What Is LPR? What Is the Pharynx?

Laryngopharyngeal reflux (LPR), also called respiratory reflux, is a form of acid reflux that affects the throat, voice box, and airways—rather than just the esophagus. Unlike classic GERD, which is associated with heartburn and indigestion, LPR often causes subtle or “silent” symptoms that can affect speaking, swallowing, breathing, sleep, and even ear function.

Understanding the pharynx—the region where the respiratory and digestive tracts intersect—is key to understanding how reflux can affect so many parts of the body.

What Is LPR (Respiratory Reflux)?

LPR, or laryngopharyngeal reflux, occurs when stomach contents travel beyond the esophagus and into the pharynx (throat) and larynx (voice box). I coined the term LPR in 1987 to distinguish what I was seeing in my patients—throat, voice, and airway symptoms—from the typical heartburn and esophageal issues of GERD.

Later, in 2017, I introduced the term respiratory reflux as a simpler, more intuitive way to describe the same condition. Unlike GERD, which primarily affects the digestive tract, respiratory reflux involves the entire respiratory system—from the nose and sinuses down to the lungs.

The symptoms of respiratory reflux are varied and often resemble unrelated conditions, which is why the diagnosis is frequently missed or delayed. These symptoms can include:

• Voice problems like hoarseness, vocal fatigue, and effortful speech
• Chronic throat issues such as frequent clearing, post-nasal drip, or a sensation of something stuck in the throat (globus)
• Ear-related symptoms including pressure, pain, tinnitus, or muffled hearing
• Respiratory complaints like chronic cough, shortness of breath, wheezing, or asthma-like symptoms
• Sleep disruptions, including loud snoring or obstructive sleep apnea
• Difficulty swallowing, or the feeling that food isn’t going down easily

In many of these cases, patients don’t experience heartburn at all, and respiratory reflux can go unrecognized for years—even in people with serious symptoms.

What Is the Pharynx—and Why It Matters in Reflux

The pharynx is a complex, vital anatomical region that stretches from behind the nose down to the top of the esophagus and windpipe. It’s divided into three main parts:

• Nasopharynx – the upper section, located behind the nasal cavity
• Oropharynx – the middle section, at the back of the mouth and throat
• Hypopharynx – the lower section, just above where the airway (trachea) and food pipe (esophagus) separate

Because both air and food pass through the pharynx, it serves as a shared space for two systems: respiratory and digestive. This dual function is why the pharynx is often referred to as the aerodigestive tract.

I often describe the pharynx as the Grand Central Station of the human body. It’s where everything—air breathed, food swallowed, and refluxed material coming up—converges and crosses paths. This constant intersection makes the pharynx especially vulnerable to irritation and inflammation from reflux.

When acid and digestive enzymes reach this area, they don’t just cause discomfort—they can disrupt one or more systems, often in ways that seem unrelated. That’s why LPR symptoms can seem so scattered or unrelated: one person may notice chronic cough, another may struggle with swallowing, and someone else might experience sleep disturbances or ear pressure.

Understanding the structure and function of the pharynx is essential to understanding why respiratory reflux can affect so many seemingly disconnected parts of the body.

LPR in the Ears and Sinuses (Nasopharynx)

The nasopharynx houses the openings of the eustachian tubes, which help regulate pressure in the middle ears. Every time you swallow, these tubes briefly open—a sensation often felt as a small “click” in each ear.

When reflux reaches the nasopharynx—especially during sleep—it can inflame the tissues surrounding these tubes. That inflammation interferes with normal pressure regulation, leading to symptoms such as:

• Ear pressure or fullness
• Pain or discomfort
• Muffled hearing
• Tinnitus (ringing in the ears)

Reflux-related inflammation in this region can also contribute to post-nasal drip, sinus congestion, and even chronic sinusitis—conditions often attributed to allergies or infections but sometimes rooted in silent reflux.

LPR in the Throat and Palate (Oropharynx)

The oropharynx is the middle section of the pharynx, located just below the nasal cavity, at the level of the soft palate and uvula—the small, teardrop-shaped structure that hangs at the back of the throat.

