There are patients who suffer from a persistent
phlegmy throat for months if not years that seems to defy all explanation and resist all
the usual standard medications. Some of these patients have suffered from
persistent throat mucus triggering constant throat-clearing and cough for years resulting
not only in frustration for the patient, but aggravation from loved ones and friends. The phlegmy throat 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, eosinophilic esophagitis, and other
forms of esophageal dysmotility can cause persistent throat phlegm due to mucus that
the esophagus may regurgitate up into the throat. It is important to keep in mind that a patient
with a phlegmy throat may not have any symptoms beyond the mucus 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
mucus 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 phlegmy throat due to post-nasal
drainage. Workup for sino-nasal causes for throat mucus
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 with a phlegmy throat ultimately
find that certain foods trigger throat mucus production. The most common foods that have been found
to cause throat mucus 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. Rarely, autoimmune disorders like Sjogren’s
Syndrome may cause the saliva that is normally produced to become more thick and viscous
which may lead to a sensation of constant phlegm production. In this situation, the phlegm is just normal
saliva that everyone else normally produces… it’s just thicker than normal.
Finally, a patient’s throat mucus complaint
may actually be an illusion. In such patients, there is no more or less
mucus present than any other normal individual. The difference is that those who complain
of constant throat mucus may 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, phlegmy throat due to neuropathy
can cause an illusory constant throat mucus sensation. Once the cause of a person’s constant phlegmy
throat 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 mucus 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, rheumatologist, and neurologist..
