An occasional cough or throat clear usually is not a concern. But a cough that lasts eight weeks or longer is considered a long-lasting (chronic) cough. Chronic cough and throat clearing are common, affecting between 10 and 20 percent of the population.

In this Q&A, Benjamin Laitman, MD, PhD, a laryngologist with the Mount Sinai Health System, explains how a chronic cough differs from occasional throat clearing, and when you should see a doctor for that chronic cough.

“Often these two are intertwined because when people feel something in the back of their throat, some people will do it with a cough, some people will do it with a gentle throat clear,” says Dr. Laitman, who is also an Assistant Professor in the Department of Otolaryngology-Head and Neck Surgery at the Icahn School of Medicine at Mount Sinai and a member of the Grabscheid Voice and Swallowing Center of Mount Sinai.

What causes chronic cough and throat clearing?

The three most common causes are:

• Lung problems, such as asthma, chronic obstructive pulmonary disease (COPD), and infections
• Reflux disease. Severe heartburn, a painful burning feeling in the chest or throat, can happen when stomach contents move upward into the esophagus and throat. This can lead to chronic cough
• Postnasal drip and sinus disease

If these causes are ruled out, you may have irritable larynx syndrome, also called throat or laryngeal hypersensitivity. With this condition, the nerves in your throat can sense irritation more easily and send signals more often. You may feel as though something is in your throat and needs to be cleared, even when nothing is there.

What doctor should I see for a chronic cough?

The right doctor depends on what may be causing your cough. Start with your primary care doctor, who can refer you to the right specialist.

1. Allergies and sinus problems: Your doctor can check for a sinus infection or recommend an allergy and immune system specialist (allergist or immunologist). Conditions such as chronic rhinosinusitis or allergic rhinitis can cause postnasal drip and cough. If the problem keeps coming back or becomes chronic, your doctor may recommend an ear, nose, and throat (ENT) specialist.
2. Lung problems: Your primary care doctor may refer you to a pulmonologist, a doctor who specializes in lung diseases. This doctor may order lung testing. Pulmonary function tests or chest X-rays can help rule out or identify common causes, such as asthma or other lung disease.
3. Heartburn: If you have heartburn or notice that your cough is related to meals, your doctor may recommend a gastroenterologist, a doctor who specializes in the digestive system, to look for reflux. Reflux happens when food or acid from the stomach moves up into the esophagus. Laryngopharyngeal reflux is a type of reflux in which food or acid rises as far as the throat. This can cause irritation, extra mucus, hoarseness, chronic cough, and throat clearing.

Benjamin Laitman, MD, PhD

What should I do if my chronic cough does not have an obvious cause?

If these possible causes have been evaluated and no cause is found, you may be referred to an ENT doctor with additional training focused on the throat (laryngologist). This doctor can evaluate you for laryngeal hypersensitivity, sometimes called irritable larynx syndrome. Doctors diagnose this condition only after other causes have been ruled out.

With laryngeal hypersensitivity, nerves in the throat send signals to the brain that make you feel as though you need to cough or clear your throat, even when nothing is there. Coughing can then irritate the throat further, creating a cycle that can be difficult to break.

Treatment for this cycle is different from treatment for lung disease, reflux, or sinus problems. The source describes two approaches: behavioral cough therapy and treatment to reduce nerve firing.

In behavioral cough therapy, speech-language pathologists work with the laryngology team to help you respond differently when you feel the urge to cough and break the cycle. Another approach is to reduce nerve firing with a localized injection or longer-term medications such as gabapentin and amitriptyline. The source states that these medications have been shown to reduce this hypersensitivity.

What doctor should I see if throat clearing is my main symptom?

Throat clearing and chronic cough can be two signs of the same underlying problem, so doctors generally look for the same causes. If throat clearing is your main symptom, it is still important to rule out postnasal drip, sinus disease, and reflux. An ENT specialist can check for postnasal drip and irritation in the back of the throat. If you have heartburn symptoms, a gastroenterologist can evaluate you for reflux.

If those causes are ruled out, throat clearing can also be a sign of laryngeal hypersensitivity. The same evaluation and treatment approach may apply.

Throat clearing can also be related to a swallowing problem. If you feel as though food is getting stuck in your throat, an ENT specialist can check for a blockage or another problem. You may also see a laryngologist and a speech-language pathologist.

If you have swallowing problems or feel that food is getting stuck along with throat clearing, your care team may perform swallowing tests. In one type of test, you eat or drink while a camera is used to view your throat. Imaging tests can also show how food moves from your throat toward your stomach.

