The most common cause of chronic throat clearing, too much mucus and post-nasal drip is acid reflux. We call it silent reflux because it doesn’t have the best-known symptoms, heartburn or indigestion. However, only 20% of people with reflux have those symptoms. Most people (80%) who have acid reflux have silent reflux (LPR) and respiratory issues, including problems with throat mucus.
Post-nasal drip is a symptom and not cause of other conditions. This is important to understand! For example, post-nasal drip does not cause chronic cough, but reflux can cause both the drip and the cough. Many patients undergo unnecessary tests and procedures for these problems unnecessarily because doctors don’t understand respiratory reflux very well. (More about that later.)
Some Throat Clearing from Mucus Is Normal
Skin is the lining covering the outside of the body, and the lining on the inside of us is made up of mucous membranes. It may come as no great surprise, but the mucous membranes manufacture and secrete mucus. The lining of the nose, sinuses, throat, actually the entire respiratory tract, is lined by mucous membranes; and under normal circumstances the nose and throat make about a quart of mucus a day. This normal mucus is not too thick or not too thin, and it is usually swallowed unnoticed.
The respiratory system’s mucus has many functions, but its two most important are its lubrication and barrier functions. Inhaled viruses, bacteria, and particulate matter are trapped on and in this sticky layer, which prevents such foreign material from being absorbed or attacking us all the time. When the mucus membranes are irritated or inflamed, they produce more/ excess mucus. Many things can cause this, including allergy, acid reflux and inhaled irritants. And when there's too much mucus, it causes throat clearing.
Allergic Mucus is Thin and There’s Usually a Lot of It
Different medical conditions result in different consistency and color of the mucus. When people have inhalant allergies, e.g., dust, mold, pollen, the consistency of the mucus produced is usually copious, thin, and watery.
Many people with allergic rhinitis, for example, walk around carrying Kleenex; and, when exposed to their inciting allergen, they usually have related symptoms such as stuffy nose, runny nose, sneezing, and itchy, watery, red or swollen eyes; chronic throat-clearing is not typically a symptom of allergy.
Most people with allergic rhinitis (nose) have attacks when they come in contact with their offending allergens; some people have more chronic symptoms, particularly those who are in constant contact with the offender(s); however, many people who have constant allergic symptoms actually may have respiratory reflux. When patients with allergic rhinitis are examined by a knowledgeable physician, the usual findings are boggy, swollen, purplish nasal lining with a thin, clear-as-glass type of mucus.
People with allergic rhinitis can be successfully treated with antihistamine medications and steroid inhalers. That being said, the steroid inhalers must be used twice a day for an extended period of time before any benefit is realized. So it’s not relief immediately following a spray.
Reflux Mucus Is Thick and Associated with Other Reflux Symptoms
Almost 77,000 people responded to a poll we ran asking what reflux symptom(s) people have. Post-nasal drip was the number one symptom (15%) and the second most common was chronic throat clearing (14%).
The consistency of reflux-caused mucus is thicker than that of allergy, and for the sufferer, the mucus is sticky and hard to move, especially when it gets on the vocal cords. On examination by a physician, reflux-mucus is thick, white, and widely dispersed in the nose and throat, especially on the back wall of the pharynx (the throat).
If you wake up in the morning and the taste is bitter / salty / sour, that’s a tell-tale sign you have acid reflux.
Coughing up mucus that is salty is also common with acid reflux, especially if use a lot of salt in your food. Nevertheless, is important to note that real infections, both sinusitis and bronchitis, can sometimes produce salty-tasting mucus.
If your post-nasal drip has been bad enough, you may have been recommended surgery. Unfortunately, it’s often done unnecessarily. Understand that the nasal sinuses (maxillary, ethmoid, sphenoid and frontal) are hollow cavities in the face (the cheek areas, around and above the eyes) — they have ostia (openings) that allow them to breathe and drain into the back of the nose. A lot of sinus and nasal surgery is unnecessary surgery because that drip is a reaction to reflux, not a problem in itself.
Fix the reflux and you fix the post-nasal drip, mucus and sinus problems.
The Diagnoses of Allergy and Reflux Are Often Confused
For certain, all post-nasal drip is not allergy, and most self-diagnosing, self-treating patients falsely assume that their post-nasal drip is due to allergy when in fact they have silent respiratory reflux. Indeed, reflux is far more common than true allergy of the upper airway.
Many medications, including over-the-counter mucus-reducing medications, will improve the post-nasal drip of both allergy and reflux. However, in the case of reflux, the short-term improvement of post-nasal drip will not improve the underlying reflux condition. With reflux, patients can have nasal congestion and runny nose, but not usually sneezing or itchy eyes. The most common “other” symptoms associated with reflux are chronic throat-clearing, a sensation of a lump in the throat, hoarseness, and cough.
Many physicians are unaware of the clinical differences between allergy and reflux. Specifically, they are ignorant of the different physical findings, including the difference in the consistency of the mucus.
Why Does A Reflux Diagnosis Take So Long?
Part of this issue is due to medical specialization.
The trend towards medical specialization has intensified over the last 50 years… while simultaneously disenfranchising primary care physicians (PCPs). Each specialist – including lung doctors, ENT doctors and GI specialists – just takes care of one part of the body. This has led to specialists who are unable to diagnose / treat reflux because they don’t understand how the respiratory and digestive tracts are connected. They are directly connected at the upper esophageal valve, which is supposed to protect against reflux in the throat. There is also a direct connection between the throat and the lungs at the level of the vocal cords.
I have taken care of thousands of patients with reflux over the course of my career, and almost all have seen multiple specialists including PCPs, allergists, otolaryngologists, pulmonologists, and gastroenterologists.
What to Do About Reflux
- Don’t take PPIs!
- Understand that acid reflux increases your risk of esophageal cancer, so get screened
Reflux is curable with effort and commitment to change.
However, here are the most important pieces of advice I can offer:
- No eating or drinking within five hours of going to bed
- Sleep on an incline no less than 45-degrees (gravity helps)
- Eat five small meals
- No fried or high-fat foods
- No alcohol, chocolate or soft drinks (including fruit juice) of any kind
- Take Pepcid 20 mg. before each meal and before bed
- Take a tablespoon of Gaviscon Advance Aniseed after each meal and before bed (not available in stores in the U.S., but available online)
- Drink alkaline water as much as you conveniently can: an alkaline pitcher is convenient (and test it with pH paper or a pH tester to make sure it's 8.0 or greater)
- Chew sugar-free gum after eating or drinking anything but water.
If you've read at least one of my books and you're following this guidance and you still need help, you can book a consultation with me.