Throat Clearing and Globus Sensation

Keith G. Saxon and Jo Shapiro

The symptoms of throat clearing and globus sensation may be presenting complaints or may be associated with other presenting complaints either separately or together.

Throat Clearing

Patients may be unaware of throat clearing even though it is obvious to those around them or present during their clinical exam. The act of throat clearing is a choice the patient makes as a response to a perceived sensation. The key differential points of throat clearing turn on the chronicity of the problem and the presence or absence of findings on laryngoscopic inspection, as well as associated history and symptoms. Allergic rhinitis, chronic sinusitis, gastroesophageal reflux (GERD)/laryngopharyngeal reflux (LPR), and cough-variant asthma account for the vast majority of throat clearing in nonsmokers with a normal chest x-ray.

Acute causes of throat clearing include the following:

Allergy: Either as a result of alteration of secretions, inflammation of the mucosa, or sensory changes. Associated history and symptoms include seasonal occurrence, rhinorrhea, nasal congestion, and itchy eyes. Findings on physical examination may include turbinate hypertrophy, nasal mucosal edema, rhinorrhea, and the absence of laryngeal findings on endoscopy. There is often a response to antihistamines and topical nasal steroids.

“Postnasal drainage” (PND): This term, although ubiquitous, is relatively meaningless. Normal nasal and sinus physiology assumes all patients have PND. However, when there are excessive posterior nasal secretions, it is usually due to rhinitis or sinusitis.

Rhinosinusitis/upper respiratory tract infection (URI): Alteration in quantity and viscosity of secretions so that the patient may actually feel those secretions in the hypopharynx. Other systemic or focal symptoms, the presence of mucus in the middle meati, nasopharyngeal inflammation such as erythema, purulence or adenoid hypertrophy, or lymphoid hyperplasia of the oropharynx support this diagnosis.

Laryngopharyngeal reflux: Single events of reflux may give rise to many days of symptoms, especially if the response of the patient is to throat clear. Direct laryngoscopic findings of inflammatory changes in the hypopharynx and esophageal introitus, and response to lifestyle changes, antacids, H2 antagonists, or proton pump inhibitors (PPIs) support this etiology.