When reflux reaches this area, especially during sleep, it can cause significant swelling of the palate and uvula. In some cases, the uvula becomes so enlarged that it rests on the tongue or even makes contact with the larynx, triggering sensations of gagging, choking, or throat irritation. This is often misdiagnosed, and many patients are referred for palate or uvula surgery, while the underlying cause—long-standing reflux—goes unrecognized.

Symptoms related to reflux in the oropharynx may include:

• Swollen or elongated uvula
• Snoring, often loud and disruptive
• Obstructive sleep apnea
• Choking or gagging sensations
• A feeling of throat tightness, especially at night

When the oropharynx becomes swollen from years of reflux, its normally wide, open space—roughly the size of a golf ball—can shrink down to something closer to a marble. As the tissue thickens and stiffens, airflow becomes restricted, contributing to sleep-disrupting symptoms.

This condition is often treated surgically, but in many cases, the procedure is unnecessary—and it doesn’t resolve the underlying issue. When inflammation is the result of reflux, the focus should be on addressing its cause rather than removing tissue affected by it.

The encouraging news is that this kind of swelling is often reversible. With a comprehensive reflux management plan—centered on dietary changes and lifestyle adjustments, the tissue can return to its normal state, reducing or eliminating symptoms without the need for surgery.

LPR in the Voice and Airway (Hypopharynx)

The hypopharynx, also known as the laryngopharynx, is the lowest part of the pharynx. It sits just above the point where the respiratory and digestive tracts divide—where the airway (trachea) and the swallowing tube (esophagus) separate.

Voice and Vocal Cord Symptoms

At the center of this region are the vocal cords, which not only produce sound but also protect the airway by closing during swallowing. When irritated by reflux, they can become swollen, stiff, and less effective—leading to a range of symptoms including:

• Hoarseness
• Vocal fatigue
• Effortful or strained speech

These issues are especially common in people who rely on their voices professionally, such as singers, teachers, or speakers. In many cases, the inflammation resolves with proper reflux management—without the need for voice therapy or vocal surgery.

Reflux and Lower Airway Involvement

If reflux travels below the vocal cords and enters the trachea or lungs, it poses a more serious risk. At this level, it may contribute to the development or worsening of respiratory conditions, including:

• Chronic cough
• Asthma
• Bronchitis
• COPD

These symptoms often lead patients to pulmonary specialists or allergists, when the underlying driver may be reflux. Recognizing this connection is critical for accurate diagnosis and effective treatment.

Swallowing, Globus, and the UES

Also located in the hypopharynx is the upper esophageal sphincter (UES)—a muscular valve that opens during swallowing and closes to keep reflux from rising back into the throat.

When reflux irritates and inflames the UES, its ability to function properly declines. Over time, this can create a cycle of worsening reflux and new symptoms such as:

• A sensation of a lump in the throat (globus)
• Difficulty swallowing (dysphagia)
• Sensations of tightness or incomplete swallowing

The good news is that most UES-related symptoms are reversible. With a consistent reflux control plan—including diet and lifestyle changes, normal valve function can often be restored.

Beyond the Pharynx: LPR and Oral Health

Although the oral cavity lies outside the pharynx, it can also be affected by reflux—especially when stomach contents reach the mouth during sleep.

LPR may contribute to a range of dental issues, including gum inflammation, enamel erosion, and rapid dental decline, even in adults with no prior history of oral health problems. These symptoms are often overlooked as possible signs of reflux. I explore this connection in more detail in this post on reflux and oral health.

Conclusion: Recognizing and Reversing LPR

LPR is often overlooked because it may cause symptoms in the ears, throat, and lungs—many of which aren’t commonly recognized as reflux-related.

The reason for this wide range of effects lies in the pharynx, the shared pathway of the respiratory and digestive tracts. When reflux reaches this vulnerable region, it can disrupt multiple systems and cause symptoms that are frequently misdiagnosed or treated in isolation.

The good news is that in most cases, the damage caused by LPR is reversible. Healing depends on a comprehensive approach that includes consistent dietary and lifestyle changes to reduce reflux and support recovery. Addressing the root cause, rather than just the symptoms, can make all the difference.

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For more information about diagnosis and treatment of acid reflux, see two companion books on Amazon: Dr. Koufman’s Acid Reflux Diet and Dropping Acid: The Reflux Diet Cookbook & Cure. If you would like to receive personalized guidance and strategies for lasting relief, consider scheduling an online consultation.