15+ years in practice
Published: November 10, 2026 | Last Reviewed: September 2026
The recent temperature drop in Houston marks the start of cold and flu season. Sore throat, cough and congestion usually point to a viral upper respiratory infection. Silent reflux can cause the same symptoms. If yours last for months instead of days, reflux may be the real cause.
What Is Silent Reflux?
Silent reflux is also called laryngopharyngeal reflux, or LPR. Stomach contents are believed to reach the throat in LPR. These include acid, bile and digestive enzymes such as pepsin.
This reflux inflames the lining of the throat, vocal cords and nasal passages. The result mimics a viral infection. Cold and flu symptoms are seasonal. LPR is not. It causes chronic hoarseness, congestion, cough and constant throat clearing.
Why Sinus Procedures Often Fail to Fix LPR
Most LPR patients who come to Houston Heartburn and Reflux Center have already had balloon sinuplasty for chronic sinusitis. LPR-induced inflammation of the lining blocks sinus drainage. Over time, this leads to chronic sinusitis.
These patients usually report temporary relief after sinuplasty. The symptoms return because the underlying cause was never addressed.
Why LPR Is Difficult to Diagnose
No single test reliably confirms LPR. Ambulatory pH testing is typically negative in LPR patients. Upper endoscopy may show a small hiatal hernia and distal esophagitis.
Ambulatory multichannel intraluminal impedance testing detects acid, non-acid and gas reflux. It may suit LPR testing better. In my experience, however, impedance testing has shown limited sensitivity and negative predictive value for LPR.
An ENT physician can perform laryngoscopy. It shows redness and swelling around the voice box and throat. These findings are not specific to LPR. Salivary pepsin testing is promising. It still lacks the sensitivity and specificity to rule LPR in or out.
Why LPR Is Difficult to Treat
High dose PPIs are the usual first treatment. The response varies from patient to patient. PPIs are less likely to neutralize the erosive effect of bile and pepsin on the throat lining.
Surgery is also less predictable for LPR. Hiatal hernia repair and Nissen fundoplication eliminate LPR symptoms less often than classic GERD symptoms such as heartburn and regurgitation. One possible explanation is related to irreversible damage to the throat lining that persists after the reflux stops. For this reason, early intervention is usually recommended in cases of LPR before irreversible damage sets in.
What the Published Evidence Shows
Reported success rates for Nissen and other laparoscopic fundoplication in LPR range widely, from roughly 48% to 94%. The most rigorous synthesis is a systematic review by Lechien and colleagues in JAMA Otolaryngology-Head & Neck Surgery. It pooled 34 studies and 2,190 patients.
The weighted mean was 83.0% of patients with symptom improvement (95% CI, 79.7% to 86.3%). Complete resolution of symptoms occurred in 67.0% (95% CI, 64.1% to 69.9%). The studies differed markedly in diagnostic criteria, inclusion and exclusion criteria, and outcome measures. The authors concluded that this heterogeneity made reliable conclusions about efficacy impossible. They called for a diagnostic standard, clear surgical indications and better outcome measures.
How I Treat Silent Reflux
At Houston Heartburn and Reflux Center, I have helped many patients overcome chronic cough, adult onset asthma, hoarseness and persistent throat clearing. Nissen fundoplication with hiatal hernia repair remains the best treatment for silent reflux.
My success rate for completely eliminating LPR symptoms is more than 80%. That is higher than the pooled 67% in the Lechien review. It comes from my own practice, not a controlled trial. The other 20% of my LPR patients improved in symptom severity but not completely. This was true at 6 months and one year of follow-up.
I perform every preoperative study myself, including endoscopy, manometry, pH-impedance testing and contrast studies. I see patients from Houston, The Woodlands, Katy, Sugar Land and Pearland, and from across the United States.
Key Clinical Points
- LPR mimics a viral infection but causes chronic hoarseness, congestion, cough and throat clearing instead of seasonal symptoms.
- Chronic LPR inflammation can block sinus drainage. Sinuplasty gives temporary relief when the reflux goes untreated.
- No single test rules LPR in or out. pH testing, impedance testing, laryngoscopy and salivary pepsin each have limits.
- A systematic review of 34 studies found 83.0% improvement and 67.0% complete symptom resolution after fundoplication for LPR. The authors called the evidence inconclusive because study methods varied widely.
- Nissen fundoplication with hiatal hernia repair is the best treatment for silent reflux. Dr. Darido’s success rate in completely eliminating LPR symptoms is around 80%.
If you have had a cough, hoarseness or sinus symptoms for months, or a sinus procedure that did not last, reflux may be the cause. I encourage you to schedule an evaluation with Houston Heartburn and Reflux Center at 832-945-8717.
Houston Heartburn and Reflux Center
Reference
Lechien JR, Dapri G, Dequanter D, et al. Surgical Treatment for Laryngopharyngeal Reflux Disease: A Systematic Review. JAMA Otolaryngol Head Neck Surg. 2019;145(7):655-666. doi:10.1001/jamaoto.2019.0315 (retrieved via PubMed)
Originally published: November 10, 2026 | Last reviewed: September 19, 2026