EpistemisChronic laryngeal throat clearing
Specialty: Otolaryngology.
Why it occurs
- Chronic postnasal drip due to chronic rhinosinusitis or persistent allergic rhinitis
- Laryngopharyngeal reflux disease that generates direct chemical irritation of the mucosa of the posterior vocal cords
- Side effect of antihypertensive drugs, especially angiotensin-converting enzyme inhibitors (ACE inhibitors)
- Chronic neuromuscular habit or tic after an infectious episode of the upper airways
Initial workup
Nasofibrolaryngoscopy with strobe light to evaluate the motility and vibration of the vocal folds, 24-hour dual-channel pH-metry, skin allergy tests, and suspension of ACEI drugs such as enalapril, replacing them with ARA-II if clinical suspicion is high.
red flags
Presence of progressive or fixed dysphonia lasting more than 3 weeks, hemoptysis or hemoptoic sputum, persistent unilateral odynophagia referred to the ear, dysphagia to solids, or palpable ipsilateral cervical mass.
Standard management
- Nasal corticosteroid spray such as fluticasone if the primary cause is postnasal drip
- Second generation antihistamines
- Proton pump inhibitors such as omeprazole — 20-40 mg every 12 hours
- Pharyngeal mucosa protectors based on sodium alginate with bicarbonate (10 ml after main meals and before going to bed to mitigate non-acid reflux).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 4