What is the medical term for constant throat clearing?

Medical Terminology for Constant Throat Clearing

The medical term for constant throat clearing is "Upper Airway Cough Syndrome (UACS)," previously known as Postnasal Drip Syndrome (PNDS). 1

Understanding Upper Airway Cough Syndrome

UACS is recognized as the most common cause of chronic cough according to the American College of Chest Physicians (ACCP) guidelines. The term was adopted to replace "postnasal drip syndrome" because it more accurately reflects the underlying pathophysiology - the condition may involve both postnasal drip itself and direct irritation or inflammation of cough receptors in the upper airway. 1

Key Features of UACS:

• Frequent throat clearing
• Sensation of something dripping down the throat
• Nasal discharge
• Mucoid or mucopurulent secretions visible in the nasopharynx/oropharynx
• "Cobblestoning" of the mucosa on examination

Differential Diagnosis

Constant throat clearing can be associated with several conditions:

1. Upper Airway Cough Syndrome - Most common cause 1
2. Laryngopharyngeal Reflux (LPR) - Reflux of gastric contents into pharynx/larynx causing throat clearing, hoarseness, globus sensation 1, 2
3. Globus Pharyngeus - Sensation of a lump in the throat without dysphagia 1
4. Laryngeal Hypersensitivity Syndrome - Heightened sensitivity of laryngeal receptors 1
5. Functional Laryngeal Disorder - Symptoms without clear organic cause 3

Clinical Assessment

When evaluating constant throat clearing, clinicians should consider:

• Duration of symptoms - Acute vs. chronic (>8 weeks)
• Associated symptoms - Hoarseness, cough, globus sensation, nasal drainage
• Timing of symptoms - Worse at night (suggests reflux) 1
• Triggers - After meals (suggests reflux), with temperature changes or irritants (suggests hypersensitivity)
• Response to previous treatments - Particularly to reflux medications

Diagnostic Approach

The diagnosis of UACS is often clinical and based on:

1. History and physical examination - Looking for evidence of nasal or sinus disease
2. Laryngoscopy - To assess for signs of inflammation, particularly in the interarytenoid region
3. Response to therapy - Improvement with specific treatment is often diagnostic 1

Common Pitfalls

1. Missing silent reflux - Up to 20% of patients with UACS are unaware of postnasal drip or its link to their throat clearing 1
2. Overdiagnosis of LPR - Laryngoscopic findings have high interobserver variability 3
3. Unnecessary testing - Modified barium swallow studies and esophagrams often fail to add significant diagnostic information for patients with globus sensation 4
4. Inadequate treatment duration - Many clinicians prescribe reflux medications for insufficient periods (only 2 months) 5

Treatment Approach

Treatment should target the underlying cause:

1. For UACS due to rhinitis/sinusitis:

   • First-line: Antihistamine/decongestant combinations
   • Second-line: Nasal corticosteroids

2. For LPR-related throat clearing:

   • Proton pump inhibitors (first-line therapy)
   • H2 receptor antagonists
   • Lifestyle modifications (avoid late meals, elevate head of bed)

3. For persistent throat clearing without clear cause:

   • Breaking the cycle with behavioral techniques
   • Sipping ice cold carbonated water may help reduce symptoms 6

Conclusion

When patients present with constant throat clearing, clinicians should recognize this as a potential symptom of Upper Airway Cough Syndrome, which has replaced the older term "postnasal drip syndrome." A thorough evaluation for underlying causes is essential, with treatment directed at the specific etiology identified.