Chronic Cough and Throat Clearing

Abstract

The diagnostic approach to chronic cough and its management are well established by international consensus guidelines. In some cases, the main or predominant associated complaint is excessive throat clearing. Cough and throat symptoms, including throat clearing, have been well documented and have serious impacts on quality of life and a patient’s sense of well-being, so much so that they are the first and second most common reasons that patients seek medical attention, respectively. Throat clearing is distinct from cough in its sound, in the amount of volitional control, physiology, and neurophysiology. It is proposed that the differential diagnosis for chronic cough with throat clearing is the same as for chronic cough alone. However, in a nonsmoker without other environmental inhalational exposures, the presence of prominent throat clearing skews the likelihood of specific diagnoses to favor upper airway cough syndrome (UACS) and gastroesophageal reflux disease (GERD) rather than lower airway diseases such as asthma or nonasthmatic eosinophilic bronchitis (NAEB) when these latter conditions are uncomplicated by rhinosinus diseases or environmental exposures. Other causes of cough with excessive throat clearing include direct irritations of the laryngopharyngeal mucosa by inhaled environmental agents, somatic and tic disorders that commonly feature throat and vocal symptoms, and, uncommonly, inflammatory diseases that originate within the patient such as collagen vascular diseases and other autoimmune disorders involving the upper airway. Similar to the treatment of chronic cough alone, the medical treatment for chronic cough with excessive throat clearing should target the underlying disease processes with specific therapy rather than nonspecific cough suppressants. Usually, when the underlying cause is specifically addressed, the excessive throat clearing will resolve in parallel with the resolution of the patient’s chronic cough.