If food is not moving normally, your care team may need to make sure it is not entering your lungs. This is called aspiration, which can lead to pneumonia.

Why is it important to get treatment for chronic cough and throat clearing?

Chronic cough and throat clearing may seem like minor annoyances, but they can disrupt sleep and make everyday activities, such as going to a movie or having dinner with friends, uncomfortable. In severe cases, repeated coughing or throat clearing can strain the voice and lead to a vocal cord injury.

There is often an identifiable cause. Once your care team knows whether the cause is a lung problem, reflux, sinus disease, or laryngeal hypersensitivity, they can identify an appropriate treatment path. If you have a chronic cough or ongoing throat clearing, start with your primary care doctor, who can help guide you to the right specialist.

For parents with children who have a food allergy, sending kids off to school can be worrisome.

In fact, about two children in every classroom have a food allergy. The most common food allergies are peanut, tree nuts (like walnut, cashew), shellfish (like shrimp), egg, milk, wheat, soy, fish (like salmon and cod) and sesame seeds.

Treatments are emerging and researchers at Mount Sinai’s Elliot and Roslyn Jaffe Food Allergy Institute are working hard to find better therapies and cures. Options like the injected medication omalizumab and therapies where “microdosing” of the allergen is performed under doctor supervision are increasingly being used.

For many, the primary approach to managing food allergy is to avoid eating the problem foods and to recognize allergic reactions and treat them promptly. Serious allergic reactions are treated with epinephrine, a safe medication delivered through an autoinjector or nasal spray. The epinephrine helps to relieve symptoms that can be life-threatening, such as trouble breathing and problems with blood circulation.

Scott Sicherer, MD

If you are sending your child to school with food allergies, here is a checklist of tips from Scott Sicherer, MD, Director of the Jaffe Food Allergy Institute and author of The Complete Guide to Food Allergies in Children and Adults (Johns Hopkins University Press).

 Make sure you work with your allergist to confirm the diagnosis of food allergy. Often, children are avoiding foods to which they are not truly allergic. Sometimes they may be allergic to a food not yet identified. Your allergist will consider the past reactions, and allergy test results to make sure your child’s food allergies are properly identified.

 If there is a potential severe food allergy (anaphylaxis), learn how to recognize and treat it. Talk to your allergist or pediatrician about symptoms of an allergic reaction. These can include:

• hives (itchy rashes that look like mosquito bites) on the skin
• swelling of the lips/face
• gut symptoms such as vomiting, nausea, or pain
• asthma type symptoms like cough, wheeze, trouble breathing, voice changes, and throat or chest tightness
• signs of poor circulation such as paleness, dizziness, or passing out

It is important to treat a progressive allergic reaction early with epinephrine and to seek medical attention for severe reactions, such as calling 911. Several epinephrine products are on the market and are activated in different ways—check out online videos and practice with trainer devices.

Share a written food allergy and anaphylaxis emergency plan with the school. A written plan is important to confirm with your school that there are allergies, and what to do in the event of a reaction.  An example plan is one from the American Academy of Pediatrics.

In an age-appropriate fashion, make sure your child knows how to avoid allergens and when to inform an adult for any reactions. Depending upon their age and abilities, children may either have simple responsibilities (such as knowing who is trusted to provide them food and snacks and to let an adult know if they are not feeling well), or they may be able to read ingredient labels, identify allergic reactions, carry medications and even self-treat. However, in school, adults should be ultimately responsible to assure avoidance strategies are in place and to have a plan to identify and treat any allergic reactions.

Check that your child’s medications are up-to-date. Epinephrine self-treatment devices may need to be renewed. Keep track of expiration dates.

Discuss how the school will keep your child safe. Most schools have had experience with children having food allergies. Discuss their approaches. Craft projects using food can avoid the allergen with substitutions. Celebrations could favor non-food approaches, such as playing a game or watching a video. Younger children may have supervision during meals. Discuss how food service will provide safe meals, including careful ingredient control with attention to avoiding allergen cross contact and identifying hidden allergenic ingredients. Supervising adults should be familiar with recognizing and treating allergic reactions.

Think about bullying. Children with food allergies report a high rate of bullying associated with their allergies. Ask your child about this. Let the school know if there are any issues.

On the bus. For those taking the bus, some good approaches include:

• Ensuring the driver knows about the allergy and has a cell phone in case of any emergency
• Not eating on the bus
• Never putting a child on the bus if they are experiencing a possible allergic reaction
• Having younger children with food allergy sit closer to the driver