Conditions Treated
Laryngopharyngeal Reflux (LPR / Silent Reflux)
Silent reflux — also known as laryngopharyngeal reflux (LPR) — is one of the most underdiagnosed conditions in ENT. Unlike classic acid reflux (GERD), silent reflux does not typically cause heartburn. Instead, acid and pepsin reach the throat and voice box, causing symptoms that are frequently misattributed to other causes.
Symptoms include a persistent sensation of something stuck in the throat (globus pharyngeus), chronic throat clearing, hoarse voice particularly in the morning, sore throat without infection, a persistent cough, and recurrent episodes of laryngitis. Because the primary symptom is rarely heartburn, patients can spend years being investigated for other conditions before LPR is considered.
Treatment involves dietary changes (reducing caffeine, alcohol, tomatoes, chocolate, fatty foods), eating earlier in the evening, raising the head of the bed, and where necessary, proton pump inhibitor (PPI) medication. Professor Veer has a particular interest in the relationship between LPR and sleep-disordered breathing, which can make reflux significantly worse through the negative intrathoracic pressure generated during obstructed breathing at night.
Globus Pharyngeus
The sensation of a lump in the throat without any actual structural obstruction is called globus pharyngeus. It is extremely common and can be deeply distressing. Patients frequently worry about cancer, but in the vast majority of cases the cause is benign — often LPR, anxiety, or postnasal drip. A thorough assessment including flexible nasendoscopy (a camera passed through the nose to view the back of the throat) is required to exclude any structural cause and provide reassurance.
Persistent Sore Throat
A sore throat lasting more than three to four weeks requires specialist assessment to exclude underlying causes. In most cases, the cause is benign — chronic tonsillitis, postnasal drip, LPR, or mouth breathing from nasal obstruction. However, a thorough examination is always warranted. Professor Veer will examine the throat, tonsils, and surrounding structures with a flexible endoscope where needed.
Difficulty Swallowing (Dysphagia)
Difficulty swallowing can range from a mild intermittent sensation to a significant symptom interfering with eating and drinking. Causes range from reflux and structural narrowing to neurological conditions. Urgent assessment is required if swallowing difficulty is worsening, associated with weight loss, or associated with a change in voice.
Hoarse Voice
Hoarseness (dysphonia) lasting more than three weeks should be assessed by an ENT specialist. NICE guidelines recommend urgent referral for hoarseness persisting beyond three weeks in patients over 45. Common benign causes include vocal cord nodules, polyps, reflux, and vocal overuse. Nasendoscopy allows direct visualisation of the vocal cords.
Throat and Tonsil Conditions
For information about tonsillitis, tonsil stones, adenoid problems and tonsillectomy — please see our dedicated Tonsils & Adenoids page.
Throat and Sleep
Many throat conditions are made significantly worse by sleep-disordered breathing. Snoring causes chronic vibration trauma to the soft palate and throat tissues. Obstructive sleep apnoea generates repeated episodes of high negative intrathoracic pressure that drives acid reflux. Mouth breathing from nasal obstruction dries out the throat throughout the night.
If you have throat symptoms that do not seem to respond to standard treatment, or if your symptoms are worse in the morning, Professor Veer will always consider the possibility of a sleep-related contribution.
When Should I See a Specialist?
- A sore throat or hoarse voice lasting more than three to four weeks
- Difficulty swallowing, particularly if worsening
- A lump felt in the neck or throat
- Unexplained throat pain on one side
- Persistent cough without obvious cause
- Recurrent episodes of tonsillitis
- A persistent sensation of something stuck in the throat
- Any rapidly changing or severe throat symptom
What to Expect at a Consultation
Professor Veer will take a detailed history of your symptoms and perform a thorough examination including flexible nasendoscopy where indicated. This is a brief, well-tolerated procedure in which a thin, flexible camera is passed through the nostril to view the back of the nose, throat, and vocal cords in real time. It takes approximately two minutes and provides immediate information that significantly aids diagnosis.
Following your consultation you will receive a clear explanation of findings, a diagnosis where possible, and a structured management plan.