Maybe It’s Not Allergies- Post-Nasal Drip and Cough Can Be Signs of Reflux
Most people have heard of acid reflux, or gastroesophageal reflux, also known as GERD. Did you know there is another type of reflux, known as laryngotracheal (LTR) or extra-esophageal reflux (EER)? People with LTR may not have any heartburn or indigestion symptoms. LTR sufferers complain of sinus and allergy symptoms, such as stuffy nose, post-nasal drip, and cough. Other symptoms reported are non-productive cough, hoarseness, pain with swallowing, and the sensation of having a lump in the throat.
Gastroesophageal Reflux (GERD)
When we eat, the food passes down our esophagus into the stomach. The esophagus is a slender tube, and the stomach is like a holding tank. There is a sphincter at the junction of the two structures. Ideally this sphincter is a one way valve that helps keep food and beverages moving in one direction. The stomach produces acid to digest food. Sometimes, the acid & other stomach contents backwash into the lower esophagus. This backwash tends to cause the symptoms we associate with reflux, such as heartburn.
Anatomy for Air and Food Passages
Dr. Kurt Barrett
Dr. Kurt Barrett has a different perspective on reflux. He is a physician who felt helpless to relieve the allergy suffering of his daughters. His girls had terrible allergies that did not respond to treatment. As it turned out, the reason they did not respond to treatments aimed at allergies, is because they did not have allergies! They had reflux.
Dr. Barrett proposes that as many as 50% of reflux sufferers do not have any symptoms commonly associated with reflux, such as heartburn and indigestion. Instead they have symptoms such as sore throat, hoarseness, phlegm, nasal stuffiness, post-nasal drip, coughing, and choking.
Allergy Medicine Does Not Help
Reflux and Pneumonia
Dr. Barrett explains the phenomena of sinus and allergy symptoms with reflux. The body produces mucous to coat the pipes, so to speak. This response is triggered by acid entering the lower esophagus, and creeping upward toward the larynx and trachea, where it could gain entry into the lungs. The mucous is an attempt to protect the lungs.
Sometimes stomach contents do rise up the esophagus to the trachea, and spill over into the lungs. This series of events could result in pneumonia. When this happens, we would call it aspiration pneumonia. Young children and the elderly seem to be particularly vulnerable to aspiration pneumonia. If someone gets one or two episodes of pneumonia per year, especially if they are known to have reflux, then aspiration should be considered.
Sinusitis and Ear Infections
The Sinus Info Center notes stomach acid sometimes travels as high as the throat and voice box, and even higher. They note symptoms such as sore throat, hoarseness, throat clearing, painful swallowing, and a feeling of fullness in the throat. Acid can cause sinusitis in children and adults, and ear infections in children.
Dr. Robert O’Reilly and his team, at DuPont Hospital for Children in Delaware, published a study in 2008 on the incidence of reflux in children with chronic ear infections. The study included over 500 children with chronic ear infections, and 64 children with no history of ear infection. They found the stomach enzyme pepsin in the ear canals of 20% of the children with chronic otitis media. You can find a short, easy to read summary of this study on Dr. Russell Faust’s website. He also has an article on childhood asthma linked to reflux.
Physical Findings of Laryngotracheal Reflux
In his book, Are You Sick of Being Sick?, Dr. Barrett describes physical findings associated with reflux. In his practice he found changes in the appearance of the uvula and ear drum. He also noted swelling and scarring of the nasal turbinates. These findings can be crucial in the diagnosis of the client who has reflux, with no common gastric symptoms like heartburn.
My Own LTR Story
I’ve probably had reflux my entire life. I was hospitalized with pneumonia when I was four years old. As the story goes, I had not been sick, not even a sniffle, then woke my dad in the night because I was having trouble breathing. As a child, my grandmother said I had borderline asthma, not that that’s a real thing. As a teen, I often had a stuffy nose, and sometimes had to sit up in bed because that seemed to relieve my stopped-up nose.
By the time I was an adult, I considered myself a life-long allergy and sinus sufferer. I even tested positive multiple times for dust and dust mites. In hindsight, funny thing is, I virtually never sneezed, had a runny nose, nor itchy, watery eyes. In my early 20s, I started having a major episode of presumed sinus issues every fall, with post-nasal drip and coughing that was so bad it required prescription meds to clear it up. By my mid-30s, I was having four to six episodes a year of sinusitis and sinus infection, for which I was prescribed anti-biotics. I finally got relief using Dr. Robert Ivker’s Sinus Survival program.
In my early 40s, I started having what was presumed to be terrible allergies. Despite higher and higher doses of antihistamines, my post-nasal drip got worse and worse. I coughed constantly, and sometimes gagged and wretched. My symptoms were waking me three to five times a night. This progressed to the point of sometimes waking me ten to twelve times a night. At this point, I wasn’t sleeping much at all, and had taken to sleeping in a recliner, which helped a little.
Things were so bad that I had spoken to an Air Force colleague, a psychologist, to consider at what point I would need to be removed from patient care as an occupational therapist. My symptoms had been going on for nine months. It’s a very long story that perhaps I will tell sometime in another article. For now, I’ll give the short version. I was sent to an ENT sinus specialist, who suggested reflux and gave me Prevacid, a reflux medication. Unfortunately it did not help at all, and I suffered another four to five months.
Finally! Relief with Reflux Medication
In my own experiment, I tried Primatene Mist, an asthma inhaler, and Prilosec, a different reflux medication. The Primatene Mist didn’t seem to make an impact. My symptoms were better after four days on Prilosec, and at two weeks, I slept through the night for the first time in nine months. About five years later, a physician’s assistant told me I likely had laryngotracheal reflux. I did some online research, and finally things all made sense.
Hard to Diagnose
The bottom line is this: Laryngotracheal or extra-esophageal reflux is hard to diagnose. Most clients with allergy symptoms are going to be treated for allergies. Many sufferers go for years without being correctly diagnosed. If they are being treated for allergies, when their symptoms are actually caused by reflux, they will not get meaningful relief.
Talk to Your Health Care Provider
This article is not intended to be a substitute for professional medical advice, diagnosis or treatment. Consult your doctor or alternative medicine provider.
There are multiple links above in the body of my article. Here are a few more resources you might find interesting and helpful.
Sinusitis Causes- Inflammatory and Infectious Causes- Reflux, on SinusSuccess Blog
O’Reilly et al., The role of extraesophageal reflux in otitis media in infants and children. Laryngoscope, 118 (Suppl. 116): 1-9; 2008.
Barrett, K.A.(2002). Are You Sick of Being Sick? Michigan: Barrett Publishing.
My article on strategies to manage reflux.
This article is about my personal experience with reflux and home remedies. Dietary modifications, natural digestive strategies, natural products for symptom relief, sleep recommendations, chiropractic adjustment and more.
Elevate the Head of the Bed
Questions & Answers
I have had a cough for over ten years. I have tried every inhaler, every allergy, and acid reflux medicine--nothing helps. My phlegm comes from my lungs or chest and goes to my throat and makes me cough. Can you help?
Since it seems that Western medicine has not helped you, I would look into alternative and natural medicine. Consider going to a naturopath, homeopath, herbalist, or acupuncturist.Helpful 29
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