Throat Clearing

 

Background

Throat clearing is an abrasive action where the voice box is typically pushed and rubbed against the back wall of the throat to relieve irritation. Cough is an explosive closing and opening at the level of the vocal cords to clear the airway.

Excessive throat clearing itself becomes the cause of swelling and irritation leading to a vicious circle of irritation, sensitivity and abrasive clearing of the throat.

 

 

Indication for referral

If endoscopy is required for purpose of simple reassurance, there are two referral pathways, depending on referrer discretion as to their own assessment of risk. Refer to either:

• Routine ENT OPD, OR
   
• Urgent throat symptoms assessment clinic
  
  • Available as an alternative referral pathway on the ENT 2WW form 
  • ENT will aim to see these patients within 4 weeks

 

 

Primary care assessment prior to referral

A careful history and examination of the neck, oropharynx, nose and ear are required to rule out alternative or underlying pathology.

No investigations are required or recommended prior to referral.

 

 

Management options prior to referral

1) Provide patients with the Throat Symptoms Patient Information Leaflet: 

• Explain the nature of the problem; specifically that the symptoms are made worse, not better, by continuing to throat clear and/or cough
• Advise patient to stop throat clearing and coughing, and to drink water instead

2) If suspicion of post nasal drip, treat nasal / sinus disease (see “chronic sinusitis/polyposis”) 



3) Consider treatment for possible underlying laryngopharyngeal reflux. Typically, we would prescribe:

• Omeprazole 20mg twice a day for 2 months AND
• Gaviscon Advance 10mls four times a day to be taken after meals and before bedtime for 3 months

If symptoms worsen when coming off medication they may need to be taken for longer.

 

Information to include in referral

• Relevant history
• Management option(s) already tried

 

 

Red flags

Refer via 2WW if: 

• Previously un-investigated, unexplained PALPABLE lump in the neck (including thyroid, parotid and submandibular glands)
   
• Unexplained persistent (>4 weeks) sore or painful throat (especially with otalgia)                                                                                         
  (NOT for globus or throat discomfort)
  
  
• Persistent (>3weeks) unexplained hoarseness and age ≥ 45yrs

 

 

Review Date                December 2021

Next Review Date        December 2022

GP Sifter                      Dr Laura Vines

Contributor                   Mr Venkat Reddy

Version                         2.0