Throat Discomfort and Neck Tension: A Patient's Journey

Sensation of a foreign body in the throat with tightness in the back of the neck?

Hello Doctor: I tend to be overly anxious and have a history of gastrointestinal bloating, constipation, headaches, and chest tightness due to spinal and cervical misalignments.
Long-term use of Western medicine has not improved my condition.
After undergoing chiropractic treatment for a period, my symptoms slightly improved, but I still feel that my muscles easily pull my bones out of alignment again.
Six months ago, I visited a psychiatrist and took medication for about a month, which, combined with my existing chiropractic care, led to significant improvement.
However, after stopping the medication and chiropractic treatment for a month, I began to experience chest tightness again, possibly due to academic pressure and excessive anxiety.
I initially planned to return to the psychiatrist, but shortly after, during the New Year, I choked while eating.
I coughed severely, feeling as if something was blocking my vocal cords, and my voice suddenly became hoarse, making it difficult to speak.
Whenever I tried to talk, I felt the urge to cough, but I couldn't bring anything up.
Eventually, I had to tense my throat muscles and swallow forcefully to stop the coughing.
However, after that, I started to feel tightness in the area between my neck and shoulders (the space between my collarbones), as well as at the junction of my cervical spine and head.
Especially when I lower my head, my chin feels stuck, which pulls on my back muscles, and I experience a sensation of blockage when inhaling, leaving me feeling very fatigued.
For the past two months, I have been continuously seeing doctors in psychiatry, otolaryngology, pulmonology, gastroenterology, traditional Chinese medicine, and chiropractic care.
I have undergone chest X-rays and a CT scan of my throat, all of which showed no abnormalities, and I haven't responded well to medication.
Consequently, I researched various conditions related to the sensation of a foreign body in the throat, including gastroesophageal reflux, globus sensation, chronic pharyngitis, and autonomic nervous system disorders.
I have been prescribed medications for gastroesophageal reflux and autonomic nervous system disorders from the gastroenterology and psychiatry departments, respectively.
The other conditions seem to be somewhat related to my symptoms, but I'm hesitant to consult other doctors.
I suspect there might be an undetectable foreign body in my throat (should I consider an endoscopy or bronchoscopy?), or it could be due to muscle dysfunction in the throat (is it a form of tension?) or excessive anxiety.
If that is the case, why haven't traditional Chinese medicine and medications for the autonomic nervous system been effective? I hope you can help me understand the underlying cause of my condition and what steps I should take.
I am at my wit's end and in desperate need of assistance.
Thank you.

Xiao Hao, 20~29 year old female. Ask Date: 2017/04/09

Dr. Chen Taicheng reply Family Medicine

● It is important to determine what you may have choked on to rule out any issues with obstruction in the esophagus or trachea; however, since you have undergone a CT scan of the throat, it should initially rule out foreign body issues in the larynx.
You may want to consult an otolaryngologist to examine the base of the tongue and larynx to confirm there are no foreign bodies or injuries, which would likely indicate that it is not an otolaryngological issue.
A chest X-ray should help to preliminarily rule out foreign bodies in the lungs or trachea.
● If you experience a clicking sensation when lowering your head, please have the doctor check for any enlargement of the submandibular glands, lymph nodes, or thyroid gland in the neck.
● Given your condition, swallowing and laryngeal function should generally be normal; however, to confirm, an upper gastrointestinal series can be performed to assess the function of the entire larynx and esophagus, as well as to check for significant gastroesophageal reflux.
Whether an endoscopy is necessary should be further evaluated by your physician.
● It is recommended to seek further evaluation at a major hospital's otolaryngology and gastroenterology departments.
Additionally, medications for autonomic nervous system treatment in psychosomatic medicine may take some time to show significant effects.
Furthermore, cervical spine misalignment could be a primary cause of related discomfort, so please consult a rehabilitation specialist for further diagnosis and treatment.
● If no definitive cause is found during medical consultations, it usually indicates that the condition is not severe; however, your symptoms should be manageable and improve with multidisciplinary assistance.
Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department is concerned about you.

Reply Date: 2017/04/09

More Info

It sounds like you are experiencing a complex interplay of physical and psychological symptoms that are significantly impacting your quality of life. Your journey through various medical consultations and treatments reflects the challenges many patients face when dealing with chronic discomfort and anxiety. Let's break down your concerns and explore potential avenues for relief.

Understanding Your Symptoms
From your description, it seems you are dealing with several overlapping issues: throat discomfort, neck tension, anxiety, and gastrointestinal problems. These symptoms can often be interrelated, especially in the context of anxiety and stress. Anxiety can manifest physically, leading to muscle tension, which may contribute to discomfort in the neck and throat areas. This tension can create a sensation of tightness or blockage, which you have described as feeling like something is stuck in your throat.

Possible Causes
1. Muscle Tension: Chronic anxiety can lead to muscle tension, particularly in the neck and shoulders. This tension can cause discomfort and may even lead to headaches or exacerbate existing conditions like cervical spine issues.

2. Gastroesophageal Reflux Disease (GERD): You mentioned experiencing gastrointestinal issues, including bloating and constipation. GERD can cause throat discomfort and a sensation of a lump in the throat (globus sensation). This condition occurs when stomach acid flows back into the esophagus, irritating the lining and potentially affecting the throat.

3. Psychosomatic Symptoms: It’s important to recognize that psychological factors can lead to physical symptoms. Anxiety and stress can manifest as physical discomfort, and addressing the psychological aspect may help alleviate the physical symptoms.

4. Post-viral Symptoms: If your throat discomfort began after a respiratory illness (like a cold or flu), it could be a lingering effect of that illness, which sometimes leads to chronic throat irritation or muscle tension.

Recommendations for Management
1. Consultation with Specialists: Since you have already seen multiple specialists, it may be beneficial to revisit a few of them, particularly an ENT (Ear, Nose, and Throat) specialist, to rule out any underlying conditions that may not have been detected in previous examinations. A gastroenterologist can also assess for GERD or other gastrointestinal issues.

2. Psychological Support: Given the significant anxiety you are experiencing, working with a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) is particularly effective for anxiety and can help you develop coping strategies to manage your symptoms.

3. Physical Therapy: Engaging in physical therapy focused on the neck and shoulder areas may help relieve muscle tension. A physical therapist can teach you exercises to improve posture and reduce tension.

4. Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation, deep breathing exercises, or yoga, can help reduce anxiety and muscle tension. These techniques can promote relaxation and may alleviate some of the discomfort you are experiencing.

5. Dietary Adjustments: If GERD is a concern, consider dietary changes that may help reduce symptoms, such as avoiding spicy foods, caffeine, and large meals before bedtime. Keeping a food diary can help identify triggers.

6. Follow-Up on Medications: If you are currently on medications for anxiety or gastrointestinal issues, discuss with your doctor whether adjustments are needed. Sometimes, it may take time to find the right medication or combination of treatments that work for you.

Conclusion
Your symptoms are valid, and it’s understandable to feel overwhelmed by the complexity of your situation. It’s crucial to continue seeking help and advocating for your health. Remember that healing can take time, and a multidisciplinary approach may be the most effective way to address both the physical and psychological aspects of your condition. Don’t hesitate to reach out for support from healthcare professionals, family, or support groups as you navigate this journey.

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