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The explanation: An abundance of mucus in the back of the throat can be due to chronic rhinitis or acid reflux
This is a common problem, and often a symptom that persists for years because patients have difficulty in obtaining a diagnosis, let alone a cure.
Sometimes I fear this is because they seem to be otherwise healthy and so the symptom is not investigated further by the doctor. The patient gets used to it, yet they are driving those around them crazy with the constant throat clearing.
There are two possible causes for the problem you describe: chronic rhinitis or acid reflux. The first is a problem with the nose and sinuses causing excessive mucus production.
The upper respiratory tract - which connects the nose, sinuses and throat - is lined with a wet membrane covered in cells that secrete mucus.
This helps to moisturise and warm the air as it passes through the tract and also, importantly, traps any harmful infections that are inhaled. But if this membrane becomes inflamed - as a result of viruses, bacteria or allergies - it produces much more mucus, causing a runny or stuffed up nose, or a nasal 'drip'.
Around 90 per cent of chronic rhinitis cases are caused by allergies - often the only symptom is the constant build-up of mucus, or catarrh, in the throat.
Chronic rhinitis means the allergy is to something in the air all year long (for instance, house dust mites) and not to something seasonal (such as pollen).
Most cases improve after a few weeks of treatment with a strong anti-allergy medication: a twice-daily nasal spray of the anti- histamine azelastine, the steroid fluticasone or both.
If these fail, it may be that the rhinitis is non-allergic - a response to irritants in the air or variations in temperature, which is much harder to identify or cure.
However, I suspect what you have is not allergic rhinitis, but acid reflux, where acid passes upwards from the stomach into the gullet.
This is most commonly associated with heartburn or, at times, severe chest pain as the oesophageal muscle spasms.
However, what is less well known is that it can be relatively silent, causing mucus in the throat, a cough, hoarseness and possibly nasal discharge.
These are triggered by stomach acid making the throat swell - mucus can then stick to the swollen tissues.
Proving acid reflux is the cause of your symptoms may be tricky, as it may come and go or occur only when you are asleep at night and lying flat.
But for those with significant and persistent symptoms, many doctors will suggest a trial of four to eight weeks of a proton pump inhibitor.
These drugs almost switch off stomach acid production - surprisingly, this does not affect the way food is digested.
To test the diagnosis, high doses of the drug are needed twice daily. If the symptoms improve, after a few weeks the dose is lowered.
Treatment will have to be continued long term - a year or two - and may have to be re-started if the mucus and consequent throat clearing recurs.
Finally, do note we all normally have some mucus in the throat draining from the sinuses - this gets rid of the tiny particles of rubbish from the air we breathe.
On occasions people become over-sensitive - basically, too aware - of having to swallow it, which is known as irritable throat syndrome. This will respond to relaxation therapy from a speech therapist or physio.
For the past two months, my wife, 83, has been having blood tests to find out why she is so lacking in energy and can fall asleep at the drop of a hat.
The conclusion is that her blood contains too much iron and that the only cure is to have regular blood letting. Is there any alternative, and what could have caused the condition?
W. H. Metcalf, Cheltenham, Glos.
It sounds as though your wife has haemochromatosis. This is an inherited condition that increases the absorption of iron from food - it affects one in 200 people in Britain (that's 300,000 people).
Normally, the amount of iron we absorb from food is controlled according to how much we have in storage, but in those with this genetic abnormality, this control mechanism is lost.
Typically, we lose about one milligram of iron a day through sweat, shedding skin cells, hair loss and from the intestine.
Pre-menopausally, women lose about double that amount due to monthly menstrual loss. Someone with haemochromatosis absorbs at least double the normal amount of iron - over many years, this leads to a gradual build-up of iron.
Up to half of those affected will have diabetes due to damage to the pancreas, and there may be widespread joint pains and other symptoms. Haemochromatosis can also make the skin look yellow or bronzed (as if suntanned).
The treatment is to remove the excess iron - and the sooner the better once the symptoms have become obvious and the diagnosis has been made, as early detection and prompt treatment reduces the complication rate.
The most obvious way of doing this is with venesection: removing a pint of blood on a regular basis.
This encourages bone marrow to produce more red blood cells, which in turn requires iron - with each 500ml of blood that's removed, more than 200mg of iron is used up from the excess stores.
Most patients benefit from this simple treatment. Generally, there are no complications.
The rare exceptions are people in whom the bone marrow does not function well for other reasons.
In this case, they can be treated by infusions of a drug that binds iron so it passes out through the kidneys (though this is a more complex and less efficient process).
A weekly session will remove more than 10g of iron in a year. After each session your wife would be advised to keep up a good fluid intake and avoid vigorous exercise for the first 24 hours.
Once her iron levels reach a safe baseline, her good health could be maintained on, perhaps, one blood-letting session every two or three months.
By the way... Don't bribe patients to take their medicine
Paying patients to behave better: A worrying development
Should we really be paying patients to behave better? A recent study found that giving a cash incentive to patients on long-term psychiatric treatment makes them more likely to have their regular injections of medication.
This could be seen as good sense and at least one expert supports this approach, on the basis that anything which reduces the recurrence rate of such serious illnesses must be considered.
But it is a worrying development. Time was when patients living independently in the community who needed this type of regular medication would be seen and monitored by a community psychiatric nurse: the continuity, the support and the value of regular familiar contact cannot be under-estimated for such individuals, who can be lonely and isolated.
It would be particularly undesirable if bribing patients to encourage them to self-administer their regular injections of medication led to a reduction of that service.
There is so much more to the care and treatment of chronically psychiatrically ill patients than the large hit of an anti-psychotic drug every month.
And once the principle of financial incentives to increase compliance with treatment became established, where would it end? We could have incentives to persuade diabetics to get their blood glucose levels down or bribes to encourage those who are obese to reduce their weight and score a body mass index (BMI) below the magic figure of 30. And why not pay people to run five or ten kilometres twice a week?
Just think of the army of managers and clerks that would be needed to maintain and govern all this. And you can bet the cost would be met by cutting back on medical staff.
In my experience, the best way to persuade a patient to take their medication or change their lifestyle, is to simply explain how much better they will feel if they do. Bribery never pays.
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