Why do I have to constantly clear my throat?

Globus is a term often used in the medical community signifying an unusual feeling in the back of the throat. “Throat clearing” and “a lump in the throat” are common complaints. Other symptoms include sore throat, hoarseness, difficulty swallowing, and painful swallowing in some patients. There are many possible causes of globus. Varied treatment regimens have been used to manage globus.

To identify possible causes of globus, a thorough exam of the back of the throat and vocal cords is necessary. This is sometimes done with a small flexible fiberoptic scope passed through the nostril. Rarely a lesion is found. More commonly, scarring and swelling in the vocal cord area is identified and may be the cause of the throat symptoms.

Treatment of globus is based on identifying the presumed cause. Acid reflux from the stomach is the overwhelming cause in most patients. Terms often used for this include gastroesophageal reflux disease (GERD) and laryngoesophageal reflux disease (LPRD). This problem is very common in an otolaryngologist’s (ENT) practice. Management of LPRD is based on elevation of the head of bed, raising from the waist by using cinder blocks, a wedge (about 10-12 inches at the neck), or multiple pillows. Some patients even sleep in a recliner to maximize elevation, which can keep the stomach contents from rising up to the throat. The second treatment regimen involves diet modification. Patients with LPRD should eat small meals and avoid snacking after the evening meal. Patients should avoid spicy food, citrus, tomatoes, coffee, tea, soda, caffeine, alcohol, cigarettes and tobacco, and greasy food. All of these can aggravate reflux disease both in the stomach and the throat.

Multiple medications have been used for reflux disease. Tums, Mylanta, Maalox, Carafate, and the acid blocking medications (Zantac, Pepcid, etc.) will work in some patients. For LPRD, which can be a more severe problem in spite of rare “heartburn,” proton pump inhibitors (PPIs: Aciphex, Nexium, Prilosec, Prevacid, Protonix) are the drugs of choice. These are activated by food and should be taken up to 30 minutes before breakfast. Treatment for LPRD should be continued for at least 3-6 months. In some patients, twice daily treatment is more effective. A gastroenterologist evaluation is recommended for refractory patients.

Good vocal hygiene is also important for LPRD and globus patients. Good hydration (water and sports drinks only) and vocal restraint (avoiding whispering, coughing, yelling) are imperative for recovery. Singing can be very hard on vocal cords and should be done sparingly and under a vocal coach’s supervision.

Globus can also be caused less commonly from post nasal drainage (“sinus drainage”). Management of sinus and allergy symptoms should be addressed in these patients. Stress and anxiety are other causes of globus. These should be considered when other possibilities have been exhausted. Several rare causes of these throat symptoms have been identified and will need to be ruled out during your office visit. Follow up is typically within 3-6 months to ensure that the treatment regimen is appropriate and working well. With attention to detail, most patients with globus and throat clearing can be managed successfully.