Constant throat clearing

[crazy_kz]

For many many years I have had trouble with constant clearing my throat--to the point of loosing my voice completely if I don't keep clearing it.  It is most previlent after eating and in the morning (but not right away).

I have had a barium swallow test done, tried 4-5 different steroid sprays, allergy testing (negative), large doses of guaifenesin.  Nothing has helped!

After eating, I have to cough hard from my chest to bring up flem (phlegm).  The more I talk, the better it stays; however I have to continue to almost like "groan" to keep the vocal cords clear all day.

Any other clues?

[National Jewish]

The most likely source of the mucus is the upper airways, including the nose and sinuses.  Postnasal drip is drainage from the nose and sinuses dripping down the back of the throat.  There could be several reasons for this drainage.  One reason is an allergy.  A second reason is a non-allergic, non-infectious inflammation in the sinuses that can linger after a cold.  A third reason is chronic sinusitis.  Postnasal drip can cause complete voice loss as a result of irritation of the throat and vocal cords.  You may experience the postnasal drip as a constant feeling of mucus on your vocal cords.  Typically this worsens during the night while you are laying down to sleep.  Generally this irritation feels the worst in the morning and gets better as the day goes on.  The mucus may move when you “groan”.  There may be no serious disease with throat clearing.

The fat content in dairy products can thicken mucus.  Generally eating dairy products with less fat content is helpful.  Drinking plenty of water will help to thin the mucus so that it moves more easily.  As long as you are not on a fluid restriction you should be drinking 6 to 8 8-ounce glasses of non-caffeine non-alcoholic fluid daily.  Instead of coughing hard, wait until the mucus rises and then cough it out.  Clearing your throat can irritate your throat and vocal cords.  Throat clearing can become a habit that is difficult to break.  To help break this habit sip some water to clear the mucus whenever you feel the need to clear your throat.  Another technique is swallowing rather than clearing your throat.

An antihistamine can dry up the postnasal drip.  However, it may make the mucus thicker and more difficult to move.  A decongestant like Sudafed® (pseudoephedrine) can thin the postnasal drip and decrease the swelling so it drains easier.  A combination antihistamine-decongestant will do both.  Check with your doctor to see which would help you more.  Often an antihistamine and decongestant are taken only when the postnasal drip gets bad.  It may be more helpful to take the antihistamine and decongestant on a regular basis.

A nasal wash helps remove mucus and germs from your nose and sinuses.  This can temporarily decrease the postnasal drip and lessen voice loss.  A prescription nasal steroid spray decreases mucus production by decreasing the inflammation of the nose and sinuses.  This may prevent the postnasal drip and voice loss.  To get the most help from a nasal steroid spray use it after doing a nasal wash.  A nasal steroid spray does not provide immediate relief of symptoms.  It may require several weeks of routine use to become effective.  Please read our Nasal Wash MedFact at http://www.nationaljewish.org/medfacts/nasal.html for more information about this technique.  Share this information with your doctor to see if you would benefit from this daily treatment.

Sometimes it takes the antihistamine, the decongestant, and the nasal wash followed by the nasal steroid spray ALL used routinely to keep the postnasal drip from bothering you.

[blondeviolin]

Constant throat clearing is a sign of GERD.  What did your barium swallow say?  Do GERD meds help?

[crazy_kz]

The B. Swollow test didn't show anything (I was even able to view the X-rays myself) and all of the GERD meds I've taken have not helped at all either.

[blondeviolin]

Because the barium swallow didn't show anything does not mean you don't have GERD.  The gold-standard definitive test for GERD is a 24-hr pH probe.  Hardly a less invasive test.

You could also have constant mucus becaues of post-nasal drip.  Do you have allergies?  Sinus problems?  Do you feel like you have a constant cold.  

Oh, and also, just to touch some bases, have you been tested for Cystic Fibrosis?  Does it run in your family?

[Concerned lady]

I agree with Blondeviolin! It could still be reflux (at least). Some reasons that acid blockers don't always work, to stop reflux (if you have reflux) are (at least):

1)Acid blockers don't always deal with all the underlying causes of a person's reflux. For example, if you have food sensitivities, and if you keep eating the foods that you are sensitive to, this can cause reflux, and the acid blockers may not stop the reflux.

