Understanding the Causes of Constant Throat Clearing: Diagnosis and Treatment

“I’m always clearing my throat, growling, and it feels like there’s something in there.” It’s a common patient complaint. However, it is so common, with so many different causes, that it can be difficult to know exactly what is causing this sensation and what to do. 

With constant throat clearing, it is important to find out what is causing the feeling, what the underlying issue is, and what can be done to fix it. This article will address the causes and next steps to take when throat clearing is a persistent problem.

[signup]

What is Throat Clearing?

Throat clearing is a normal physiological reaction to irritants in the throat. By rubbing your vocal cords together and expelling air, the body is trying to free any irritants stuck in the throat and free them from the body. This is not the same as full-on coughing, the result of more severe irritations or illnesses, but can still be very annoying.

Constant throat clearing lasting more than two to three weeks should be evaluated by a medical professional and should be part of a comprehensive exam and testing.

What Causes Constant Clearing of Throat?

Throat clearing irritants can include anything from a common cold causing post-nasal drip to springtime allergies and hay fever. That “ahem, ahem!” action of clearing your throat is not a problem. However, when that feeling lasts for weeks or even months, it is time to see a physician. 

In addition, chronic throat clearing often creates more irritation to the vocal folds because of the harsh contact, resulting in a cycle of frequent, persistent throat clearing.

Here are the top causes of constant throat clearing:

Postnasal Drip

Post-nasal drip is probably the most common cause of throat clearing.

Nasal mucus is a first-line defense against infections and allergens. We even create mucus in response to cold weather and dust. A runny nose is mucus dripping toward the front of the nose, Postnasal Drip is mucus drip from the back of the nose toward the throat. Laying down to sleep can cause this type of mucosal drain and if the mucus is too thick to swallow, we try to force it out by clearing the throat.

Acid Reflux (GERD)

When most patients think of GERD they think of heart burn and acidic belching. However, often the first sign of developing GERD is constant throat clearing due to acid buildup irritating the vocal cords. So if a patient asks “does acid reflux cause constant clearing of the throat?,” the answer is “yes.”

Allergies

Allergens are another common cause of throat clearing. Common allergens include dust, mildew, animal fur and dander, and pollen.

Chronic Sinusitis

• Chronic sinusitis causes sinuses to become inflamed and swollen. This keeps mucus from draining and makes the nose stuffy. This lasts 12 weeks or longer, even with treatment.
• Infection, nasal polyps, and swelling of the lining of the sinuses might all be part of chronic sinusitis. 
• Chronic sinusitis is also called chronic rhinosinusitis and affects adults and children.
• While the exact cause of chronic sinusitis is not known, it can be exasperated by the common cold, a deviated septum, dental infections, and being around smoke and other environmental irritants.

Laryngopharyngeal Reflux (LPR)

Not to be confused with GERD, LPR occurs when stomach contents, including acid and enzymes, back up into the esophagus and injure the tissues of the larynx (voice box) and pharynx (throat). The cause is malfunctioning of the upper and lower esophageal sphincter muscles.

Symptoms are similar to GERD and should be evaluated by a physician. 

Habitual or Behavioral Causes

There are also psychological and habitual factors that can cause constant throat clearing. Stress and anxiety are prime factors for this, as are smoking and carbonated beverages.

Other Rare But Serious Causes

While something as serious as esophageal cancer can cause clearing actions, it is unlikely throat clearing will be the first symptom that presents. Still, it is worth investigating any potential cause if initial treatments do not resolve the problem.

Diagnostic Approach to Constant Throat Clearing

As with any medical question, the first act should be a comprehensive medical history and evaluation. A physician should look for a history of allergies, breathing issues, reflux, and chronic bronchitis. This also includes palpating and examining the throat and mouth.

Diagnostic Tests

• Endoscopy is a nonsurgical procedure that can be used to examine your digestive tract. Using an endoscope, a flexible tube with a light and camera, doctors can view pictures of a patient’s digestive tract on a monitor. This is a minor outpatient procedure that requires some anesthesia and is usually painless.
• pH monitoring involves passing a thin tube through your nose or mouth to your stomach. The tube is then pulled back into your esophagus, and a monitor attached to it measures the acid level (pH) in your esophagus. 
• Allergy testing is performed by an immunologist. While there are some blood tests for allergens, the most common test is a skin prick test in which small traces of allergens are placed under the skin. The reaction can be seen on the skin hours or sometimes days after the skin prick. 
• Sinus imaging is usually done using an MRI. Blockages, changes to the anatomical structures, and other physical attributes are examined for anything that could be physically causing the constant throat clearing.

