The Medical Consumer's Advocate

I have a constant feeling of phlegm in the throat...

 

Q: ... It's always worse just after eating or early morning. It affects the way I talk, so I find myself "clearing" my throat constantly. I attempt to clear my throat by coughing, and something seems to move around, but I never cough anything up. Within a short time (less than 20 minutes for sure) I find I need to clear my throat again. What could cause this?

A: A sensation of phlegm, when no phlegm exists, used to be known by the impolite Latin phrase, globus hystericus. This means "hysterical ball," reflecting the fact that docs used to think this problem was, um, all in your head. Nowadays, we rarely blame the patient’s psyche for this symptom, which is known by the more politically correct term globus.

Globus sensation is due to inflammation. Inflammation of many different anatomic regions will produce a globus sensation: the nasopharynx ("roof of the throat"), soft palate ("roof of the mouth," including the uvula, that little punching bag in the back of your mouth), base of tongue, posterior pharyngeal wall ("back of the throat"), larynx ("voice box"), hypopharynx ("lower throat") and esophagus ("swallowing tube.")

Next obvious question: what causes this inflammation? Here are a few of the common causes.

Gastroesophageal reflux disease. This is arguably the most common explanation. Stomach acid and digestive enzymes "wash up" or reflux into the hypopharynx and larynx. Unlike the stomach lining, these tissues are not suited for acid and digestive enzymes, and inflammation results.

Rhinosinusitis. Infected mucus from the sinuses and nasal cavities drains down the back of the throat, irritating everything in its path. Globus is usually not the only symptom of sinusitis; patients with sinusitis also complain of facial pressure and/or pain, nasal congestion, and postnasal drainage. In other words, if you had sinusitis, you WOULD cough something up when you clear your throat. Thus, I doubt that this is your problem.

Chronic throat infection. Commonly infected structures include the tonsils, lingual tonsils, and adenoids. Each is an example of lymphoid tissue, collections of cells that are supposed to fight infection. As front line shock troops, these structures can become chronically inflamed as a result of viral or bacterial infections. (The adenoids are high in the throat, in the nasopharynx. Lingual tonsils are located at the base of the tongue.)

Your best bet for rapid diagnosis and treatment of globus: your friendly neighborhood ENT. The diagnosis is often obvious on the basis of history alone ("history" is what you tell your doc.) The physical examination, which may include a fiberoptic examination of your nose and throat (see answer to the first question), often merely confirms what the ENT suspects, based upon your history.

Assuming you are correctly diagnosed and treated, how rapidly should you expect to recover? As a rule of thumb, chronic problems require chronic solutions. If your symptoms have been present for years, don’t expect results within the first week of treatment! Patience is key.

 

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