One of the most common reasons for a visit to the Otolaryngologist (ear, nose, and throat specialist) is for chronic throat clearing. Most people clear their throat because they feel the need to remove phlegm from the vocal cords. The action of throat clearing involves exhaling quickly, while forcefully bringing the vocal cords together. This forces the phlegm sitting on the vocal cords upwards and into the back of throat where it can be swallowed or expectorated.
Unfortunately, throat clearing can become a bad habit. It usually begins after an upper respiratory infection (common cold), where it is not unusual to have increased secretions or a tickle in the throat. The repeated trauma from forcefully bringing the vocal cords together causes them to swell. The swollen vocal cords then create the sensation that there is still something present in the throat. This leads to additional throat clearing, thus perpetuating the problem. The more frequently the throat is cleared, the more the sensation appears.
Gastroesophageal reflux disease (GERD) is another common cause of chronic throat clearing. GERD is a problem where stomach acid regurgitates from the stomach back into the esophagus. When it is particularly severe, the acid reaches all the way up into the throat, and is referred to as laryngopharyngeal reflux (LPR). Patients with LPR complain of a sore throat, hoarseness, chronic cough, and/or the sensation of a persistent lump in the throat. This throat irritation causes them to continually clear the throat.
There are numerous other processes that can lead to chronic throat clearing. Some common causes include inadequate fluid intake, medications that dry the mucous membranes, diuretics, smoking, post-nasal drip from allergies or sinusitis, aging, and post radiation side effects.
A complete head and neck examination by an Otolaryngologist is necessary to make an appropriate diagnosis, and rule out more serious diseases that affect the larynx. Treatment is geared towards eliminating the source of the throat irritation. Increased humidity and fluid intake are important. The diet should be modified to eliminate caffeine and foods that increase stomach acid production. Saline nasal sprays, steroid and antihistamine nasal sprays, throat lozenges, antacid medications, and mucous thinning medications are just some of the approaches for helping patients with these symptoms.