Laryngeal Sensory Neuropathy How to Diagnose & Treat and its Relation to LPR

Laryngeal Sensory Neuropathy

Laryngeal Sensory Neuropathy is a condition where the nerve in the throat called the vagus nerve sends faulty signals to the brain. It is often diagnosed by process of elimination. There are many potential causes for this including things like acid reflux & autoimmune diseases. Symptoms include things like throat pain and chronic cough.

My blog here is primarily focused towards targeting and helping people with Laryngopharyngeal Reflux or LPR for short. If you didn’t know LPR is a form of acid reflux that causes irritation to the throat and larynx area just like LSN.

The clear thing to me after learning more about LSN is that there is a clear relation between the 2. Both LSN and LPR have usually very similar symptoms. These laryngeal sensory neuropathy symptoms like coughing (sensory neurogenic cough), lump in the throat feeling and throat clearing are common for both problems so there is definitely a relation between the 2.

The thing is if you are someone who actually has LSN there is not a direct reason why it would be related to LPR, but it there could definitely be a correlation.

Diagnosing someone with LSN can be quite difficult. Usually the best way to know if you have LSN is from a process of elimination. Meaning that you eliminate the possibilities that could cause it, some causes are things like food allergies, asthma, neck masses, autoimmune disorders, acid reflux(LPR) and many others.

There is only one test that can really test for Laryngeal Sensory Neuropathy. This test is called SELSAP test which means surface-evoked laryngeal sensory action potential. It is designed to test the function of the laryngeal nerves using electrodes. The problem with the test is that even when the test is positive it does show that you have neuropathy in your nerve, but it doesn’t show what is the root cause of this neuropathy.

In regard to the problem being caused by acid reflux. It’s more common than you think. In this case the acid is constantly coming up and damaging and inflaming the throat area. This constant acid damage leads to neuropathy in the larynx area because of damaged nerves.

Lack of Information and Knowledge of LSN / LPR

Because LSN and LPR are relatively new problems they haven’t been researched well and current knowledge on them is low. For example, if someone’s LSN is because of acid reflux but you don’t have any typical reflux symptoms like heartburn your doctor/physician may immediately write it off.

This is also particularly due to the lack of knowledge and education on LPR. As someone with LPR has no typical heartburn or chest pain like someone with GERD(Gastroesophageal reflux disease) would. This is also why LPR is sometimes referred to as silent reflux because it doesn’t give the other typical reflux symptoms.

Finding your Root Cause & Acid Reflux (laryngeal sensory neuropathy natural treatment)

If you work out that your LSN is triggered by reflux that would be your own personal root cause of the problem. Once you target and treat the direct problem in this example acid reflux it can also help with treating your LSN. The thing is that acid reflux can cause LSN. Then if you treat the acid reflux properly the LSN may completely heal yourself over a period of time. Though for some people it may take much longer if at all. This is because of the prior damage the acid has done to the nerve. If you need more information on LPR check out my complete guide here.

So, let’s say you think you have these throat symptoms because of acid reflux and you treat the problem properly. But even after this treatment you still have the problem with your throat after 2 months’ time. In this case it would be more likely you have LSN because of the nerve damage. Luckily there is some medicine which should directly help treat the LSN, let me explain below.

Treatment of Laryngeal Sensory Neuropathy – Medicine

If you believe you have treated or fixed your root cause for the LSN and the problem still persists then trying a direct treatment should be a good choice for you. One of the best medicines for this is called Gabapentin.

This medicine is designed to calm the nerve down, so it stops it from sending faulty signals to your brain. The thing with this medicine is that it isn’t a pain killer and it won’t help with treating pain but only with calming your damaged nerve. This will often stop you getting the feeling of needing to cough or constantly clear the throat because the nerve is no longer sending the faulty signal.

Medication Dosage

Its best to start with 1 100mg tablet of Gabapentin a day and if you have no negative reaction build up to take 3 of them a day. Even still 100mg 3 times a day is an extremely low dose and may be all you need to help. If you have no effect at that dose you may need to boost it to 300mg 3 times a day or up to a maximum of 600mg 3 times a day. It’s basically a slow build up to the point where you are getting the relief. For some people they may only need 100mg 3 times a day whereas with others they may need 600mg 3 times a day for it to work effectively.

Taking the medicine may be a long process where you need to take it for many months if not years before your damaged nerve can completely heal. Because there is little research on this area it is hard to say for definite.

It’s also worth mentioningThere was a study done where patients with LSN who had a chronic cough took Gabapentin. A total of 68% of patients saw relief in symptoms. You can read more about the study here.

Acid Reflux Tests for Diagnosis & a Final Note

If you want more concrete evidence that your root cause is because of acid reflux there are a host of tests you can have done if that is the route you want to take. Probably the best test for knowing if your LSN is acid reflux related is called the Restech pH test which is where they put a probe up the nose and down the throat and it will measure the acidity of the esophagus and throat for 24 hours. If it is more acidic than it should be the is a good sign your root cause is from reflux. There are also other tests like endoscopy and barium swallow but the Restech pH test is the best for diagnosing this problem.

On a final note – you shouldn’t treat the problem with medicine until you are treating the root cause of the problem. This is because while taking the gabapentin may help if they nerve is still being damaged by acid you will likely start to get symptoms again if you don’t treat the root problem! If for example you believe the acid reflux is the reason you could tackle it with some of my treatment advice in my LPR guide or read more about LPR symptoms to see if you have similar symptoms. You can also take my test which is a good sign to know if your LSN is being caused by reflux. The Reflux test is here. Continue reading below for frequently asked questions about Laryngael Sensory Neuropathy.

