Many of our patients come to our office with a chief complaint of frequent throat clearing with or without hoarseness. Patients with this complaint also frequently report a sense of something stuck in their throats that they can’t resolve by coughing. This symptom is often due to allergies with post-nasal drip or silent reflux or both. Much less frequently, people may have a throat mass or develop habitual throat clearing. Because it is important to rule out throat cancer, it is imperative for patients with this symptom get a full evaluation in our office. This includes an in-office endoscopy to visualize the throat and voice box. These structures are not visible on a typical office physical examination.
Every day, two liters of thin mucous travel from the nose and mouth into the throat where it is swallowed. This lubricates the upper airway and protects us from infection. Any interference or thickening of this flow of mucous can cause throat clearing and hoarseness.
Allergies cause irritation and inflammation in the upper airway. This thickens the mucous, which doesn’t allow it to flow like normal mucous. Patients then develop a constant sense of mucous in their throats and subsequently they clear their throats frequently to remove this sensation. Allergies can be diagnosed with skin testing performed in our office and can be treated with antihistamines and/or nasal steroid sprays.
Sometimes the sensation to clear the throat is related to stomach acid refluxing into the esophagus (feeding tube) and onto the voice box. This acid burn gives a sensation of something stuck in the throat and subsequently provokes the need to clear the throat. This is caused “silent reflux” because there are no complaints of heartburn or indigestion. Patients are often surprised to learn they have “silent reflux”. This type of reflux can be diagnosed with pH testing which we can perform in our office. Typically, we can treat this with dietary and lifestyle changes.