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.