Persistent Throat Mucus: Which Specialist Should You See?

Q: Persistent Throat Mucus: Which Specialist Should You See?

Dear Miss Bear：<br>1. <br>The respiratory system consists of the nose, pharynx, larynx, trachea, bronchi, and lungs. <br>The upper respiratory tract includes the nose, pharynx, and larynx, while the lower respiratory tract includes the trachea, bronchi, and lungs. <br>The upper r

Phlegm in the throat?

Hello Doctor: I have had phlegm in my throat for three months.
I have visited an otolaryngologist several times, but there has been no improvement.
Recently, I have experienced a mild cough and a slight itchy sensation, but no other symptoms (the phlegm is clear and white).
I am unsure which specialty to consult—should I see a gastroenterologist, an internist, or a pulmonologist? Or do you recommend any specific tests? Thank you.

Xiong Xiong, 30~39 year old female. Ask Date: 2021/08/02

Dr. Xiao Yongxun reply Family Medicine

Dear Miss Bear:
1.
The respiratory system consists of the nose, pharynx, larynx, trachea, bronchi, and lungs.
The upper respiratory tract includes the nose, pharynx, and larynx, while the lower respiratory tract includes the trachea, bronchi, and lungs.
The upper respiratory tract serves as the passageway for air to enter and exit, secreting mucus to filter, warm, and humidify the air, and it also has olfactory and phonatory functions.
The mucosal layer of the lower respiratory tract is composed of pseudostratified ciliated columnar epithelium (respiratory epithelium), where the movement of cilia and the secretion of mucus help purify and humidify the air.
If there is foreign body irritation in the trachea, it can trigger a cough reflex to expel it.
Occasionally, gastroesophageal reflux (for example, when the lower esophageal sphincter is weak), infections, alcohol consumption, smoking, caustic injuries from strong acids or bases, radiation damage, and excessively hot foods can lead to esophagitis.
When reflux material ascends to the throat, it can create a sensation similar to phlegm.
In fact, any secretions or foreign bodies entering the vicinity of the throat can produce a feeling of phlegm or a foreign body sensation in the throat.
2.
Common differential diagnoses for "phlegm in the throat" include gastroesophageal reflux (reflux esophagitis), pharyngitis, bronchitis, laryngitis, vocal cord disorders, allergic rhinitis, allergic bronchitis, post-nasal drip, chronic obstructive pulmonary disease, and bronchial asthma, among others.
Additionally, there are many rare diagnoses that must be considered.
3.
It is recommended that you discuss this thoroughly with your family physician before making any decisions, or seek care at a regional hospital or higher-level thoracic medicine outpatient clinic.

Reply Date: 2021/08/02

More Info

Persistent throat mucus can be a frustrating and uncomfortable condition, especially when it lingers for an extended period. Given your symptoms of throat mucus lasting for three months, accompanied by a mild cough and itchiness, it’s essential to approach this issue systematically to identify the underlying cause and receive appropriate treatment.

Initially, since you have already consulted an otolaryngologist (ear, nose, and throat specialist), it may be beneficial to consider other specialists who can further evaluate your condition. Here are some recommendations:
1. Pulmonologist (Chest Specialist): Since you are experiencing persistent mucus and a mild cough, a pulmonologist would be an excellent choice. They specialize in respiratory issues and can conduct tests such as pulmonary function tests, chest X-rays, or CT scans to assess your lung health and rule out conditions like asthma, chronic bronchitis, or other pulmonary disorders.

2. Gastroenterologist: If there is a possibility that your symptoms are related to gastroesophageal reflux disease (GERD), which can cause mucus production and throat irritation, a gastroenterologist would be appropriate. They can evaluate for acid reflux and may recommend lifestyle changes, dietary adjustments, or medications to manage reflux symptoms.

3. Allergist: If allergies are suspected to be a contributing factor to your throat mucus, an allergist can perform tests to identify specific allergens. Allergies can lead to post-nasal drip, which often results in throat mucus accumulation.

4. Internal Medicine Physician: An internist can provide a comprehensive evaluation of your overall health and help coordinate care among specialists. They can also assess for any systemic issues that might be contributing to your symptoms.

Recommended Tests and Evaluations
- Chest X-ray or CT Scan: To visualize the lungs and check for any abnormalities.

- Pulmonary Function Tests: To assess lung function and rule out obstructive or restrictive lung diseases.

- Allergy Testing: To identify potential allergens that may be causing your symptoms.

- Esophageal pH Monitoring: If GERD is suspected, this test can help determine if acid reflux is contributing to your throat symptoms.

Additional Considerations
- Hydration: Ensure you are staying well-hydrated, as this can help thin mucus and make it easier to expel.

- Humidifier: Using a humidifier in your living space can help keep the air moist, which may alleviate throat irritation.

- Avoid Irritants: Stay away from smoke, strong odors, and other environmental irritants that can exacerbate throat mucus production.

When to Seek Immediate Care
If you experience any worsening symptoms, such as difficulty breathing, chest pain, or significant changes in your cough (e.g., blood in mucus, high fever), seek immediate medical attention.

In conclusion, based on your symptoms, starting with a pulmonologist would be a prudent choice. They can help determine if there is an underlying respiratory issue that needs to be addressed. If necessary, they can refer you to other specialists based on their findings. Remember, persistent symptoms warrant thorough investigation to ensure proper diagnosis and treatment.

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