Stop Acid Reflux from Stealing Your Voice

When it comes to acid reflux, singers and speakers who are dependent on their voices to perform or communicate in dynamic ways on a daily basis, are particularly vulnerable. This is because everything that affects your body, or your “instrument” in this case, can directly affect your voice. 

When stomach acid backs up into the esophagus, it can cause irritation and inflammation of the vocal folds and surrounding areas. This inflammation can lead to a scratchy or sore throat, reduced vocal range, poor tonal quality, chronic coughing, and general fatigue. 

In this blog, we will explore everything you need to know about reflux, including what can cause it, how it can affect your voice, and what you can do to reduce GERD and its symptoms. Let’s begin!

Acid reflux can go by many names; heartburn, gastroesophageal reflux disease (GERD), silent reflux, and acid indigestion. However, laryngopharyngeal reflux (LPR) tends to be the leading culprit in damaging the vocal folds and silencing singers. This is because LPR reaches the larynx (voice box) and can cause a sore throat, hoarseness, and chronic cough. One of the most frustrating aspects of LPR is that you may not even feel it! This is where the term “silent reflux” comes from, which means it doesn’t cause uncomfortable heartburn often associated with reflux issues.

LPR happens when the acidic contents of your stomach travel backward up your throat, beyond the upper esophageal sphincter. This is different from gastroesophageal reflux disease (GERD) and is more likely to happen in the daytime when you’re upright, whereas GERD tends to occur more at night when lying down.

So, why does this happen? Well, there are two ring-shaped muscles known as sphincters that control the passage of food along the esophagus. The first sphincter is where the pharynx transitions to the esophagus, and the second is called the lower esophageal sphincter, which sits at the gastroesophageal junction. If the lower muscle weakens or becomes damaged, digestive juices like stomach acid can flow into the esophagus and cause that burning sensation we know as heartburn.

Now, when it comes to LPR, the larynx and pharynx are more susceptible to chemical trauma from pepsin and acid. And the inflammation caused by LPR can cause the vocal folds to swell, giving the speaking voice a raspy quality and often lowering the pitch of one’s speaking voice. Singers may experience vocal fatigue and loss of range when singing. Some laryngologists (voice specialists) believe that LPR also puts patients at greater risk for nodules, polyps, and other vocal fold disorders.

!! IMPORTANT !! Before we go any further, let’s take a quick moment to point out that just because you might experience heartburn or your voice is fatigued and hoarse, it DOES NOT automatically mean that you suffer from GERD or that your singing voice is permanently damaged in any way! 

Because your vocal instrument is hard-wired to your brain, additional stress and worrying about your voice can cause muscle tension throughout your body and generate more reflux symptoms. So take a deep breath, don’t make any assumptions, and let’s learn more about acid reflux below with lots of tips and potential solutions for you and your singing voice. When in doubt, simply schedule an appointment with your doctor to discuss your concerns. 

Don’t let the possibility of reflux get in the way of your singing and quality of life!

Here are 10 commonly associated causes of acid reflux (in no particular order):

1. Certain foods: Some foods are known to trigger acid reflux in susceptible individuals, including spicy foods, citrus fruits, tomatoes, onions, chocolate, caffeine, and fatty or fried foods.
2. Hiatal hernia: This occurs when the upper part of the stomach protrudes through the diaphragm, allowing stomach acid to flow into the esophagus more easily.
3. Pregnancy: Hormonal changes and the growing uterus can put pressure on the stomach, increasing the risk of acid reflux in pregnant women.
4. Stress: Chronic stress and anxiety (including stage fright) can affect the digestive system, including the functioning of the lower esophageal sphincter, potentially leading to acid reflux.
5. Medications: Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), aspirin, sedatives, and some blood pressure medications, can contribute to acid reflux symptoms.
6. Alcohol: Consuming alcoholic beverages can relax the lower esophageal sphincter, making it easier for stomach acid to flow back up into the esophagus.
7. Obesity: Excess weight can put pressure on the abdomen, leading to the backward flow of stomach acid into the esophagus.
8. Eating large meals or lying down after eating: Overeating can cause the stomach to stretch, putting pressure on the lower esophageal sphincter. Additionally, lying down or bending over after a meal can increase the likelihood of acid reflux.
9. Smoking: Cigarette smoke can irritate the esophagus and weaken the lower esophageal sphincter, a muscle that helps prevent acid reflux.
10. Carbonated beverages: The carbonation in soda and other fizzy drinks can cause bloating and increase the pressure on the stomach, triggering acid reflux symptoms.

