Persistent Throat Symptoms
and Reflux

Persistent throat symptoms are a collection of symptoms that include:

• Hoarseness or a ‘croaky’ voice
• A sensation of a lump in the throat (‘globus’)
• Repeated throat clearing
• A sensation of excess mucus in the throat
• An uncomfortable or sensitive throat

These symptoms often have multiple causes including dryness, unhelpful muscle tension in the throat, increased throat sensitivity or awareness and, in some cases, reflux. They can also be made worse with psychological distress.

When to Seek Medical Help

You should make an appointment to see your GP if you experience any of these symptoms for a period of longer than 3 weeks. Your GP may suggest medications to trial in the first instance. If treatment and lifestyle changes are ineffective you may be referred to a Multi-disciplinary Voice Clinic for further assessment with a team who understands the demands of a performer experiencing these symptoms.

If you find that your throat is feeling dry, itchy, or as if there is something sticking in your throat such as mucus or catarrh, you may find the following suggestions helpful:

Stay Hydrated

Dehydration affects the pliability of the vocal cords, increasing the driving force required for speaking and singing. To ensure you stay well hydrated, you may find the following helpful:

• Take small sips of water little and often throughout the day, aiming for 6-8 glasses of non-caffeinated fluid per day (you may require more than this on rehearsal and performance days).
• Reduce caffeinated drinks such as coffee, tea, coke and energy drinks as these can be drying on your throat and may dehydrate you further.

Avoid Throat Clearing

Repeated throat clearing and coughing can cause trauma and swelling to the vocal cords. It can also cause further irritation and lead to muscle tension imbalances that can affect singing. Trial a brisk sniff through your nose followed by blowing out slowly through pursed lips as an alternative to throat clearing. Alternatively take a sip of water and swallow firmly.

Reflux

Reflux describes symptoms caused by stomach acids and enzymes travelling up the food pipe (oesophagus) and causing irritation. These acids and enzymes are important for digesting food, but if they are present in the oesophagus they can cause symptoms such as ‘heartburn’ or indigestion. This is referred to as Gastro-Oesophageal Reflux Disease (GORD). If they reach the delicate lining of the throat or voice box (larynx), it can cause a sour, bitter or metallic taste or a burning sensation after eating. For performers and singers, acid reflux into the larynx could cause irritation and swelling which will have a negative impact on voice production. This is sometimes called Laryngopharyngeal Reflux (LPR).

Reflux Causes

There may be several underlying factors linked with reflux including

• Being overweight
• Smoking or drinking alcohol
• Weak muscles of the oesophagus
• Hiatus hernia
• Pregnancy

Reflux and Voice Performers

Some research suggests that voice performers are affected by reflux more than the general population. This could be due to lifestyle or work-related factors. For example: –

• Eating meals late at night due to evening performances
• Irregular schedules leading to difficulty eating regular meals
• Lack of access to healthy meals and snacks
• Increased risk of stress and using unhealthy coping mechanisms e.g., vaping, alcohol or smoking
• Significant abdominal contraction for breath support during singing

Managing Reflux

If you think you have reflux, it’s important to see your GP as there may be other health problems causing your symptoms. If your GP suspects you have reflux, they may discuss lifestyle changes (see box below) or prescribe a course of medication.  If you have throat symptoms alone, an alginate should be advised (e.g. Gaviscon Advance). Alternatively, if there is heartburn, a Proton Pump Inhibitor (PPI) (e.g. Omeprazole) may be prescribed to reduce stomach acid. If these medications do not help with symptoms, the GP may prescribe other medication or advise further investigations. However, lifestyle and dietary changes can be highly effective alone, so try these first.

Do

• Leave at least 3 hours after eating before going to bed, lying down or exercising
• Try to sleep on your left side
• Eat smaller, more frequent meals
• Eat slowly and chew each mouthful well
• Maintain a healthy weight
• Find positive ways to manage stress

Avoid

• Smoking
• Alcohol, caffeine, fizzy drinks, and citrus juices
• High-fat meals, deep fried foods, highly spiced and processed foods
• Wearing tight fitting clothing
• Bending from the waist

You could also try raising the head of your bed by 10-20cm using blocks, books or leg raisers. There are also specialist reflux ‘wedge’ pillows to help prevent stomach acid travelling upwards towards the throat during sleep.

Performance Meal Planning

To avoid overeating before or after a performance, plan to spread food intake over the course of the day. Aim to have your main meal at least 4 hours before the performance starts and choose a balanced meal that includes complex carbohydrates and protein. Reduce the size of your meals towards the performance. A small snack could be eaten during the interval to help reduce hunger post-show and sustain energy. Optimal hydration is also important, so take regular sips of water throughout the day. If you are touring or travelling, pack nutritional foods such as nuts or dried fruits for healthy snacks.

Example Performance Day Meal Plan

If you have a matinee performance, a large brunch at 10am can help boost your energy intake with plenty of time to digest before the performance.

Managing stress

Your symptoms may feel worse with stress, which increases muscle tension and can influence acid production in the stomach. For further information about managing stress, see the BAPAM Psychological Self Care factsheet.

Further advice

If you have persistent throat symptoms or signs of reflux and your voice is affected, it is important to seek medical advice. You can contact the BAPAM helpline to arrange a free GP appointment to get further support and guidance.

For more dietary information for performance professionals, check out the BAPAM factsheet: Dietary Advice for Performance Professionals

References 

Merati, A. L. (2006). Reflux and the performer’s voice. In The performer’s voice (pp. 117-130). Plural Publishing, Inc. San Diego (CA).

O’Hara, J., Fisher, H., Hayes, L., & Wilson, J. (2022). ‘Persistent throat symptoms’ versus ‘laryngopharyngeal reflux’: a cross-sectional study refining the clinical condition. BMJ Open Gastroenterology, 9(1), e000850-. https://doi.org/10.1136/bmjgast-2021-000850

Özenoğlu, A., Anul, N., & Özçelikçi, B. (2023). The relationship of gastroesophageal reflux with nutritional habits and mental disorders. Human Nutrition & Metabolism, 33, 200203–200203. https://doi.org/10.1016/j.hnm.2023.200203

Sataloff, R. T. (2017). Nutrition and the Professional Voice. In Vocal Health and Pedagogy: Science, Assessment, and Treatment, Third Edition. Plural Publishing, Incorporated.

Sivasankar, M., & Leydon, C. (2010). The role of hydration in vocal fold physiology. Current Opinion in Otolaryngology & Head and Neck Surgery, 18(3), 171–175. https://doi.org/10.1097/MOO.0b013e3283393784

Resource Information 

Contributors:

Ben Cosway, Consultant ENT Surgeon
Dr Eleftheria Iliadou, Otorhinolaryngologist
Lucy Swain, Speech and Language Therapist

We are grateful for further advice and clinical oversight from the BAPAM Vocal Health Working Group.

Published: November 2025

Date of next review: November 2028