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Swallowing and speaking is usually effortless and cough only happens occasionally. We don’t usually notice our throat until something goes wrong. Symptoms can include:

  • A change in the sound of the voice or a feeling of strain when speaking.
  • A feeling in the throat like a tickle or a lump or mucus.
  • Frequent coughing.

Most cough, voice and throat problems are harmless. Occasionally, there can be serious disease like cancer, auto-immune disease or unusual infection. Signs you may have a serious problem include:

  1. Being a smoker or drinking alcohol every day.
  2. Having trouble swallowing, getting worse over time.
  3. Coughing while drinking water or thin fluids.
  4. Pain in the throat and ear.
  5. Coughing or vomiting blood.
  6. Change in voice lasting longer than one month.

If you have these symptoms, your GP will make an urgent referral to an Ear, Nose and Throat/Head and Neck surgeon.

Viral infections can cause cough, voice and throat problems. The symptoms usually resolve without treatment within a few weeks. For some people, post vial cough can last for months. Post-COVID cough can last up to 12 months and this link has useful information, although we don’t recommend lozenges for chronic cough (they contain irritants that can make cough worse over time).

Other common reasons for having cough, voice and throat problems lasting longer than 4 weeks are:

  1. Rhinitis.
  2. Asthma or other lung disease.
  3. Gastro-oesophageal reflux.
  4. Stress, distress, grief and anxiety

If your cough, voice and throat problems last longer than 4 weeks, there are no signs of serious disease and there is no obvious cause for the symptoms, your GP may make a non urgent referral to see an ENT surgeon.

The surgeon does a thorough examination including nasal endoscopy

Irritable larynx syndrome

We have a healthy cough reflex that protects the lung from inhaling dust or small objects. The cough reflex involves sensory nerves in the pharynx and larynx to detect dust or small objects and nerves to the muscles to make the cough happen. For patients with irritable larynx syndrome, the cough reflex has become hyper-sensitive or too switched on. They cough often and for no reason. The more often you cough, the more sensitive the cough reflex becomes. This causes trauma to the larynx (voice box) and makes the voice hoarse and strained.

Globus pharyngeus syndrome

This is similar to irritable larynx syndrome. The sensory nerves in the pharynx have been hypersensitive and you may have a constant feeling of a tickle or a lump or mucus in the throat. This may cause anxiety about what is happening and you may try to clear the throat a lot to relieve the symptom. Anxiety and throat clearing make the muscles tenser and make the problem feel worse. Sometimes the pharynx can feel terrible but look normal.

Laryngospasm

https://my.clevelandclinic.org/health/diseases/22406-laryngospasm

Treatment includes

  1. laryngeal hygiene: do more of the helpful things below and less of the harmful or unhelpful things
  2. treatment of rhinitis, reflux, asthma, stress, anxiety
  3. speech therapy to learn breathing and laryngeal relaxation techniques to practice every day and to use at the first signs of an attack.
What causes it?

Irritable larynx syndrome and globus pharyngeus are due to:

  1. Irritation of the sensory nerves: exposure to irritants like smoke, a severe viral infection of the throat or chest, rhinitis, asthma and reflux.
  2. Increased tension in the muscles of the larynx and pharynx. Every time you cough or clear the throat the muscles get tenser. Feeling anxious or distressed increases muscle tension.
What helps?

Have a thorough examination including flexible endoscopy. Sometimes tests for asthma, reflux and swallowing are also needed.

Your surgeon will recommend treatment for rhinitis and reflux. If voice or cough is your main problem, you’ll be referred for speech therapy (laryngeal retraining therapy).

For more information about speech therapy:
www.southwesthealthcare.com.au/swh/content/speech-pathology
www.speechpathologyaustralia.org.au/

Your GP will manage asthma and sometimes you will be referred to a respiratory physician.

There are lots of small things that can help the larynx and pharynx feel better and lots of things that can make the problem worse. Doing more of the helpful things and less of the harmful things makes a big difference. Most people have improvement in symptoms over 1-2 months of treatment.

Helpful

Keep the throat moist: Drink water regularly, room temperature is best, eat and drink regularly, don’t skip meals.

Get enough sleep.

Relax the throat muscles:

  • Breathe, take enough air in to be able to speak clearly.
  • Regular exercise and regular use of relaxation techniques.
  • Breathing through the nose, sniffing and humming, yawning, swallowing, sighing, deliberately relaxing the throat muscles.
  • Meditate: mini meditation (stare, breathe in, breathe out, swallow) or try www.smilingmind.com.au

If voice is your main problem:

  • Reduce background noise so you don’t need to strain to be heard.
  • Warm up the voice with humming at a comfortable pitch and loudness.
  • Listen to your body, be sensitive to the early signs of voice fatigue and throat tightness.
  • Rest the voice when needed/after periods of increased use, when the voice feels strained.
  • Use alternatives to voice (clap, whistle, wave) or a microphone when talking to a group or in a large room.
Unhelpful and harmful

These things cause irritation and dryness in the lining of the larynx and pharynx and in the sensory nerves:

  • The single best thing you can do for your health is to stop smoking www.quit.org.au
  • Coke, caffeinated or energy soft drinks and alcohol. Avoid these completely.
  • Very hot and very cold drinks.
  • Drying medications (old type antihistamines, cold and flu tablets).
  • Mouth wash/gargles, change to rinsing with water after brushing and flossing.
  • Sucking lozenges/lollies that contain glycerine, menthol, local anaesthetic.
  • Mouth breathing.
  • Coffee and tea. Limit to 2 per day.

These things increase muscle tightness in the throat:

  • Throat clearing, coughing: when you feel the urge to cough, try to do something else (sniff, yawn, hum or drink a glass of water). The more you cough the worse you will feel.
  • Talking a lot.
  • Screaming, yelling, shouting, whispering or straining to talk over noise, talking while exercising or straining.
  • Feeling stressed, tense or distressed.
  • Continuing to talk when tired or voice feels strained.