Ahem! Why you keep clearing your throat

Dr Flo,

I am always clearing my throat.

I used to think it meant I am allergic to cold, but it happens at any time of the day in varied weather conditions.

What can I do about this persistent problem and which medication can I take to alleviate it?

Elias

Dear Elias,

Constant clearing of the throat can be caused by several issues:

Sinusitis: If you also have chronic sinusitis (inflammation of the sinuses), and the sinuses have a lot of mucus in them, some of it can flow out and backwards, down your throat in what is called post-nasal drip, casuing irritation to the throat. If your nose is always blocked, sometimes on one side only, and you occasionally have a headache or pain in parts of your face, and if your sinuses are full on a CT scan, then you are suffering from sinusitis. Treatment includes antihistamines, decongestants, nasal sprays, and if necessary, surgery to drain the sinuses.

Allergies: If you are allergic to cold, dust, strong smells, pollen, dander or fur, causing a constant running nose, sneezing or stuffiness in the nose, this can irritate the throat and even lead to the formation of excess mucus that gives rise to recurrent clearing of the throat. You might also experience post-nasal drip. This is treated with antihistamines, decongestants and nasal sprays.

Laryngopharyngeal reflux (LPR): This means that the contents of your stomach come back up the oesophagus and irritate the throat. Sometimes they spill over into the airways, irritating the vocal chords. This can be accompanied by other symptoms of reflux such as heartburn and  nausea but sometimes there are no other issues other than throat irritation. This is usually diagnosed by an ENT specialist who might send you for further tests such as the barium swallow and endoscopy.

Treatment for LPR is usually the same as that for the reflux that leads to heartburn and other abdominal symptoms. This includes medication that reduces the amount of acid produced in the stomach (proton pump inhibitors) and medicine that reduces reflux/regurgitation like mosapride or domperidone.

Lifestyle changes such as avoiding alcohol, spicy and acidic foods and beverages, quitting smoking, eating at least two to three hours before bedtime and avoiding eating large meals in the evening, can help reduce the symptoms. Staying upright after eating and sleeping in loose-fitting clothes and with the upper body raised with pillows, as well as maintaining a healthy weight, can also help

Lung disorders: Asthma, chronic bronchitis and other chronic lung disorders can lead to persistent throat irritation due to recurrent cough and also from the use of inhalers.

Medication: Some drugs cause throat irritation while others make you feel like coughing or as if there is something stuck in your throat. Some hypertension medications, anti-depressants and inhalers are culprits.

Dehydration: If you do not have enough water in your body, the throat becomes dry and the voice can even become hoarse. The solution is to take adequate amounts of water, and avoid warm, dry environments e.g. air-conditioned rooms and car heating systems.

Voice strain: Talking a lot, shouting a lot or frequently singing loudly using incorrect technique, can all cause strain on the vocal cords, and persistent throat irritation. It can even lead to growths (nodules and polyps) on the vocal chords.

Anxiety: When you are anxious about this particular problem, or about any other issues, then the throat muscles tense up, leading to a feeling of fullness in the throat. Many people clear their throats or loosen clothing around the neck when they feel tense.

Coughs and throat clearing: It’s a vicious cycle – the more you cough or clear your throat, the more you irritate your throat and feel like clearing it and coughing again. The original cause of the throat clearing or cough e.g. an infection, or allergy may have been managed already, but the throat clearing continues. Everyone produces some mucus at the back of the throat every day, and swallows it at some point, most of the time without noticing. Those who clear the throat a lot are just more aware of this mucus. To manage this, try as much as possible not to clear your throat every time you feel the urge to. Instead, take a sip of water.

Other issues: Neurological disorders and problems with the larynx (voice box) or the oesophagus can lead to persistent throat clearing. An ENT specialist can help you manage the problem or refer you for tests with the appropriate specialists as necessary. 

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Dr Flo,

Sometimes I get a feeling of chest tightness that lasts for a few minutes and sometimes it is accompanied by palpitations.

Doctors have carried out all possible tests on me but none points to anything. They say I am fine.

What could be the problem?

Margaret Njogu

Dear Margaret,

The information you have provided is scanty – it does not explain what the tests were looking for. I will assume that the tests you refer to are for heart and lung conditions, since those are the most common causes of chest tightness and palpitations. Having palpitations means that you are aware of your heartbeat. Other possible causes of chest tightness and palpitations include:

 Medical conditions like severe heartburn or hyperacidity, thyroid disorders, hormonal changes due to the monthly cycle, pregnancy, or menopause; low blood sugar, low blood level, high or low blood pressure, potassium and vitamin B12 deficiency and of course, heart and lung conditions.

 Some medicines may trigger palpitations. They include asthma medication (like ventolin, franol, and theophylline), some hypertension drugs, antidepressants, some antihistamines and some antibiotics. Taking a lot of caffeine e.g. in coffee, tea, cocoa, energy drinks and soda, can also trigger the symptoms.

 When you are stressed, anxious, or excited, the hormones released into the bloodstream can speed up your heart rate and breathing, causing a feeling of chest tightness, difficulty in breathing and palpitations. This can happen with day to day stress reactions and also in anxiety disorders, acute stress disorder, post-traumatic stress disorder and panic attacks.

 Other causes of chest tightness and palpitations include exercise, lack of adequate sleep, alcohol overuse, smoking and use of drugs like miraa, bhang or cocaine.

You may require further tests to establish the cause of your symptoms. However. in many cases, palpitations and chest tightness are harmless, and can be managed through deep breathing exercises and relaxation, and the symptoms will usually pass in a few minutes. Only get concerned if there is also chest pain, severe breathlessness, dizziness and/or fainting, and also if the symptoms last for long.