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March 11, 2009

Mucus in Throat or the Phlegmy Throat!!!


NOTE: A more complete discussion on this topic can be found here.

A common complaint of patients seeing an ENT doctor is for a persistent phlegmy throat or sensation of mucus in the throat. Other symptoms that a patient may complain of include constant throat-clearing, cough, raspy voice, and a lump sensation in the middle of the throat (aka, globus).

Reflux (Acidic or Non-acidic)

In the VAST majority of patients with this complaint, 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 settles in the throat region. This mucus collection can even be seen on fiberoptic endoscopy as shown in the picture here. 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 one can try are listed at the end of this article.

To read more about this disorder as well as treatment options, click here.

Post-Nasal Drainage

Sometimes, the throat mucus can come from the nose. 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.

Food "Sensitivities"

Uncommonly, food "sensitivities" can cause excessive throat mucus to develop. The most common culprit is dairy products (many folks develop lots of phlegm in the throat when drinking lots of whole milk for example). Other common triggers include egg and wheat. Treatment for this problem is mainly avoidance.

To be clear, we are NOT talking about food allergies.


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.

Read more about these and other cause of phlegmy throat conditions here.



Medications that may help reflux:
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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