enthelp.com

Gastro-oesophageal and Pharyngeal Reflux

The stomach produces acid that is corrosive and irritant. It is possible in some situations that the acid can reflux up into the oesophagus and even into the pharynx causing irritant symptoms of indigestion, burning, sore throat, hoarseness, coughing fits or a lump sensation in the throat.

There are things one can do to prevent the production and the reflux of the acid and thereby decrease the symptoms incurred by the patient. It is important to adhere to the advice given to decrease the reflux and its effect.

Medications

Over the counter antacids such as Rennies or gelusil or gaviscon a liquid preparation that prevents the acid irritation are available without prescription and can be of help. It is useful to take them before going to sleep but if symptoms are sever then it is useful to take them 30-45 mins before eating meals.
Proton pump inhibitors (PPI’s) are often prescribed in this situation by your GP or ENT surgeon. These should be taken as instructed by your doctor and instructions should be meticulously adhered to. PPI’s decrease the production of acid from the stomach and therefore decrease the effects of the acid when it refluxes.
Beware that some medications increase acid production such as anticholinergics, beta blockers, aspirin, theophylline and non steroidal anti-inflammatory drugs.
Also smoking increases acid production and it’s cessation is beneficial to the treatment reflux.

Weight

An increased Body mass index (BMI) above the normal level increases the chances of reflux. In this situation it is beneficial to try to lose weight to reach your target weight for height (BMI).

Posture

Acid reflux is not an uncommon symptom at night and is related to the fact that lying down allows for the easier refluxing of acidic contents. Elevating the head end of the bed between 4-10 inches will decrease the chances of reflux whilst not being too high so as to feel like you are sliding off the bed.

Diet

Smaller frequent meals are more conducive to avoiding reflux. The avoidance of irritating foods and drinks such as caffeine, chocolate, alcohol should be avoided. Also any specific foods that cause an individual heartburn should be avoided.

Vocal Hygiene Advice

Ensure adequate fluid intake of water / squashes (NOT coffee or tea which contain caffeine and will dry the throat). Approximately 8-10 drinks per day is appropriate.

Steam inhalations to be undertaken carefully if possible twice a day. This may include the steam in a shower. Also ensure humidification of your bedroom / living room (a bowl of water near the radiators).

Avoid smoky noisy environments where you will strain your voice whilst irritating it.

Eat regular balanced meals avoiding late night eating which is associated with indigestion.

Get adequate amounts of sleep as the larynx is a complex muscular organ that will under perform if you are tired.

Chewing gum or sucking ordinary pastilles can keep the mouth moist. Try to avoid medicated lozenges as they may numb the throat or the menthol can dry it.

Avoid aspirin gargles especially if having an acute infection.

Ear Care Advice

• The ear canal is self-cleaning. Do not insert any implements such as cotton buds into the ear. They will damage the delicate skin lining the ear and increase the chance of you developing an ear infection, itchy ears or a problem with wax.
• To dry/ clean the outside of the ear use a dry tissue or alcohol free baby wipes around and behind the ear after showering or bathing.
• If you suffer from excessive wax; insertion of 1 to 2 drops of olive oil on a regular basis may help the ear clean itself.
• If the entrance to the ear canal is dry and/ or itchy, you may find it of benefit to insert one drop of olive oil into the ear canal as instructed by your practitioner. Keep the ears dry from any entry of water, as it may be shampoos and soaps irritating the skin.
• If you have experienced an external ear infection keep the ears dry from any entry of water.
• To keep the ears dry from water entry use cotton wool coated in petroleum jelly or ear plugs placed at the entrance to both ear canals.
• If the symptoms with your ear do not improve make an appointment with your doctor.

How to insert olive oil drops into the ear canal

To obtain the olive oil drops purchase olive oil and the glass dropper bottle that has been designed for ear drops from a chemist. If you have used previous wax dissolving drops, discard all the liquid, wash out the glass bottle and when the container is clean, insert olive oil (almond oil/ coconut oil could be used if you do not suffer from a nut allergy).

1. Insert the closed glass dropper bottle containing the oil into a cup of warm water for two minutes. Dry the container and insert one-drop of oil onto your hand to ensure that it is not too hot. If you feel the oil is too hot wait for it to cool prior to commencing. The correct temperature of the oil should be 37?C. Alternatively, for the oil to reach body temperature (37?C) place the bottle in a pocket of your clothing currently being worn for 20 to 30 minutes.
2. Holding the prepared dropper bottle lie on a bed with the affected ear towards the ceiling.
3. With one hand pull the top of your ear upwards and outwards to straighten the ear canal.
4. Placing the filled dropper part of the bottle of oil over the entrance to your ear canal and squeeze the dropper until one drop (or the amount specified by your nurse) is instilled. Maintain that position for a total of five minutes however, after one minute release the ear and massage the tragus (located at the front of the ear at the level of your cheek-bone) for one minute. Remain on your side and relax on the bed for a further 3 minutes.
5. Wipe the excess drops that pool outside the ear when you sit up. Do not insert cotton wool into the entrance of the ear canal as this will diminish the effect of the drops.
6. Unless instructed otherwise by the nurse insert the drops into both ears, repeating steps two to five on the opposite side.

Patient Advice Prior to Ear Irrigation

• Insert 1 to 2 drops of olive oil into the ear(s) requiring wax removal every morning and evening, commencing one week prior to the appointment (unless instructed otherwise by the nurse).
• Continue to use the drops twice daily until the wax has been successfully removed.
• Instilling olive oil (coconut or almond oil can be used as an alternative if you do not suffer with a nut allergy) will assist with the wax removal process and reduce discomfort that may be felt during the procedure.

Patient Advice Post Ear Irrigation.

• The ear canal may be vulnerable to an ear infection after irrigation. This is caused by removal of all the wax, which has inherent protective properties for the ear canal.
• Until the ear produces more wax to protect the canal keep the ear(s) that have been irrigated dry from entry of water for a minimum of four or five days after the procedure.
• To keep the ears dry when you are washing your hair, showering, bathing or swimming, insert ear plugs or cotton wool coated in petroleum jelly into the outside of the ear canal(s) to act as a protective seal.
• In the unlikely event that you develop pain, dizziness, reduced hearing or discharge from the ear after the procedure, consult with your nurse/ doctor.