2)Some reflux is not acid reflux, but can be alkaline reflux, or even a "neutral" reflux. All reflux liquid is corrosive, and can damage the esophagus, throat, vocal cords, and lungs. Acid blockers may not stop alkaline reflux episodes. An example of an alkaline reflux, is when bile that is in the duodenum (first part of the small intestine, just past the stomach) backs up into the stomach, where the bile doesn't belong. This can irritate the stomach, leading to an alkaline (bile) reflux episode, and acid blockers may not stop this reflux.

3)One usually unsuspected problem, can be possible adverse (bad) side effects of acid blockers, that can even include...gastric reflux! (Check the side effects in the paper package insert).

Sometimes, dietary and "life-style" changes for the better, can control reflux at least as well (if not better) as acid blockers.

You can also telephone a LUNG LINE nurse, to find out about more possible problems, regarding your own situation, by calling 1-800-222-LUNG(5864).

Concerned lady
http://cantbreathesuspectvcd.com

[crazy_kz]

Blondeviolin, I do not have any PND, no allergies, rarely get sick, no sinus troubles (allthough a lot in the past).  There is no history of CF in my family either.

[spagnuolo]

I am no pro but my boyfriend is going through something like this. We think its vasomotor rhinitis....its causes are obscure, there seem to be so many. If you have a lot of post nasal drip and a cough but no cold, no allergy etc. It might be worth looking into Vasomotor rhinitis. If I find more useful information on treatment. Like it actually works for boyfriend I'll post it here. Everything triggers it, change in air quality, emotional stress, smoke, everything. Its maddening...the cough is anyway. Its so dry sounding. Breathing in steam seems to make him feel better but it hasn't stopped the problem. It came on very suddenly in Aug/Sep after a period of extreme emotional stress and exposure to family members with colds. Although I don't think he got a cold...

[spagnuolo]

opps sorry you said you don't have post nasal drip...

[mscbybls]

I too have had this problem for years.  Tried various nasal sprays, had x rays of the sinus cavity and an esophogram.  No response.  One week ago I decided to test caffine.  I slowly switched from caffinated coffee to decafe.  Immediately about an 80% reduction in frequency and intensity.  For the last three days I have abstained from all coffee (and soft drinks with caffine and now I am about 95% free of the problem.  Occassional mild throat clearing is all that remains.  It sounds too easy but for me, is the real deal.  Hope this helps.

[lucius]

I have heavy PND in the morning and right after eating or drinking. No matter what it is, I always have it. It gets worse when eating and talking together. I don't cough but right after a meal I actualy feel it drip into my lungs. A big cough would clear most of it.
I experience also heart burn from time to time. Maybe that's related.

Funny you mention about caffeine.
I never drink water, only diet Coke. About 1,5/2 liters a day. Maybe the solution is as simple as that??

[spagnuolo]

My boyfriend does drink his fair share of coffee...with milk and sugar. I'll mention this to him. Its so easy its worth a shot. Steam helps too.

[Concerned lady]

It's also good to keep a food diary that includes foods, drinks, snacks, etc. See which agree and which don't agree with you.

Diet soda pop has a large list of ingredients, most of which can irritate the stomach (or worse), leading to gastric reflux (or worse). Diet soda pop also can cause weight gain!

Gastric reflux can cause more mucus, more phlegm, and all kinds of breathing problems.

Concerened lady
http://cantbreathesuspectvcd.com

[spagnuolo]

Luckily he's not a big soda fan. Other than the coffee which I don't think is bad (unless that is the thing that is making him sick) he eats fairly well. Although too fast. This thing feels like a respiratory problem to be. I can hear the liquid gurgling in his lungs at night. Its bad. The cough and the post nasal drip are the two biggest factors at play. Well he's got another doctors appointment on the 17th. Anyone else ever feel as though some doctors take advantage of insurance? Not all of them mind you! Just some.

[lucius]

What I was wondering. It was mentioned here several times that one should drink a lot to keep hydrated. It was mentioned non-caffeine drinks. Why no caffiene drinks?

[spagnuolo]

I am personally not sure why. I think that we are just trying to eliminate any kind of possible contributing factors one at a time to see if it helps. Water I know helps because its thins out the drip, of course then you just have a very watery drip. Is this better or worse than a thicker version? I guess its personal preference...

[Concerned lady]

One of the reasons to avoid caffeine (there are probably more) is that caffeine DEHYDRATES people. This works against drinking more water to PREVENT DEHYDRATION.

Concerned lady
http://cantbreathesuspectvcd.com

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