As a vocalist, it’s important to note that many of the items listed above may or may not have an immediate or obvious impact on your voice. This is because everyone has different thresholds due to genetics, lifestyle, personality traits, immune systems, allergy sensitivities, and so on. 

Another factor to consider is the pressure generated by singing itself. According to Dr. Reena Gupta, an LA-based laryngologist, the breath control demands of singing can create intense pressure from the diaphragm on the stomach and the valve muscle at the top of the stomach, which normally prevents reflux. If you already have excess gas pressure in your gut, the added pressure of singing could be the tipping point that causes refluxate to enter the esophagus.

Acid reflux, or GERD, can have symptoms that overlap with other common and chronic diseases, such as allergies, sinusitis, asthma, and upper respiratory infections, making it difficult to properly diagnose. However, there are some telltale signs that can indicate the presence of acid reflux. One major symptom is heartburn, which is a burning sensation in the chest or abdomen area. Another symptom is regurgitation, which happens when contents from the stomach backwash into the throat and mouth. For singers, there are several additional clues that reflux may be an issue based on the responsiveness of their singing or speaking voice. This can include: 

1. Chronic hoarseness in the voice when speaking
2. Difficulty or discomfort when speaking or singing
3. Decreased vocal range or pitch instability
4. Vocal fatigue or loss of voice after a very short period
5. Increased effort or strain required to produce sounds
6. Unintentionally “breathy” sounding voice
7. Inability to speak or sing loud
8. Loss of falsetto and head registers
9. Excessive clearing of the throat or coughing
10. The sensation of a lump or ball in the throat

Keep in mind that experiencing any number of the vocal imbalances listed above does not automatically mean that reflux is the cause. However, it does suggest that the vocal folds may be inflamed and should not be ignored. If vocal complications or discomfort lasts for a period of two weeks or more, it’s best to consult with a healthcare professional, such as an otolaryngologist, for proper diagnosis and treatment.

There are thousands and thousands of professional singers actively performing while dealing with some form or reflux or another. So there is no reason to jump to any conclusions here. If you are experiencing acid reflux and noticing a persistent change or disruptions in your voice when speaking or singing, it’s important to consult a doctor about the severity and type of reflux you may have. This will help determine the appropriate steps to take.

Exerting your vocal folds when they are tired or swollen for prolonged periods can make them vulnerable to injury. So If chronic issues persist despite treatment or management strategies, it may be necessary to reduce singing and limit overall voice usage until your voice heals.

Nonetheless, with proper vocalization techniques, quality vocal exercises, rehabilitation, and behavioral training for singing can often still be accomplished. This allows you to maintain your skills and continue improving as a vocalist. To assist you in getting started, consider the following tips to cultivate a healthier and more reliable voice.

As a singer with reflux or even reflux-like symptoms, it can be difficult to maintain a healthy voice for speaking and singing. Here are 18 tips and steps you can take to manage your symptoms and reduce the agitation of reflux within your instrument:

