There are some individuals who seem to spend most of the time clearing their throat. It can be quite an annoying and embarrassing experience for that individual. This condition of constant throat clearing does not hurt nor does it affect the swallowing process. The person usually does not have any other additional symptoms other than this persistent throat clearing, which becomes quite a nuisance for the patient as well as friends and family members.
This constant throat clearing can occur about few times in a day or can be quite frequent to about a few times in a single minute. Some individuals need to constantly clear their throat after eating whereas some do not. This reflex of throat clearing can also affect a person's quality of life. If it does, then patient should seek medical attention to find out the cause and treat this condition accordingly.
Symptoms of Constant Throat Clearing
If the patient has any other additional symptoms along with throat clearing, then they may include:
- Globus, which is a sensation of a lump in the throat.
- Dry cough.
- Ticklish feeling in the throat.
- Feeling of mucus in the Throat
- A "wet" sounding voice.
Causes of Constant Throat Clearing
Constant Throat Clearing Caused due to Post-Nasal Drainage
Nasal drainage can cause accumulation of mucus in the throat triggering throat-clearing reflex. These individuals can clearly feel the drainage traveling from the nose and down to the throat. If an ENT doctor inspects the back of the throat, then the post nasal drainage can be clearly seen. Treatment depends on the cause of this drainage. If sinusitis is causing the post nasal drainage, then antibiotics are prescribed. If allergies are causing the post nasal drainage, then allergy medications are prescribed. If the cause is vasomotor rhinitis, then nasal sprays such as atrovent, astelin and patanase are prescribed. Surgical procedures, such as turbinectomy or turbinoplasty, to reduce the turbinates also help in reducing the amount of drainage.
Constant Throat Clearing Caused due to Reflux (Non-acidic/ Acidic)
Patient complains of nausea, heartburn, indigestion etc; symptoms which are commonly seen with reflux. This occurs because there is a protective layer in the swallowing tube which prevents damage occurring from acid reflux. For this reason, the swallowing tube is able to tolerate many reflux episodes without producing any problems, but same is not the case with the voice box and throat region. Only a single episode of reflux produces symptoms.
Reflux can be also non-acidic in nature where the patient does not have any burning type symptoms. Treatment comprises of medications used in GERD. The treatment is lengthy and can take up to 6 weeks to 3 months. Given below are some lifestyle changes, which can be incorporated to improve the symptoms of reflux and subsequently throat clearing.
- Elevate the head of the bed to about 30 degrees. You can do this by placing 2 bricks under the head of bed so that the entire bed is tilted and not just the head portion.
- Avoid food and drinks which cause reflux such as alcohol and caffeine.
- Avoid eating or drinking within 3 hours of lying down.
- Avoid spicy, tomato-based and fatty foods.
If reflux is not relieved after adopting the above mentioned conservative methods, then it means that the reflux is reaching the level of the throat and that surgery is required for treating this condition. Some of the investigations which are done to diagnose reflux which trigger throat clearing include:
- Barium swallow
- 24 hour multichannel pH and impedance testing with manometry.
- Upper endoscopy.
- A rapid spit test.
Constant Throat Clearing as a Side-Effect to Some Medications
Medications given for treating hypertension, such as ACE-Inhibitors and Angiotensin Receptor Blocker medications can produce a side effect of a "ticklish" sensation in the throat. This sensation makes the individual want to cough or clear the throat continuously. If constant throat clearing is occurring while taking these medications, then consult your doctor to change these medications to others, such as calcium channel blocker or beta-blocker etc.
Constant Throat Clearing due to Food Allergies
In rare cases, food allergies or any sensitivity, can also cause irritation in the mucosa of the throat or can lead to accumulation or production of excessive throat mucus, which triggers the act of throat-clearing. Most common foods are dairy products, such as wheat, egg, soy, rice, etc. which cause reactions. Treatment comprises of avoiding these foods.
Constant Throat Clearing Caused due to Laryngeal Sensory Neuropathy
This is a rare situation where there is an abnormal sensitization of the throat due to which even the slightest irritation triggers the act of throat clearing. Other related symptoms of this condition include laryngospasm and chronic dry cough.
Constant Throat Clearing due to Zenker's Diverticulum
Zenker's Diverticulum is an even more rare condition where there is an anatomic abnormality in the throat. In this condition there is formation of a pouch which protrudes from the esophagus and catches the mucus and food thus preventing it from travelling down towards the stomach. At random occasions, there is sudden regurgitation of the contents of the pouch resulting in aspiration and collection of mucus in the throat. The treatment for this condition is surgery.
Constant Throat Clearing Caused due to Anatomic Triggers
These include a very long uvula or extremely large tonsils. The enlarged tonsils or the uvula touch the epiglottis and this results in the person trying to remove the irritation by clearing his/her throat. Treatment comprises of removing the uvula or the tonsils (tonsillectomy).
Constant Throat Clearing due to Non-organic Tic
Constant throat clearing can be a result of a tic. Just like the facial tic and eye twitches, there can be a tic which causes the patient to persistently clear his/her throat. Treatment comprises of Botox injections to the vocal cord and patient may also be referred for neurology evaluation.
Constant Throat Clearing due to Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS)
This is an extremely rare disorder, which occurs only in kids. In this condition, strep infections cause tics which lead to throat clearing. If this condition is suspected, then the child is referred to a pediatric neurologist and treatment is done accordingly.
Treatment for Constant Throat Clearing
Treatment depends on the underlying cause or condition, which is causing the throat clearing. If the cause is found to be reflux, then proton pump inhibitors such as prevacid or prilosec are prescribed. Treatment may take almost a month. Investigations, such as upper esophageal manometry or a barium swallow can be done to asses if there are any physical anatomic abnormalities or if there is any abnormality in the muscle itself.
Other than this a 24 hour pH probe and a multichannel impedance testing can also be done to find out the cause of throat clearing. If the barium swallow is abnormal, then an esophagoscopy will need to be done. Allergy testing is also done to find out if allergy is the cause behind the throat clearing.
Whatever the cause, careful assessment and multiple investigations need to be done on the patient, especially if the patient's quality of life is getting affected, to diagnose what exactly is causing this persistent throat clearing and treatment is started accordingly.
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