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August 07, 2016

Hillary Clinton's Constant Throat-Clearing

Image by Gage Skidmore in Wikipedia
Many viewers noted that presidential nominee, Hillary Clinton, constantly cleared her throat during her speech at the Democratic National Convention on July 28, 2016 (watch video below). About 22 times in fact. Media have noted that this throat problem has been going on for far longer... since January 2016.

Why is she clearing her throat so often? Why is she coughing so much?

Is it manufactured as some have suggested?

Or could there be a medical reason for her throat problem? For what seems to be a relatively minor annoyance can require an unusually long and extensive workup to diagnose, treat, and resolve mainly because so many different conditions can cause this symptom. Indeed, Mrs. Clinton has been throat-clearing for at least the past 6 months if reports are to be believed. This obviates a simple answer or treatment.

Should Mrs. Clinton come to my office wondering what could be done to eliminate her unintentional chronic throat clearing, the following steps would be pursued:

1) Endoscopic laryngoscopy to evaluate for any physical problems in the voicebox region. Specifically, evaluating for any evidence of mucus collection in the hypopharynx which could be due to Zenker's diverticulum, esophageal dysmotility, laryngopharyngeal reflux, etc.
2) Depending on the endoscopic findings, trial of the following interventions may be recommended:
     • A reflux medication like nexium to address any reflux getting up into her throat. Avoiding fatty, fried, spicy, tomato-based foods would also be advisable.
     • Nasal sprays like flonase and astelin to address any post-nasal drainage that may be dripping down into her throat
     • Avoiding egg, wheat, and dairy which seem to increase the amount of throat phlegm in some patients.
3) Ensuring she is not taking any medications known to cause throat-clearing as a side-effect. The top two category of medications are ACE Inhibitors like lisinopril as well as ARB (angiotensin receptor blockers) like losartan, both used to treat hypertension. Less commonly, high cholesterol statin medications like simvastatin may be a factor.
4) Tests would be ordered including:
     • Allergy testing to evaluate for any allergic triggers
     • Barium swallow to evaluate for any esophageal pathology beyond the voicebox
     • Bloodwork to check for any autoimmune disorders like Sjogren's which may cause saliva to thicken and collect in the throat.


Depending on the results of the above initial steps, further testing may eventually be pursued including :

     • Esophagoscopy
     • 24 hour multichannel pH and impedance testing with manometry
     • PepTest
     • SELSAP

Although throat-clearing appears to be Mrs. Clinton's main symptom, other patients may complain of other related throat problems including:

     • Globus
     • Chronic cough
     • Phlegmy throat

Hopefully, Mrs. Clinton gets her throat symptoms resolved as soon as possible as it apparently is happening frequently enough to distract her constituents/audience where focus should instead be placed more on her message.

However, she as well as others who suffer similarly need to be aware that there are MANY different causes for chronic throat clearing and without knowing what is causing it, the treatment will be haphazard and commonly ineffective.

Sources:
WATCH: Clinton's Constant Throat Clearing. DailyWire 7/29/16.

Hillary Clinton Treats Theories About Coughing Attack With Dose of Humor. NYT 9/6/16

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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