One of the more frequent symptoms that I address as an internist is chronic throat clearing. Sometimes I’ve had a patient do this throughout an entire office visit and they don’t even realize it because it has become so commonplace to them. Other times, family members or spouses will roll their eyes and state the patient does it all the time, annoyingly. Although there are additional reasons, I have found two primary causes in my twenty year clinical experience thus far: Laryngopharyngeal Reflux and Allergic Rhinitis.
Laryngopharyngeal Reflux (LPR) is quite common. It is caused by a reflux (GERD) of acid going from the stomach up the esophagus all the way to the throat. Only about half of people with this condition also complain of heartburn. They may experience chronic throat clearing, hoarseness or even a simple persistent cough. The exposure of the esophagus to acid repetitively may increase the risk for a Barrett’s esophagus which carries a precancerous risk so it is essential to diagnose and treat this condition.
The LPR risk goes up with an increase in abdominal weight. Spicy foods, caffeine, alcohol and even breath mints may serve as food triggers. Tight fitting clothing around the waist can also trigger the reflux. Medical therapy is available with quick acting medications such as Zantac or Pepcid but for more serious cases, stronger acid lowering medications like omeprazole and pantoprazole could be used. Most cases can be treated with a change in lifestyle habits. LPR patients are encouraged to lose weight and avoid foods rich in spice, acid and fats. Caffeine and alcohol are also minimized. Smoking should be avoided. Loose clothing is advised as well as stress control. Reflux patients are encouraged not to lie down for 2 hours after eating. Sleeping propped up also helps. In most cases, the approaches listed here will help cure LPR.
Another common cause of chronic throat clearing is allergic rhinitis. There is a nasal reaction to an allergen which then causes histamines to be further released. This in turn causes nasal congestion, sneezing or a post nasal drip. It is this post nasal drip that gives rise to throat clearing. Obviously, if the patient can avoid what is causing the allergic reaction it would be beneficial, but this may be difficult if the allergen is mold and it is the rainy season or pollen during the springtime.
Nasal saline spray is used to help treat the nasal drainage and congestion. This may also help remove the allergens from the nasal mucosa as well. As histamine release is the main issue causing symptoms, over the counter anti-histamines (i.e. Claritin, Allegra, Zyrtec, etc.) could be taken to help fight off the allergic reaction. Nasal steroids are also commonly added to dramatically relieve the nasal swelling and nasal symptoms. For more significant allergy sufferers not helped by these initial forms of treatment, an allergist may start a series of allergy shots to help decrease the reaction to the allergen in time.
When I evaluate someone with throat clearing, just asking some basic questions can tell me a great deal. When is it worse? What kicks it off? What helps? Is it positional? Does food trigger it? For those patients that do not respond well to the treatments I’ve listed here, I refer them to an ENT specialist for direct visualization of their vocal cords and if needed, the sinuses. In either case, it is important to answer the question: acid reflux (LPR) or post nasal drip or a combination of both? If LPR is the cause, getting control of the acid and preventing Barrett’s esophagus is essential. Therefore, please take your throat clearing seriously and discuss it with your primary care physician or ENT specialist.