1. Journal: Keeping a food and symptom journal is a great first step to identifying the foods and actions that worsen your reflux symptoms, making it easier to know which dietary or lifestyle changes need to be addressed.
2. Medication (consult with your doctor first): PPI (omeprazole) and Histamine (H2) Antagonists can be effective in decreasing stomach acid production. However, they are only recommended for short-term use due to the risk of rebound acidosis, osteoporosis, pneumonia, and other infections.
3. Avoid/Minimize caffeine: Consuming high amounts of caffeine (i.e. coffee and energy drinks) are known to trigger reflux due to the acidic nature of the fluids.
4. Avoid spicy foods: Spicy foods can exacerbate GERD symptoms.
5. Avoid/Minimize tobacco: Smokers have a 70% greater risk of reflux due to chemical irritants. Reducing tobacco usage can help alleviate symptoms relatively quickly.
6. Sleep on your left side: Laying on your left side while sleeping will help to reduce reflux symptoms by preventing stomach acid from flowing into the esophagus.
7. Weight loss (if obese): Obesity is often linked to GERD and reflux-like symptoms. Losing an appropriate amount of weight may help reduce symptoms.
8. Botanicals: Certain herbs such as Ginger root and Slippery Elm Bark (known to help with nausea and reduce heartburn) and other herbs with anti-inflammatory properties such as Bee Propolis, Garlic, and Black Licorice are beneficial to the body’s general health.
9. Hydration: Drinking an appropriate amount of water to keep your vocal folds hydrated will help minimize friction when speaking and singing. As a general rule, the more alkaline-based the water is, the better. 
10. Don’t sing on a full stomach: Singing just after eating a large meal can lead to reflux. Singers should wait until they have fully digested their food before singing.
11. Angle the bed: Elevate the head of your bed by 4 to 6 inches to keep your head above your stomach, helping to prevent acid reflux while you sleep.
12. Modify exercise: Some exercises, such as weight lifting or bicycling, can worsen reflux symptoms. Search for alternative means to maintain your physical health that won’t cause or aggravate reflux.
13. Vocalize: Keeping your vocal folds loose and responsive will help minimize inflammation that may have been caused by reflux. Focus on Flexibility based exercises as suggested in the Vocal Gym.
14. Chew gum: Chewing gum stimulates the salivary flow rate, washing away and clearing any acid that has accumulated in the esophagus more quickly.
15. Baking soda: For calm indigestion, try adding 1/4 teaspoon of baking soda to a glass of water to help neutralize the acid in your stomach.
16. Avoid carbonation: Carbonated beverages such as soda, beer, and seltzers can cause an increase in pressure on the lower esophageal sphincter, which increases the likelihood of gasses or fluids entering the esophagus from the stomach. 
17. Reduce stress: Remove yourself from stressful situations whenever you can or explore various forms of meditation.
18. Practice mindfulness: Remember that your voice is ALWAYS with you, so every time you speak, yell, laugh, or cry, your vocal folds are being used. Do your best to minimize unnecessary conversations and extreme use of the voice (like screaming on a roller coaster!) or pushing your volume at the microphone when singing. This helps to reduce friction and fatigue of the vocal folds.

A REMINDER:  While these tips can help manage symptoms, if you are suffering from symptoms related to reflux for more than two weeks, it is essential to speak with your doctor to come up with an appropriate treatment plan. Managing reflux takes effort, but singers can maintain their voices and continue to perform with the right approach.

The amount of time it takes for the vocal folds to heal from acid reflux depends on several factors such as the severity of the damage, the individual’s overall health, and adherence to proper vocal hygiene practices. In general, it can take several weeks to several months for the vocal folds to fully heal from acid reflux, and the healing process will often require lifestyle changes such as diet modification, medication, vocal rest, and undergo vocal rehabilitation therapy to regain their vocal function. 

Although the healing process can be frustrating, it is a journey worth taking! Every step towards a well-balanced instrument and stress-reduced mindset will lead to a brighter future. Plus, many singers who go through this process often persevere with more vocal knowledge, efficiency in using their voice, and ultimately develop a stronger and more reliable singing voice!

Please note that the educational material provided on this website is not a replacement for professional medical consultation or examination. Furthermore, this material is not intended to offer advice on the appropriate medical treatment for any particular situation that you or someone you know may be experiencing.

ARTICLE WRITTEN BY: RICHARD FINK IV and JORGE SANCHEZ