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January 17, 2009

Chronic Throat Clearing

A common complaint of patients seeing an ENT doctor is for persistent throat clearing. Other symptoms that a patient may complain of include throat mucus, cough, raspy voice, and a lump sensation in the middle of the throat (aka, globus). For a more in depth discussion on this topic, click here.

Reflux (Acidic or Non-acidic)

In the VAST majority of patients complaining of chronic throat-clearing, it is due to a disorder called "laryngopharyngeal reflux" or LPR for short. This disorder is due to reflux whether acidic or non-acidic from the stomach that travels up to and briefly irritates the throat region. This transient irritation is just enough to cause a person to clear the throat without causing any other symptoms. Think of this problem like a tiny drop of acid that lands in the eye causing a person to briefly itch the eye due to irritation that may last several days.

Of note, most patients with LPR do NOT complain of heartburn, nausea, indigestion and other symptoms commonly associated with reflux.

The treatment is the same as for the more common and related GERD disorder except that treatment usually takes much longer... sometimes for as long as 6 weeks to 3 months. Some over-the-counter medications used to treat reflux are listed at end of article below.

To read more about this disorder, click here.

Post-Nasal Drainage

Sometimes, mucus can accumulate in the throat due to nasal drainage triggering throat-clearing. In these patients, they literally feel the drainage travelling from the nose and down into the throat. Often, when one looks in the back of the throat, the drainage can be seen. Treatment for this drainage depends on what it is caused by. If due to sinusitis, antibiotics is the treatment. If due to allergies, allergy treatment is recommended. If due to vasomotor rhinnitis, nasal sprays such as atrovent, patanase, and astelin may be quite helpful. In these patients, turbinate reduction may quite helpful to reduce the amount of drainage.

Medication Side-Effect

Avoid all ACE-Inhibitors as well as Angiotensin Receptor Blocker medications. Both of these classes of medications address high blood pressure. However, as a side effect, they also potentially can cause a "tickle" sensation in the throat that makes a person want to clear the throat. If you are taking one of these medications, recommend having your primary care doctor change your medication to a different one (ie, beta-blocker, calcium channel blocker, etc). Would avoid these medications for at least 3 months.

Food Allergies

Rarely, food allergies can cause excessive throat mucus to develop triggering throat-clearing. The most common culprit is dairy products. Treatment for this problem is mainly avoidance.


Zenker's Diverticulum

Even more rarely, there may be an anatomic abnormality in the throat called a Zenker's Diverticulum. Basically, this abnormality is a pouch that protrudes from the esophagus (swallowing tube) which catches food and mucus preventing it from going down towards the stomach. At random times, the contents in the pouch may suddenly regurgitate causing aspiration as well as mucus collection in the throat.

Treatment is surgical. Click here for more info.

Laryngeal Sensory Neuropathy
Perhaps in the most rare situation, the throat-clearing is due to an abnormally sensitized throat where even the slightest irritation which normally would not trigger a throat-clear does trigger one. Related symptoms include chronic dry cough as well as laryngospasm. Click here for more info.


To read more about chronic persistent throat clearing, click here.


Some over-the-counter medications used to treat reflux are listed below:
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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