LPR

Mmm...laryngopharyngeal reflux (LPR). Apparently, I have it.

I've been learning about it in my voice disorders class. It's when gastroesophageal reflux/acid that causes "heart burn" gets up to the level of the vocal folds and causes irritation. It can cause your voice to go hoarse, it can make you clear your throat a lot, etc. If it's really bad, there are medications that can help control the reflux, but I haven't really been symptomatic, although looking back I can see very subtle symptoms of it (e.g. coughing in the middle of the night, as gastric acid is most likely to go up the esophagus as I'm lying down).

How did I find out that I have LPR?

Earlier this week I decided to calculate my s/z ratio just for fun. This ratio is a test that SLPs can do to screen for a possible vocal fold pathology. The client takes a deep breath and produces the /s/ sound for as long as possible and then does the same thing for /z/. The sounds are the same except that /s/ is voiceless, meaning the vocal folds are apart during production and /z/ is voiced, meaning the vocal folds are together and vibrating. Normal ratios are 1:1. If it's greater than 1.4 it means that /z/ is shorter than /s/ and too much air is escaping between the vocal folds as a result of nodules or polyps or some other pathology. I was shocked to find that my s/z ratio was 1.5. I thought "No way, I don't have nodules or anything, this s/z ratio is bogus". And I kind of dismissed the whole thing.

Then a few days later it my last day at my clinical placement and I finally got a chance to be videostrobed. I was so excited. I couldn't wait to get a picture of my vocal folds. But my supervisor had a hard time getting a clear picture because 1) I was drooling a lot and it was making the picture foggy and blurry, 2) My oropharynx is small so by the time the strobe got past my tongue and epiglottis to see into my airway it was already up against the back of my throat and 3) My vocal folds are pretty far down my airway. Well, anyway, she was still able to get some images and as she was watching them on the monitor she goes "I hate to tell you this, but you have reflux!" What?! Not possible! Reflux is what old people get when they eat spicy food!

So I have LPR. It explains the s/z ratio. When your vocal folds are irritated by the acid they get inflamed and swollen and they may not fully come together during phonation, thereby allowing air to escape. I've had no other symptoms, no "heart burn", no hoarsenes, nothing other than a bit of coughing in the middle of the night, which I have always attributed to dry air.

Here are the pictures. Don't get grossed out. I'm really proud of them : )

Okay, back to studying. I just spent the last hour and a half posting when I should have been spending my limited supply of energy on exam prep and paper writing. Bah.