constant throat clearing

[sugardaddy1]

For about four years now I have been experiencing constant throat clearing my family doctor has called it post nasal drip. I have been treated by my PCP, an ENT, and allergists. My PCP prescribes antibiotics which helps for a few days. The ENT removed a nasal polyp and could not find any reason for the constant throat clearing which not only is bothersome to me but after while annoys others as well. I was tested for allergies and tested positive for dust mites. I have the bed covers and attempt to keep the dust level inside down to a minimum. The allergists prescribed Zyrtec, nasonex and nexium and this course of treatment helped for a while but now the constant need to clear my throat is back.  I also do the saline nostril rinse once a day as well and it helps for about thirty minutes then it is back to clearing my throat every few seconds. I am a 54 year old fairly healthy male. Are there any other interventions that may get me some relief? Thank you for your time and your response.

[sugardaddy1]

Thank you Dr. Tinkelman for your very detailed response. I shall follow your advice.

[David Tinkelman, M.D.]

Nasal polyps (NPs) represent a common clinical end point for a number of inflammatory disease processes involving the paranasal sinuses. Chronic rhinosinusitis is the most common cause for NPs, but not all NPs are created equally.  

The presence of a nasal polyp may offer the best clue as to what is happening in your nose and sinuses.  Such polyps are often associated with the production of excessive mucous that leads to throat clearing.  Clinical studies have led to a number of conclusions about polyps: 1) not all polyps are alike and the micro-anatomy of the polyp may be an indication of the likely cause, 2) nasal polyps are associated with allergens, occupational chemical exposures, cigarette smoking and gastroesophageal reflux disease (GERD), 3) many but not all nasal polyps respond favorably to inhaled nasal steroids, 4) a subclass of polyps has been shown to exhibit a reduction in size in response to low dose doxycycline administered for 3 weeks and, 5) polyp size has been shown to decrease by selectively antagonizing a substance that stimulates polyp development, IL-5, with (IL-5) monoclonal antibody antagonists.  The preceding is based on the premise that the need for throat clearing may be reduced with a reduction in polyp size, not necessarily a cause and effect.

You have been seen by a number of physician specialists in your area but you remain symptomatic.  It may be time to seek a second opinion at an institution where clinical research on nasal polyps, throat clearing and chronic inflammation of the nose and sinuses has been conducted.  The following are two such places.  If neither is close to where you live, I suggest that you call the first one, Case Western Reserve University and ask if they can refer you to specialists closer to home.

1) InstitutionDepartment of Otolaryngology, Head and Neck Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
2) Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA.


Authors Full NameChhabra, Nipun. Houser, Steven M.
InstitutionDepartment of Otolaryngology, Head and Neck Surgery, Case Western Reserve University & University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
TitleThe surgical management of allergic rhinitis. [Review]

SourceOtolaryngologic Clinics of North America. 44(3):779-95, xi, 2011 Jun.
AbstractIn their discussion of the treatment of allergic rhinitis, the authors present key features of the disease and its management, allergen responses, the role of the inferior turbinate, and reviews of outcomes with submucosal resection, total inferior turbinectomy, cryosurgery, laser cautery, radical turbinectomy, submucous turbinectomy, submucous electrocautery, and microdebriber turbinoplasty. The authors discuss radiofrequency ablation and coblation outcomes and complications, along with the role of endoscopic sinus surgery in allergic rhinitis and emphasize the need for Otolaryngologists to be facile with a variety of procedures for best outcomes. Copyright Copyright 2011 Elsevier Inc. All rights reserved.





Authors
DeMarcantonio MA. Han JK.


Authors Full Name
DeMarcantonio, Michael A. Han, Joseph K.


Institution
Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA 23507, USA.


Title
Nasal polyps: pathogenesis and treatment implications. [Review]


Source
Otolaryngologic Clinics of North America. 44(3):685-95, ix, 2011 Jun.


Abstract
Nasal polyps (NPs) represent a common clinical end point for a myriad of inflammatory disease processes involving the paranasal sinuses. Chronic rhinosinusitis is the most common cause for NPs, but not all NPs are created equally. This article outlines the current understanding of pathogenesis in nasal polyposis and discusses the implications on therapy. Copyright Copyright 2011 Elsevier Inc. All rights reserved.