If you have more questions also feel free to book a private consultation with me here.

Frequently Asked Questions

Can You Get Neuropathy in Your Throat?

Yes you can get neuropathy in your throat. There are multiple possible causes some of which are clear and some not as much. The cause which we focus mostly on here is acid reflux.

What is Vagal Neuropathy?

Vagal neuropathy comes from the vagus nerve. The vagus nerve is the nerve in the throat and vagal neuropathy is in relation to the nerve not functioning correctly and sending false signals to the brain.

Can Vagus Nerve Cause Chronic Cough?

Yes damage to the vagus nerve can cause a chronic cough, tickle in throat and other related symptoms.

Can Gabapentin Help Chronic Cough?

Yes if the cause of the chronic cough is from neuropathy. The important thing to note here is that neuropathy is often caused by another issue. For example if your cough is caused by acid reflux then you should aim to resolve that root problem, because if you take the gabapentin and don’t fix the root cause then all you are doing is simply masking the problem which may get worse over time.

What Triggers Neuropathy?

There are many things that can trigger neuropathy some which are more clear than others. To name a few diabetes, inflammatory infections, auto-immune, acid reflux etc.

How to Stop Vagus Nerve Cough?

First you must work out what caused or is causing the vagus nerve damage. For example if its due to acid reflux you must tackle that to stop it.

How Do You Diagnose Neuropathy?

Generally neuropathy isn’t the easiest thing to diagnose. It is sometimes diagnosed simply by the process of elimination. For neuropathy in the throat the best test is the SELSAP test, though this isn’t a very conclusive test but more of an indicator than anything else.

How is Reflux Causing The Neuropathy?

Acid comes up and more importantly pepsin comes up from the stomach and enters the throat. Pepsin is a digestive enzyme produced in the stomach which is used to break down proteins. The problem is when it enters the throat it inflames and damages the throat. The consistent damage can lead to the vagus nerve malfunctioning which is what causes the neuropathy.

An extra couple notes –

New Treatment Option for Laryngeal Sensory Neuropathy

The best treatment option is to figure out the root cause of the problem. Once that has been done then you can determine the best treatment option new or old.

Laryngeal Sensory Neuropathy Medication

The 2 most common medications for laryngeal sensory neuropathy are Gabapentin and Amitriptyline. They basically work to calm the nerve down so the nerve won’t send a faulty signal to the brain anymore.

6 thoughts on “Laryngeal Sensory Neuropathy How to Diagnose & Treat and its Relation to LPR”

  1. Hi David – thank you for all of the information! Have you had personal experience with LSN? Have you taken Gabapentin or amitriptyline? If so, did it help? Thank you!

    1. Hey Jessica,
      Yes I have taken Gabapentin and it didn’t help me but I later found out it wasn’t the right thing for me to take. The question is figuring out whether your symptoms are caused by neuropathy or acid reflux or a certain combination of the 2. If you are more on the neuropathy side Gabapentin/amitriptyline would likely be helpful though if you are mostly on the acid reflux side it wouldn’t be worth taking. There is a book called the chronic cough enigma which is great for helping decide which side you are on and how to address it.

  2. hello my name is joanne. i have a a sore throat over a year now. i also have arthritis in my neck and 4 degenerated disc at top of spine. I have had a scope down my nose results came back clear. I have had a barrium swallow with xrays, came back clear no gerd no acid reflux. Having a mri done next month, to find out why im haveing so much throat pain. I take gabapentin for fibro. Strange thing is after taking gabapentin before bed, my throat pain starts easing off. My doctor says i need to stop self diagonising myself. After reading your article its starting to make sense and fill in some blanks. Im not a doctor, but i feel im trying more myself to find out whats going on, than my doctor is. I would love any kind of input please and thank you.

    1. Hi Joanne, Yeah I wouldn’t trust your doctor alone on this matter because most doctors simply are not well enough informed on LPR generally. So the gabapentin is likely helping the throat because it’s damaged a nerve (vagus nerve?) in the throat and it’s sending signals to your brain which makes you feel the pain. This is considered neurological pain that is likely caused by the acid. So depending on your situation you need to treat and calm the reflux and also treat the throat with something like gabapentin. I would highly recommend this book on the topic – chronic cough enigma. It will help you determine if you have more so reflux or a neurogenic problem or a mixture of the 2 and how to go about treating it.

  3. I think my gastroenterologist is on the right track. I never heard of imipramine for cough. I was diagnosed with: Small hiatal hernia, gastritis, GERDS and narrowing of the Esophagus. I have had a chronic cough and pain for probably ten years. The cough would get so bad I quit breathing. Extreme epi gastric pain radiating across upper abdomen at night Dr has me on pantoprazole 40 mg 2 x a day. Imipramine 10 mg 2x a day and 20 mg at night. 40 mg of Pepcid at bedtime. It is slowly getting better. Just recently I was prescribed pregabulin for sciatica by orth doc. That threw me into a full blown coughing attack that would cause me stop breathing. What a battle! I hope I get better so embarrassing coughing all the time in Public surely during Covid. Everyone looks at you like you have the plague! I am getting relief and it is nice it going to take a while though. God bless you all.

    1. It sounds like you are on the right track which is something great to hear most importantly. I’ve had that experience with the coughing and I understand your thinking on it.

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