoking can aggravate reflux. Lying down after eating causes stomach contents to flow back onto the throat area, causing irritation. Being overweight and increased levels of mental stress can also cause reflux.
How do I know if I have LPR?
The best way to determine if you have LPR is to undergo 24-hour pH probe study. This is a procedure where a small tube is placed in your esophagus. It measures the level of acidity at the bottom of your esophagus and the area of your voicebox. At the end of the study, a computer print out reveals how much gastric acid your larynx was exposed to during that time.
The ENT doctor will usually perform a throat examination which allows him to see signs of reflux irritation on the larynx. Symptoms such as redness, excess phlegm, and swelling of the voicebox are common manisfestations of reflux laryngitis.
Sometimes, the ENT doctor will prescribe anti gastric acid medication based on the physical findings, to see if the symptoms are relieved. If so, diagnosis of LPR is presumed positive.
How is LPR treated?
LPR is usually treated with medication and a change in lifestyle. In addition, it is important to make changes in eating habits and stress management.
What can I do to minimize LPR?
- Quit smoking
- Limit alcohol as this weakens the esophageal sphincter
- Avoid caffeine – eg tea, coffee, soft drinks with caffeine, chocolates
- Limit food high in fat content – eg fried, oily and creamy foodstuffs
- Avoid mints
- Avoid spicy foods
- Avoid citrus food and juices
- Eat meals at least 3-4 hours before going to bed
- Eat moderate amounts of food
- Lose weight if you are overweight – it increases intra-abdominal pressr, which can aggravate reflux
- Elevate the head of your bed with blocks
- Be aware of how stress might be playing a role