Ask a doctor on the topic of Otorhinolaryngology

Difficult mucus problem in the area of the larynx - is a mucus solvent useful?

September 2, 2019 | 35,00 EUR | answered by Christian Welsch

Dear Sir or Madam,

I will try to keep it short, which is not easy at all. I am basically healthy, feel fit, am male, 35 years old, non-smoker, normal weight. The only, but persistent problem for about 4 years (!): Massive mucus forming in the area between the esophagus and trachea. As a result, the mucus needs to be constantly swallowed or coughed up (typical "snotty noise"), but the worst part is that it affects my voice. I have been through a true marathon of doctors: allergists, ENT doctors, phoniatrists, etc.
Regarding the diagnosis: blood work is normal, allegedly no allergies (even testing with Cetirizine did not bring any improvement), but there is a strong white mucous formation in the area of the larynx. The suspicion of reflux/silent reflux was investigated for a long time, but the mucous membrane is apparently not irritated by acid, even massive use of proton pump inhibitors (morning and evening) did not bring any improvement. PH level measurement was okay, so the mucus does not come from the stomach. Nevertheless, it is strange that the trachea, bronchi, and lungs are completely normal. The mucus is definitely NOT in the trachea and NOT directly on the vocal cords, therefore I do not need to clear my throat, but the mucus "pulls" on the laryngeal muscles, causing an unclear sound to occur, although I do not sound hoarse, my voice just slips away now and then - completely uncontrollably. Outsiders would not hear any voice disorder, but the high and sometimes also the low notes of the voice are almost always blocked, causing the voice to quickly become thin and tiresome. The ENT doctor has identified the mucus as the sole cause, but no one knows where the strong mucous formation comes from, there is no mucous cyst visible. Airways are completely clear, so there are no breathing problems, etc. - it has been examined. Mucus formation is very strong after consuming sweets (e.g. chocolate, but also with sugary fruits, e.g. peaches). Overnight, the mucus is almost gone, still passable in the mornings (which also speaks against silent reflux), but strong mucus formation after meals. The problem is that I have tried almost everything, from allergy tablets to proton pump inhibitors to mucolytics. The doctors have now diagnosed me with a strong mucous formation with an idiopathic cause (i.e. unknown...). I have spent hundreds of euros out of pocket for medications, guides, and doctors, but nothing seems to help, my symptom diary is hundreds of pages long. Now to my question: Since there seems to be no food allergy (which is actually surprising), the doctor suggests treating the symptoms (since the cause is unknown). But the mucus sits like a lump in the transition area between the trachea and esophagus. I believe that Ambroxol and ACC acute provide a slight improvement, however only to a small extent. I would like to know,
1. if these expectorants ONLY remove mucus in the bronchi/trachea or if they are also useful in the transition area to the esophagus
2. if there is anything at all that dissolves mucus in the esophagus (or laryngeal area) (this question is very important to me!)
3. if you think a long-term therapy with such an expectorant is appropriate or if you have any other solution in mind.
As you can imagine, despite having very good medical knowledge (acquired out of necessity), I am at my wit's end.

Thank you for your help and please only respond if you can specifically address my questions (i.e. no general statements like "drink more water" etc., I have already tried everything) and if you are knowledgeable in the area of expectorants/chemical processes of mucus dissolution.

Christian Welsch

Dear questioner, an expectorant works on all mucus.
It seems that you have a problem that several specialists have failed to solve, which makes it difficult or impossible for a remote evaluation.
I am reluctant to give expectorants to patients who complain of too much mucus because most of them respond with coughing attacks as the mucus becomes thinner. However, I have had patients who found Gelomyrtol, Soledum, or Aspecton to be helpful.
In my opinion, it should be clarified whether there is any intolerance behind it. The reaction to the sugar seems suspicious to me.
Have the sinuses been X-rayed? If you snore, one should also look for apneas as a cause of the mucus build-up, in which case one would expect more reflux-like symptoms.
I assume you do not regularly take any medications; blood pressure medications can have this as a side effect.
Otherwise, I do not have any ideas at first, but I have had patients in whom the internist found food intolerances as the cause.