Most people clear their throats almost every day.
It is such a normal occurrence that not many realise that it could potentially signify an underlying health condition.
Some do it because it feels like there is mucus stuck in the throat, they have a tickling sensation, or simply a need to clear their throat.
Others experience hoarseness, chronic coughing, a lump or irritation in the throat that doesn’t ever go away.
While regular throat-clearing is perfectly normal, you must be wary of chronic throat clearing, especially if it lasts for weeks or months.
Silent reflux is one of the most common causes of chronic throat-clearing.
Also known as laryngopharyngeal reflux (LPR), it usually does not cause heartburn – a common complaint in reflux, especially for acid reflux and gastroesophageal reflux disease (GERD).
In the absence of that burning sensation in the chest, many may not realise that the inflammation in their stomach is responsible for the symptoms in their throat.
Potential triggers
Silent reflux happens when stomach contents, such as acid and digestive enzymes, go up into the throat and voice box.
The tissues of your throat are far more delicate and sensitive than those in your stomach or oesophagus.
Even a small amount of reflux can irritate the thin tissue lining the throat, causing inflammation.
This irritation can ultimately lead to chronic clearing of the throat, hoarseness, copious mucus, sore throat, chronic cough, bad breath, trouble swallowing, or a lump in the throat known as a “globus sensation”.
But it’s not just the condition itself.
Lifestyle and diet are also significant contributors.
Overeating, especially large amounts of alcohol, coffee, carbonated beverages or spicy food, and particularly at night, as well as obesity, all put pressure on the stomach to aggravate reflux and throat irritation.
Stress plays a role as well.
Chronic stress affects the nervous system, digestion and vagus nerve function, affecting swallowing, stomach emptying and the oesophageal sphincter, which usually keeps stomach contents from rising higher.
Another common cause of throat clearing is postnasal drip.
Allergies, chronic inflammation of the sinuses, mould exposure, pollution, dust mites or pet dander may also cause excess mucus to leak into the throat.
This relentless irritation results in coughing and clearing of the throat.
Mucus production and inflammation may be further aggravated by histamine intolerance or environmental allergies.
Sleep and breathing patterns are a big part of it as well.
Mouth-breathing, snoring and sleep apnoea can dry and irritate the throat overnight, causing painful mucous membranes and hoarseness in the morning.
Even worse, sleep apnoea can produce more reflux due to pressure on the chest while asleep.
Smoking, vaping and exposure to air pollution aggravates the airway lining and increases inflammation and mucus production.
Medications like NSAIDs (non-steroidal anti-inflammatory drugs), steroids, blood pressure medications, sedatives and some antidepressants can further exacerbate reflux symptoms.
Additionally, improper enzyme production, suboptimal digestion or delayed gastric emptying, gut dysbiosis, food sensitivities, or the overgrowth of bacteria in the intestinal tract can increase pressure and gas accumulation leading to reflux.
Small Intestinal Bacterial Overgrowth (SIBO), candida overgrowth and leaky gut can also exacerbate inflammation and digestive problems.
Treatment options
Traditional therapy is mostly aimed at controlling symptoms.
Proton pump inhibitors (PPIs), such as omeprazole, esomeprazole or pantoprazole, have been found to reduce stomach acid production.
Antacids can be of temporary help, although ENT (ear, nose and throat) specialists may do laryngoscopy to inspect for inflammation, polyps and other lesions in the throat and vocal cords.
Drugs to treat allergies, as well as lifestyle changes associated with it, including avoiding late meals and acidic foods, are also often recommended.
While these treatments can certainly be helpful, functional medicine takes a broader and more root cause-based approach.
Rather than just suppressing acid, functional medicine aims to tackle the cause of the reflux or throat irritation.
The first step is to recognise and remove triggers.
The vast majority of patients do benefit tremendously from reducing alcohol, caffeine, chocolate, mint, fried foods, ultra-processed foods, carbonated drinks, and even late-night eating.
Some people might also benefit from a brief elimination of dairy, gluten or high-histamine foods to see if food sensitivities are triggering the inflammation.
Meal timing is also crucial.
Eating smaller meals, chewing food slower, trying not to eat too much and stopping at least three hours before bed helps relieve the stress on the gastrointestinal system and reduce the pressure on nerves and reflux.
It’s important to promote good digestion.
Functional medicine practitioners can work on the function of the digestive enzymes, the presence of Helicobacter pylori infection and gut microbiome status.
Diseases such as SIBO may also be tested for.
Restoring gut health is a key feature of functional medicine.
Anti-inflammatory nutrition, probiotics, fibre support, as well as gut-healing nutrients like zinc carnosine, L-glutamine, DGL liquorice, slippery elm and aloe vera, are sometimes prescribed under medical supervision to facilitate healing and reduce irritation in the digestive lining.
Stress is another key component of this strategy.
The digestive system is intimately connected to the nervous system.
Chronic stress can worsen reflux, compress the throat, alter swallowing mechanisms and increase airway sensitivity.
Helpful strategies include exercise, breathing exercises, meditation, sleep optimisation, vagal nerve support methods and emotional stress management.
These alone may noticeably improve symptoms for some people.
Quality of sleep and airway function require evaluation as well.
For patients with snoring, sleep apnoea or chronic mouth-breathing, the response to treatment should show a marked reduction in irritation to the throat.
Lying on the left side, raising the head of the bed and nasal breathing may help some patients.
Getting rid of environmental irritants, including purifying indoor air, and staying hydrated, along with stopping smoking or vaping, are also instrumental to long-term recovery.
Other serious causes
It’s important to note that chronic throat-clearing may signal more serious diseases like vocal cord lesions, chronic infections, neurological problems, or potentially tumours.
A medical evaluation is crucial if the throat-clearing is associated with trouble swallowing, unexplained weight loss, coughing blood, severe pain, persistent hoarseness or a past history of smoking.
An examination by an ENT specialist is essential to rule out the following conditions:
- Lesions on the vocal cords
- Persistent infections
- Neurological issues
- Tumours.
Finally, regular throat-clearing is often more than “just mucus”.
Silent reflux is often the result of interplay between digestion, inflammation, diet, stress, the nervous system, sleep and environmental exposure.
The goal of functional medicine in this situation is not just symptom suppression, but to also restore balance to the digestive and airway systems, to reduce chronic inflammation, and to improve long-term health and quality of life.
Datuk Dr Nor Ashikin Mokhtar is a consultant obstetrician and gynaecologist, and a functional medicine practitioner. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
