“Ahem!” This could be the sound of getting someone’s attention, but when it occurs repeatedly, it may also be the sound of chronic throat clearing.
Chronic throat clearing is a common problem that may or may not be associated with other symptoms such as a throat tickle, dry cough, and/or “lump in the throat” sensation. It may happen a few times per day, a few times per minute, or sometimes only after meals. The causes and frequency of throat clearing may be different for each person, and when persistent, require medical examination.
In general, chronic throat clearing is usually the result of hypersensitivity in the larynx (voice box) and pharynx (throat). Clearing your throat is usually your body’s response to this irritation and an effort to remove the irritation by rubbing your vocal folds (vocal cords) together. 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.
The possible causes of chronic throat clearing are numerous and should be determined by a medical evaluation. These causes may include acid reflux irritation, post-nasal drip from allergies or sinusitis, the presence of vocal fold lesions, neurologic conditions such as tics, and side effects of certain medications. Because these causes differ greatly, a comprehensive medical evaluation is necessary to plan appropriate treatment.
Diagnosis of chronic throat clearing may begin with your family physician or allergist. If typical treatments for allergies or reflux are not successful in resolving the throat clearing, an evaluation with an ear nose and throat physician and a comprehensive voice evaluation by a speech-language pathologist who specializes in evaluation of voice and swallowing disorders may be recommended.
The UK ENT Department and Voice & Swallow Clinic collaborate to provide multidisciplinary care for the evaluation and treatment of chronic throat clearing. Patients may be treated for acid reflux irritation as the cause. This irritation can reach the level of the larynx. For some patients this feeling is obvious and noticeable, but for others it is not. Either way, the result can be chronic throat clearing, as well as a lump in the throat feeling, dry cough, and/or hoarseness. It is important to note that this is a different problem from heartburn.
Treatment can include medication prescribed by a medical doctor, dietary changes such as limiting or avoiding certain foods or beverages, and lifestyle modifications such as elevating the head of the bed at night. In cases where this irritation has caused hoarseness or voice changes, voice therapy may be indicated. Again, an evaluation is needed in order to determine if these treatments will be effective.
So, what’s the bottom line? Chronic throat clearing can cause a cycle of irritation and ultimately may cause hoarseness and discomfort with swallowing, among other changes. If you think you suffer from chronic throat clearing, we recommend a referral to an ENT physician as well as a speech-language pathologist trained in voice and swallowing disorders. This will help determine the cause and appropriate treatments.
JoAnna Sloggy and Liz Campbell are with the University of Kentucky Voice and Swallow Clinic.