Can Acid Reflux Cause Sinus and Ear Problems?

Chronic acid reflux or gastroesophageal reflux disease (GERD) can produce symptoms beyond the usual heartburn and sore throat. GERD manifests itself in different ways, with some patients experiencing less common but still normal signs of the condition.

Can acid reflux lead to ear and sinus complications? Yes, it can. Although the reason for this is still indefinite, acid reflux can lead to ear and sinus infections for some patients.

On the other hand, patients experiencing postnasal drip, sore throat, and a swollen larynx may have laryngopharyngeal reflux or LPR, a similar stomach condition that is sometimes mistaken for GERD.

Ear and Sinus Problems: Common Or Worrisome?

GERD is one of the most common gastrointestinal conditions in the U.S. but its symptoms aren’t always straightforward. More and more physicians are accepting its association with ENT (ear, nose, throat) conditions.

Although it’s difficult to explain how GERD mechanisms affect the ear and sinus, doctors suggest that damages caused by GERD can change how the ear and nose behave.

Chronic Sinusitis in GERD Patients

sinus infection illustration

A group of Taiwanese doctors tried to understand the relationship between GERD and chronic rhinosinusitis. Chronic rhinosinusitis (CRS) is caused by inflammation in the sinus. This interferes with a patient’s ability to breathe and perceive smell and even taste. 

Other symptoms of chronic sinusitis include:

  • Chronic congestion
  • Postnasal drainage, or feeling mucus on the back of the throat
  • Thick discharge from nose
  • Nasal inflammation 
  • Tenderness around eyes, nose, cheeks
  • Ear pain

Although the direct cause of CRS remains unclear, doctors noticed that patients with GERD also tend to develop CRS. After observing the patients for around 2 years, scientists found that patients with GERD were at a higher risk of developing CRS than healthy patients. This same group was also more likely to develop a form of CRS that occurs without nasal polyps. 

Possible reasons for the increased risk include:

  • Prolonged exposure to stomach contents in the esophagus may have reached the nasopharynx, which directly connects to the nasal cavity
  • Constant exposure to reflux material could contribute to the development of CRS
  • The acid, pepsin, trypsin, and bile being regurgitated can damage parts of the sinus that lead to sinus dysfunction and create an environment for invasive bacteria to grow

Ear Infections in GERD Patients

ear infection

Chronic otitis media (OME) is a long-term ear problem resulting in the perforation in the eardrum. When left untreated, the middle ear can get infected with liquids. Ear problems are another known manifestation of GERD. A study was keen to understand the relationship between GERD and OME. 

The scientists tested out antireflux medication on a patient with GERD and OME to understand whether reflux medication would directly alleviate OME symptoms. Scientists found that antireflux therapy and other lifestyle modifications associated with GERD (avoiding meals and drinks at least 3 hours before bed time, more exercise) improved both GERD and OME symptoms. 

Publishers have two interesting suggestions regarding GERD-related OME:

  1. That GERD has the potential to manifest into a different condition like nasopharyngitis, and lead to a specific ear condition
  2. That chronic ear problems resistant to therapy may in fact be caused by GERD, and treated through GERD-specific therapy

Recent studies detected pepsin, a stomach enzyme apparent in reflux contents, in the fluid stuck in the middle ear. This reaffirms the suspicion that GERD may in fact be related to the development of OME. 

Another study followed patients between ages 1 to 17 with OME and used anti-reflux therapy to improve the signs of GERD. This study also confirmed that anti-reflux medication helps with patients with resistant-therapy OME, leading them to believe that OME may be directly related to GERD. 

What This Means for You

Although more research is required to reach a conclusive diagnosis, there is enough scientific proof from clinical trials and studies that show treating GERD directly may also improve ear and nose symptoms. 

As a GERD patient experiencing ear and sinus complications, we recommend visiting an ENT and informing him or her regarding your chronic reflux condition. With this information, you can have peace of mind knowing that there are medical therapies available to improve your discomfort. 

Ear and Sinus Complication: Just a Symptom Or Something Else?

Because the ear, sinus, and throat are connected to each other, it’s possible for doctors to misdiagnose similar conditions localized in this area. In some cases, what patients think of as GERD may actually be another gastrointestinal condition called laryngopharyngeal reflux or LPR. 

LPR: Silent Reflux

Laryngopharyngeal reflux is a condition that is caused by a malfunction in the “valves” of the stomach. These valves called sphincters prevent stomach contents from flowing back.

In some cases, the sphincter malfunctions, allowing stomach contents containing acid to travel back up the esophagus. 

Sounds familiar? It’s because LPR and GERD are caused by the same thing. While GERD is common across ages, laryngopharyngeal reflux is more commonly found in infants due to their undeveloped sphincter. Lying down all the time and a shorter esophagus also contribute to the development of LPR in infants. 

While the cause of LPR and GERD are the same, LPR doesn’t exhibit key symptoms that are found in GERD. Heartburn, a classic symptom, is typically absent in patients with LPR, which makes it difficult to diagnose the condition. Because of this, LPR is sometimes referred to as silent reflux. 

The main difference between GERD and LPR is the location of the reflux. When stomach contents reach the esophagus, a patient has GERD. When stomach contents reach further up the throat and affect the nasal airway, a patient has LPR.  


Are LPR and GERD the same thing?

No. LPR and GERD are separate conditions. Although they are caused by the same faulty mechanism, the symptoms and location of the problem are different. 

Can a patient have GERD and LPR at the same time?

Yes. A patient can develop GERD and LPR simultaneously. Because GERD and LPR are conditions caused by the same problem, addressing concerns for one condition could also improve the symptoms for the other condition. 

Why is it hard to differentiate GERD from LPR?

Even though heartburn is a telling sign of GERD, not all GERD patients experience heartburn. Some symptoms also overlap, causing patients and doctors to misidentify GERD from LPR and vice-versa. 

Signs and Symptoms of LPR

Reflux going up the throat and reaching the nasal cavity can produce adverse effects. Common signs of laryngopharyngeal reflux include:

  • Feeling of something stuck in the throat
  • Postnasal drip, or the feeling of having mucus in the throat 
  • Trouble swallowing 
  • Respiratory problems
  • Sore throat
  • Itchy throat, constant throat clearing
  • Chronic cough 
  • Hoarseness or loss of voice

If you feel similar symptoms to GERD but are not experiencing heartburn, get in touch with a gastroenterologist to learn the underlying cause of your symptoms. 

Do You Have LPR: Reaching a Diagnosis 

If you think you have LPR, get in touch with an ENT doctor or an otolaryngologist to investigate the nature of your symptoms. You may be recommended to take the following tests:

  • Upper endoscopy: Although this procedure is known to diagnose GERD, it can also be helpful in diagnosing LPR. Instead of investigating the esophagus, the examiner can view the upper part of the throat and use physical manifestations of the condition (damages to the throat from exposure to acid) along the throat. You can learn more in our previous post: A Complete Overview of Upper GI Endoscopy.
  • pH test: Similar to an endoscopy, a pH monitoring test involves the insertion of a catheter down the nose to detect acid. This can help localize the damage from the reflux, which will determine if you have LPR or GERD. 

Get an Answer Today

Want to learn more about the nature of your ear and sinus complications? At Gastro Center NJ, our gastroenterologists keep an open mind when treating patients with GERD. Our professionals are trained to understand the extraesophageal manifestations of GERD, allowing us to give you the best medical treatment possible. 

Schedule an appointment with us today and get treated for problematic sinus and ear complications.