Trending
DEAR DR. ROACH: Can you give me information about laryngopharyngeal reflux? I develop a croaky voice at times and have lots of mucus in the morning (which doesn’t get coughed up), among other things. Is diet alone enough to remedy the problem? I’m going in for a vocal cord vibration test. -- M.M.
ANSWER: Gastroesophageal reflux disease (GERD) is when the acid in the stomach doesn’t stay where it belongs and goes backward into the esophagus. There’s a structure called the lower esophageal sphincter (LES) that’s supposed to keep the acid in the stomach, but sometimes it doesn’t work right. This can cause the classic symptom of heartburn, as well as other symptoms.
Laryngopharyngeal reflux (LPR) is a special type of GERD where the acid gets all the way up into the back of the throat. Symptoms include throat clearing, hoarseness, a cough that’s worse when lying down or after eating, excess mucus in the throat, a sour taste in the mouth, and voice changes such as hoarseness.
The vocal cord test will be looking for “paradoxical vocal cord motion disorder,” which is strongly related to LPR. It usually causes trouble breathing, as well as a noise upon inspiration (“stridor”). Throat tightness and difficulty swallowing are also possible with this condition.
As far as treatment goes, dietary changes (and other lifestyle issues) are necessary but aren’t always sufficient to solve the problem. The most helpful dietary changes include decreasing fatty and spicy foods, acidic foods (especially tomatoes, sodas and citrus juice), and substances that weaken the LES -- especially nicotine, caffeine (coffee, tea, chocolate) and alcohol.
Other lifestyle issues may be even more critical than food choices. Not eating for 2 or even 3 hours before bed ensures that the stomach is empty so it has less acid at night when it’s most important. Keeping the head of the bed elevated uses gravity to help drain any acid that escapes the stomach. (A brick under the bed is more effective than pillows.) Smaller meals keep the stomach pressure down.
Some studies have found that these lifestyle changes are even more effective than medication, yet we doctors don’t spend as much time as we should emphasizing them. When lifestyle changes aren’t enough, medications like proton-pump inhibitors are used. I usually try these for three months. If symptoms persist, I refer my patients to an ear, nose and throat physician for a laryngoscopy to confirm the diagnosis.
DEAR DR. ROACH: Compared to the general population, what’s the likelihood of a cancer survivor contracting a new cancer (either the same type or unrelated)? — A.M.
ANSWER: Unfortunately, people who’ve had cancer once are at a much higher risk than the general population to get a second cancer. This can sometimes be of the same organ (unless it’s been surgically removed) and of different organs as well.
The likelihood somewhat depends on the cancer; for example, a woman who’s had breast cancer is at a 20% to 30% higher relative risk of getting colon cancer, particularly if she was diagnosed at a younger age. However, in absolute terms, her risk is much higher of getting breast cancer again.
In absolute terms, a woman who gets diagnosed with breast cancer at 50 has about a 1% chance of colon cancer and a 16% chance of getting breast cancer again by age 80. These estimates can vary dramatically based on the genetics and receptor status of the initial breast tumor. This is why we work so hard to reduce the risk with medication (“chemoprevention”) and increased screening whenever possible.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved