A clicking, popping or catching sensation in the throat can be surprisingly unsettling. Some people notice a small click when swallowing, while others feel or hear it when turning their head, speaking or moving their neck. For some, the sensation is painless; for others, it may be accompanied by discomfort or a feeling that something is catching inside the throat.
Although a clicking larynx is usually not dangerous, persistent or painful symptoms should be assessed, particularly if they are associated with difficulty swallowing, voice change, breathing problems or a neck lump.
What is a clicking larynx?
The larynx (voice box) sits in the front of the neck and is made up of several cartilages, muscles and ligaments. It also moves considerably during swallowing and speaking.
The larynx lies close to other structures, including the hyoid bone, cervical spine and thyroid cartilage. In some people, the anatomy of these structures means that they can come into contact during swallowing or certain movements of the head and neck.
This can produce a distinct clicking or popping sensation.
The term clicking larynx syndrome is sometimes used when this becomes persistent or troublesome. It is relatively uncommon, and many patients will never have heard of it before developing symptoms.
What causes clicking in the throat?
There are several possible causes.
One recognised explanation is contact between the hyoid bone and thyroid cartilage. The hyoid is a small U-shaped bone high in the neck that helps support the tongue and larynx. An unusually long or prominent part of the hyoid may rub against nearby structures during swallowing.
Similarly, the upper part of the thyroid cartilage can sometimes be relatively prominent or positioned in such a way that it comes into contact with the hyoid or cervical spine.
Other possible explanations include:
- anatomical variation in the hyoid bone or laryngeal cartilages
- movement between the thyroid cartilage and hyoid during swallowing
- previous surgery or trauma to the neck
- changes in the soft tissues surrounding the larynx
- calcification or ossification of laryngeal structures
- less commonly, other abnormalities within the neck
Sometimes there is no single obvious structural abnormality despite a very real and reproducible clicking sensation.
Is a clicking larynx dangerous?
In most cases, no.
A mechanical click caused by normal anatomical structures moving against one another is generally benign. Clicking larynx syndrome itself is not considered a precancerous condition and does not usually threaten the airway.
However, it is important not to assume that every new throat sensation is simply a clicking larynx without appropriate assessment.
The aim of assessment is therefore twofold: firstly, to determine what is producing the click and, secondly, to make sure that there is no other underlying cause for the patient’s symptoms.
When should I seek medical advice?
You should consider an ENT assessment if the clicking is persistent, painful, worsening or causing significant concern.
Assessment is particularly important if it occurs alongside:
- difficulty or pain when swallowing
- food sticking when you swallow
- unexplained weight loss
- persistent hoarseness or a change in your voice
- a new or enlarging lump in the neck
- coughing or choking when eating or drinking
- coughing up blood
- breathing difficulty or noisy breathing
- persistent one-sided throat or ear pain
These symptoms do not necessarily mean that something serious is wrong, but they warrant appropriate investigation rather than being attributed to a mechanical click without examination.
New or significant breathing difficulty requires urgent medical assessment.
How is a clicking larynx investigated?
Assessment usually begins with taking a detailed history. It is helpful to establish exactly when the click occurs — for example, during swallowing, when turning the head or only in a particular position.
The neck can then be examined while the patient swallows. In some patients, the click can actually be felt by the clinician.
An ENT or laryngology specialist may perform a flexible nasendoscopy, where a small flexible camera is passed through the nose to examine the throat and larynx.
If a structural cause is suspected, CT imaging of the neck can be particularly helpful because it shows the relationship between the hyoid bone, thyroid cartilage and surrounding structures.
Not everyone with a clicking sensation requires extensive investigations. The appropriate tests depend on the individual symptoms and examination findings.
Does clicking larynx need treatment?
If the examination and investigations are reassuring and the clicking is painless or only mildly noticeable, no treatment may be required.
For many patients, simply understanding why the click occurs — and knowing that there is no concerning underlying abnormality — can be reassuring.
If the symptoms are painful or significantly interfere with swallowing or quality of life, treatment can be considered according to the underlying cause.
In carefully selected patients with a clearly demonstrated anatomical abnormality, surgery may occasionally be considered. This can involve modifying or removing a small part of the structure responsible for the mechanical contact, such as a prominent portion of the hyoid bone or thyroid cartilage.
Surgery is not necessary for the majority of patients with throat clicking.
Can clicking in the throat be caused by reflux?
Patients with throat symptoms are frequently told that they may have acid reflux. Reflux can certainly cause symptoms such as throat irritation, coughing, throat clearing and voice changes.
However, a clearly reproducible mechanical click during swallowing or neck movement may have a structural explanation and should not automatically be attributed to reflux.
A careful examination can help distinguish between these different problems.
The important message
A clicking sensation in the throat can feel alarming, particularly when it happens every time you swallow.
Fortunately, clicking larynx is usually a benign mechanical phenomenon rather than a dangerous condition. In some people, it results from the hyoid bone or laryngeal cartilage coming into contact with neighbouring structures as the larynx moves.
Persistent, painful or unexplained clicking should nevertheless be assessed by an ENT specialist, particularly when accompanied by swallowing difficulties, voice changes, a neck lump or breathing symptoms.
Once the cause has been identified and more serious conditions excluded, many patients require reassurance alone. For the relatively small number of patients with severe symptoms and an identifiable structural cause, further treatment can be discussed with qualified ENT surgeon or laryngologist.
This article provides general information and should not replace an individual medical assessment. If you have new, persistent or worsening throat symptoms, seek advice from an appropriately qualified healthcare professional.
