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 ARB 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