Over many years of evaluating and treating patients with a voice impairment, throat clearing is the most common accompanying behaviors, and one of the most irritating to the vocal folds.

So why do patients do it?

 “I have phlegm,” “mucus,” “there’s something there,” are among the most common reasons patients offer for throat clearing, and while those sensations patients report may in fact have some physiologic basis, oftentimes they are merely serving as a trigger, and it’s important for patients to realize that the harsh habit of throat clearing will not likely reduce the sensation, and in fact make their voice symptoms worse.

In some instances, when a patient has a very weak voice or stiff vocal folds, as in the case of Parkinson’s, unconsciously, the individual may begin throat clearing as a method of getting the vocal folds to move and make contact but, unfortunately, the constant banging of the vocal fold edges each time they begin to speak may result in voice quality changes and a soft voice may also become  raspy.

Allergies, acid reflux, medications, air conditioning can all contribute to dryness and irritation to the vocal folds and surrounding mucosa, and secretions that are normally in the upper airway may be perceived by patients as “mucus,” or “phlegm,” that they believe throat clearing will remove. But the bad news is that the throat clearing just increases the irritation, and soon, a vicious cycle has begun.

The analogy I often use with patients is an insect bite. I am an avid gardener, and because of that, every summer at least one time, I step into an ant pile. Almost immediately the itching begins, and because I am allergic, the itching can go on for days. If I scratch the area, it will provide momentary relief, but, soon I’m itching again, and the constant scratching will causes the tissue to swell, become inflamed, even bleed, and then, just putting on a sock can set off a whole cascade of itching. So, instead, I try cool or warm compresses, topical treatments like Caldryl, rubbing gently rather than scratching. So, I don’t deny the sensation, I just deal with it in a less harmful way.

So, if you are a habitual throat clearer, you too, will be advised to substitute that harsh behavior with a more acceptable option that is less harmful to your vocal folds. Some substitutions might include:

• Water -drink, drink, drink this will help thin secretions that might be thick or sticky from medications and hydrate the tissue to reduce irritation.
• If acid reflux is the cause of your throat irritation, your physician may prescribe medication, and your speech therapist can help by advising you on some of the foods to avoid and other lifestyle changes you can make to reduce reflux symptoms.
• Suppressing the urge to throat clear and substituting a less harsh behavior, such as a hard swallow, a huff maneuver, ice chips or water, can all be effective strategies.

If throat clearing only occurs during or after a meal, and you also notice a “wet” or gurgled vocal quality, this might indicate a swallowing problem. Report these symptoms to your physician and request a referral to a speech-language pathologist who can evaluate your swallowing function.

The Good News: Throat clearing is a habit that can be quickly extinguished, just by heightening your awareness.

I am always pleasantly surprised when a patient returns for their second out-patient visit and they have already significantly reduced or eliminated throat clearing. Often, they will say to me: “I’m not clearing my throat even though I want to.” “GREAT”, I say,” you can still want to but now that I have taken the fun out of it, you are on your way to a healthier voice!”

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My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower. Mary Spremulli, MA, CCC-SLP *  FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice

Voice Aerobics the heART and Science of Voice Practice