You're sitting in a quiet place like a library, religious service or lecture hall, when the silence becomes interrupted by the guttural tones of someone who is frequently clearing his or her throat. Mind you, this is no mild "ahem." This sounds disgusting, like someone about to hock a loogie.
And it continues, without any coughing, sneezing, nose-blowing or other outward signs of a cold or allergies.
Excessive throat-clearing is more of a symptom than a diagnosis, says Dr. Phillip Song, a laryngologist at Massachusetts Eye and Ear Infirmary in Boston. It usually starts with a physical component, such as acid reflux or an upper respiratory tract infection. But then it can become behavioral when it becomes habituated, he explains. "It's hard to know when it crosses that line."
So, how can you tell the difference between garden-variety throat clearing from a cold, sore throat, or seasonal allergies and the chronic kind? If it lasts less then two weeks in general, that's situational, says Song. If it's greater than three months and it's there all the time while you're awake, that's chronic throat-clearing.
Two of the most common causes of frequent throat clearing are laryngopharyngeal reflux, or LPR, and seasonal allergies, explains Song.
Reflux from the stomach, which may or may not be acidic, comes up through the esophagus and into the back of the throat, where it can irritate the voice box. People with LPR may also have post-nasal drip, an excess of throat mucus, or the feeling like something is stuck in the throat, but nothing is there.
With allergies, an environmental trigger whether it's pollen, ragweed, or mold is causing itchiness and inflammation in the nose and throat, which forms one continuous airspace. It's tickling the throat creating a desire to clear it.
People with allergies or reflux are also producing a dry, sticky mucus that's leading to a phlegm-filled sound when the throat is cleared.
Sometimes asthma can make the throat irritable and hypersensitive. Chronic throat-clearing may also occur in a condition known as vocal hyperfunction, where friction along the length of the vocal cords from straining to speak or explosive coughing, forms small ulcers or masses.
Occasionally, excessive throat clearing is a side effect of people taking blood pressure medications known as ACE inhibitors, so you'd need to switch to a different drug.
Treatment for the problem depends on the cause. There are medications to ease reflux, allergies, and asthma. Voice therapy can help break the throat-clearing cycle of vocal hyperfunction.
If you're persistently clearing your throat and it doesn't go away, have your doctor check it out. Most of the time, people are aware they are doing this and it can disrupt their lives, Song says. But sometimes, a spouse brings the person to the doctor's office because the throat-clearing is driving them crazy, he points out.
Has constant throat clearing ever driven you nuts?