Dear Doctor Jahn,
How does acid reflux actually irritate the voice? If acid is coming up in your esophagus, how does it irritate the vocal cords, given that they are in the wind pipe?
Thank you for your thoughtful question. You’re right, when stomach contents (acid and enzymes) reflux up the esophagus, they enter the throat behind the larynx. Depending on the amount of material, it can spill over the ridge of tissue that separates the top of the esophagus from the larynx (the interarytenoid area), and cause irritation. In fact, this tissue, between the arytenoid cartilages is often red and swollen with reflux, and this finding is one of the cardinal signs of acid reflux. It is however extremely uncommon for acid to actually spill into the larynx or to damage the vocal folds directly.
For this reason, I’m always upset when a doctor scares a singer by saying “your vocal cords are burned by acid”. This is an unnecessary exaggeration, and does the patient a disservice. The commonest vocal effect of acid reflux is an irritation of the pharynx. This causes irritation of the muscles around the larynx and results in an elevation of the larynx.
There are also neurologic receptors in the pharyngeal wall which, when irritated, cause the vocal folds to tighten and come together. The net effect is an increase in muscle tension, which makes it more difficult to sing freely, causes problems negotiating the mix, and decreased resonance and power due to pharyngeal constriction.
-Anthony F. Jahn, MD, FACS, FRCS(C)
This discussion is for general information and not to be construed as specific medical advice that you should obtain from your own physician.
Dr. Jahn is an internationally renowned otolaryngologist based in Manhattan with a sub-specialty interest in the professional voice. His practice includes classical and popular singers. He holds academic appointments at Mount Sinai School of Medicine and Westminster Choir College in Princeton. He is Medical Director at Jazz at Lincoln Center, and former Director of Medical Services at the Metropolitan Opera in New York. Dr. Jahn has published several books for vocalists, including “Vocal Heath for Singers” (Singdaptive) and “The Singer’s Guide to Complete Health” (Oxford University Press).