Phlegm (pronounced FLEM) is the secretions found in the throat including saliva, nasal secretions and sometimes acid secretions from the stomach. Phlegm becomes problematic if it interrupts voice production, breathing or swallowing. Too much phlegm may cause a “wet” or “gurgly” voice, or even difficulty swallowing. Increased amount of phlegm may cause one to clear his or her throat out often and repeatedly. Phlegm may also be a reason that individuals wake up at night. Phlegm normally thin in nature; however when it becomes thick it becomes difficult to tolerate. When there is not enough phlegm present that may become problematic as well.
Phlegm is mostly saliva, which is made by the salivary glands. There are four major salivary glands – two parotid glands located in front of the ears, and two submandibular glands located below the mandible or jaw bone. These four glands produce the majority of saliva. Sublingual glands, located below the tongue and minor salivary glands located throughout the mouth, throat and even the nose provide small contributions to the amount of saliva.
There are disorders where patients may complain of decreased secretions such as Sjogren’s syndrome. This is an autoimmune process in which individuals have dry eyes and dry mouth. Medications may also cause patients to complain of dry mouth as well. Finally, radiation used to treat head and neck cancer may cause salivary glands to produce less saliva that is often thick in quality.
Nasal secretions also contribute to phlegm. These secretions originate from the mucosa, or internal lining of the nose. For patients with allergic symptoms increased nasal secretions may drain into the throat, causing “too much phlegm”.
Acid reflux from the stomach also may contribute to phlegm. Acidic contents from the stomach may reflux, or travel backwards into the esophagus and throat. Acid from the stomach may be very irritating to individuals, causing problems of difficulty swallowing, cough, and even burning sensations in the throat.
Control of phlegm can be challenging because, as listed above, there are many contributions. Stepwise approaches considering these causes of phlegm may be necessary.