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Chronic Throat Clearing Causes

There are patients who constantly clear their
throat for not just a few days, but months to years, that seems to defy all explanation
and resist all the usual standard treatments. Some of these patients have suffered from
chronic throat-clearing for years resulting not only in frustration for the patient, but
aggravation from loved ones and friends. Chronic throat clearing is difficult to treat
mainly due to the many different possible triggers. As such, in order to properly diagnose and
treat this issue, a comprehensive evaluation is mandatory. Numerous tests will be required with the attitude
of leaving no stone unturned. Just trying medications is no longer sufficient. Let’s go thru all the possible causes and
potential testing required. The esophagus is the swallowing tube that
connects the mouth and throat to the stomach. Reflux, zenker’s diverticulum, and other
forms of esophageal dysmotility can cause an irritated throat that will trigger a constant
urge to throat clear. It is important to keep in mind that a patient
who constantly throat-clears may not have any symptoms beyond the throat-clearing itself. All these symptoms may be absent: heartburn,
throat burning, choking, lump in throat sensation, or trouble swallowing. However, if such symptoms ARE present, it
does reinforce the possibility of some type of esophageal disorder. Workup for esophageal causes of chronic throat
clearing include upper endoscopy with biopsies, barium swallow, 24 hour multichannel impedance
testing, manometry, and even spit tests. Sino-nasal conditions such as allergies, chronic
sinusitis, and vasomotor rhinitis can trigger a persistent throat clear due to post-nasal
drainage. Workup for sino-nasal causes of throat clearing
include trans-nasal endoscopy, allergy testing, and CT sinus scan. Workup also includes a trial of two different
nasal sprays, an anti-histamine nasal spray as well as ipratropium nasal spray, to address
vasomotor rhinitis for which no good test exists. Some patients who persistently throat clear
ultimately find that certain foods trigger this symptom. The most common foods that have been found
to cause throat clearing are wheat, dairy, and egg. Keep in mind that food sensitivities should
not be confused with food allergies nor should it be confused with foods that may cause reflux. There are certain drug classes known to commonly
cause a throat irritation as a side effect leading to throat clearing and/or cough. The biggest culprits are certain blood pressure
medications known as ACE-inhibitors. Less commonly, another class of blood pressure
medications called angiotensin receptor blockers may also trigger constant throat-clearing
as a side effect. Finally, a patient may constantly throat clear
due an illusion of throat irritation. Patients suffering from chronic throat-clearing
may actually be suffering from nerve damage of the throat responsible for throat sensation. This condition is known as laryngeal sensory
neuropathy. To use an analogy, a temporary sensory neuropathy
occurs when a person gets a numbing shot at a dental office. When the jaw becomes numb, it is not unusual
for the individual to feel as if the area has not only become swollen, but also to feel
as if drool is constantly present. But when looking in the mirror, no swelling
nor drool is present. Similarly, throat clearing due to neuropathy
can be caused by a constant illusory throat mucus sensation. Once the cause of a person’s constant throat
clearing complaint has been determined, treatment can then be initiated with successful resolution. Keep in mind that it is not unusual in patients
with constant throat clearing going on years that more than one cause may ultimately be
found to be present and as such, multiple different treatments may be required. A full workup may require seeing multiple
different specialists including an ENT, gastroenterologist, allergist, and neurologist.

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