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.
- 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.
- 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.
- 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.