DEAR DR. DONOHUE: About two months ago I become quite hoarse. The doctor diagnosed laryngitis and treated me for it. The hoarseness did not go away, so he sent me to an ear, nose and throat doctor, who examined my throat with a scope. He told me I had acid reflux and put me on medicine for it. Have you ever heard of this? – D.C.

ANSWER: Yes, I have, and it’s not as rare as you might think. Some estimate that 50 percent of hoarse patients are hoarse because of reflux. Most of us think of acid reflux – the upward spurt of stomach juices into the esophagus – as being the cause of heartburn only. Sometimes, the refluxed acid spurts all the way to the neck and produces symptoms in the vocal cords without any heartburn. It’s called laryngopharyngeal reflux.

Other symptoms that suggest this diagnosis are constant throat clearing, a sensation that there’s a lump in the throat, and cough. Laryngopharyngeal reflux is not the only cause of these symptoms. Infections, voice abuse (like yelling at a football game), allergies, smoking and alcohol are other causes.

When the doctor sees the irritated vocal cords with a scope and when the patient denies any symptoms consistent with other diagnoses, then this syndrome comes to mind. The doctor might even see an ulcer on the cords due to the refluxed acid.

This kind of reflux is treated in the same way that heartburn reflux is treated. Overweight people need to lose some pounds.

Smokers must quit smoking. Alcohol use should be greatly moderated. Affected people should avoid chocolate, fats, citrus fruits, carbonated beverages, tomato-based foods and caffeine.

Medicines that stop the production of stomach acid are usually prescribed. They include Prilosec, Nexium, Prevacid, Aciphex and Protonix.

The booklet on hiatal hernia, heartburn and acid reflux does not describe the above condition, but it does give the details on the more common forms of acid reflux.

To obtain a copy, write: Dr. Donohue – No. 501, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Several acquaintances of mine are troubled with nosebleeds. I read that tissue salts, present in whole grains, prevent them, as do vitamins C and K. Can you suggest something for these people? – I.S.

ANSWER: Many nosebleeds come from a drying of the nasal lining, when a gentle finger touch to the nose can set off a bleeding episode. That problem can be remedied by humidifying the house and applying a light coat of petroleum jelly at the lowermost parts inside the nostrils.

High blood pressure doesn’t cause nosebleeds, but uncontrolled high blood pressure prolongs a nosebleed and makes for heavy bleeding.

Clotting disorders are another cause of nosebleeds. A check of blood platelets, the blood cells essential for clot formation, and of clotting factors – blood proteins also necessary for clot formation – is a good idea for all who have one nosebleed after another.

Arteriosclerosis – artery hardening – is another nosebleed cause. Some inherited disorders, rare as they may be, should be thought of, especially if the individual is young. Hereditary hemorrhagic telangiectasia is an example.

Vitamin K has a hand in clot formation. A deficiency of vitamin C can lead to scurvy, where bleeding, especially gum bleeding, is a sign. It’s unlikely that too little of either vitamin is a cause of nosebleeds in North America.

I don’t know what tissue salts are or how they would be involved.

DEAR DR. DONOHUE: When is it safe to stop using a preventive method for pregnancy? – Anon.

ANSWER: Menopause is the stage in life when women can no longer conceive. It is said to occur when a woman goes for 12 months without having a period and when she experiences some menopausal symptoms, like hot flashes. If the woman has been taking the kind of birth control pill that promotes monthly periods and makes it hard to determine whether menopause has started, she has to go off the pill for one or two weeks and get the level of the hormone FSH checked. During the pill-free time, she should not have intercourse, in order to avoid even a remote chance of pregnancy.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.