Differential Diagnosis

While rare, there are other causes for constant throat clearing that should be considered, especially if the common causes have been ruled out.

• Zenker’s diverticulum is a rare anatomical abnormality in which the esophagus has a small pouch that traps food and other substances.
• Tourette’s Syndrome is a rare neurological disorder that includes facial tics and spasms.
• Pediatric Autoimmune Neuropsychiatric Disorder (PANDAS) is a rare complication of strep throat and can involve vocal and facial tics.

Treatment and Management Strategies

Treatment and management of constant throat clearing can differ depending on the root cause. Here are some standard treatments:

Management of Postnasal Drip

Treatment for postnasal drip can include medication, dietary changes such as limiting or avoiding certain foods or beverages, often dairy products, and lifestyle modifications such as elevating the head of the bed at night.

Medications for post-nasal drip and allergies include antihistamines, decongestants, and nasal sprays.

Management of Acid Reflux (GERD)

Eating an anti-reflux diet and not lying down shortly after eating may help in some cases. Often, people have to use medications such as PPIs for several weeks or months to lower stomach acid production. Antacids may also be recommended for managing GERD.

In addition, lifestyle modifications such as reducing coffee, spicy foods, and high acidic foods can help.

Management of Allergies

The best treatment for allergies is to remove the allergen from the area. However, that is not always possible and over-the-counter medications, such as antihistamines, are easy to use. Allergy injections (immunotherapy) can be used for more serious chronic allergies. For these shots, an allergy/immunology referral is usually required.

Avoiding other triggers, such as smoking, can be an important management strategy as well. A home air purifier, humidifier, and dehumidifier can be beneficial to control air quality and consistency throughout the year.

Management of Chronic Sinusitis

Treatment for chronic sinusitis includes saline nasal irrigation and nasal sprays. More severe cases might require surgery to repair a deviated septum or to remove polyps. 

Balloon sinuplasty, a procedure where a balloon is inserted and expanded to open the sinus cavity, can also be successful in patients with severe blockages.

Management of Laryngopharyngeal reflux (LPR)

Common treatments for LPR include dietary changes, quitting smoking, and changing eating habits to more frequent, smaller meals to limit the amount of gastric acid production.

Management of Habitual or Behavioral Causes

As with anything psychological, these are best treated by a psychiatrist and certified counselor. Dietary habits and smoking can be addressed by a physician; however, a licensed counselor can also be of significant help in making lifestyle changes.

Behavioral interventions also include breathing exercises, smoking cessation, and meditation.

Other Lifestyle and Home Remedies

Dietary changes can often be a good first line of attack as a constant throat clearing remedy. Foods such as dairy can increase mucus and influence an inflammatory reaction. 

Other foods, such as hot tea, can help keep the throat clear and hydrated. Reducing spicy foods can help with reflux, as can the cessation of coffee.

When to Seek Medical Help

Red flags and warning signs

• Throat clearing, while normal, should not last for significant periods of time. After two to three weeks, a patient should seek medical advice.
• Any additional symptoms, such as chronic vomiting, nausea, or diarrhea, can indicate the need for specialist care, such as a gastroenterologist.
• Breathing issues should immediately be assessed.

The timely diagnosis and treatment of chronic throat clearing is vital. Since it does not seem like a problem to many patients until they have experienced it for a month or more, it is important to evaluate and treat what has now become a chronic condition.

It is likely that a primary care physician will consult with specialists, such as an ENT, allergist, or gastroenterologist. This can be especially true if an obvious source of the problem is not seen. ENTs, in particular, are valuable in their training to see what a general practitioner may not recognize.

[signup]

Key Takeaways

Constant throat clearing, while initially appearing as something mild, can be a cause of significant impact on a patient’s health and lifestyle.

Since constant throat clearing can be an early warning sign of greater issues, such as GERD, LPR, chronic sinusitis, or even Tourette’s, it is important to seek medical advice and evaluation sooner rather than later.