Throat Tightness: Causes and Solutions for Discomfort

Q: Throat Tightness: Causes and Solutions for Discomfort

Hello： It is recommended to consult a gastroenterologist to evaluate whether an endoscopy is necessary to determine if the symptoms are caused by gastroesophageal reflux disease (GERD). <br>Changhua Hospital cares about your health. <br>Dr. <br>Tsai An-shun.

Feeling of obstruction in the larynx and chin?

Hello Dr.
121464: I tend to experience excessive anxiety along with gastrointestinal bloating, constipation, and a history of headaches and chest tightness due to spinal and cervical misalignment.
Long-term use of Western medicine has not led to improvement.
After undergoing chiropractic treatment for a period, I noticed slight improvements in my symptoms, but I still feel that my muscles easily pull my bones out of alignment again.
Six months ago, I visited a psychiatrist and underwent medication treatment for about a month, which, combined with my existing chiropractic care, resulted in 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 considered returning to the psychiatrist, but shortly after, during the New Year, I choked while eating.
I coughed violently at that time, 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, which stopped the coughing, but afterward, I began to feel tightness in the area connecting my neck and shoulders (between the two clavicles) and where the cervical spine connects to the head.
Especially when I lower my head, my chin feels stuck, which pulls on the back muscles, and I experience a sensation of blockage when inhaling.
When I swallow afterward, my chin tightens (feeling the muscles moving upward and colliding with my chin), leaving me feeling very fatigued.
For the past two months, I have continuously visited various specialists: psychiatry, otolaryngology, pulmonology, gastroenterology, traditional Chinese medicine, and chiropractic care.
I have undergone chest X-rays and a CT scan of my throat, all showing no abnormalities, and I have not responded well to medications.
Consequently, I researched many conditions related to the sensation of a foreign body in the throat, including gastroesophageal reflux, globus sensation, chronic pharyngitis, and autonomic nervous system dysregulation.
I have been prescribed medications for gastroesophageal reflux and autonomic nervous system issues by the gastroenterologist and psychiatrist, respectively, but after about a week, I still feel tightness.
The other conditions seem ambiguous in relation to my symptoms, and I am hesitant to consult other doctors.
I wonder if there might be a foreign body in my throat that cannot be detected by standard examinations (should I consider an endoscopy or bronchoscopy?), or if this is due to muscular dysregulation in the throat (is it a form of "sudden tightness" in Taiwanese?) or excessive anxiety and tension? If that is the case, why have traditional Chinese medicine and medications for autonomic nervous system treatment not been effective? I hope you can help me understand the underlying cause of my condition and what steps I should take.
I am reaching out for help as I feel overwhelmed by this illness.
Thank you.

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

Dr. Cai Anshun reply Gastroenterology and Hepatology

Hello: It is recommended to consult a gastroenterologist to evaluate whether an endoscopy is necessary to determine if the symptoms are caused by gastroesophageal reflux disease (GERD).
Changhua Hospital cares about your health.
Dr.
Tsai An-shun.

Reply Date: 2017/04/09

More Info

Understanding throat tightness and discomfort can be a complex issue, especially when it is intertwined with anxiety, gastrointestinal problems, and musculoskeletal issues. Based on your description, it seems that your symptoms are multifaceted, involving both physical and psychological components.

Causes of Throat Tightness
1. Anxiety and Stress: One of the most common causes of throat tightness is anxiety. When you are anxious, your body goes into a fight-or-flight response, which can lead to muscle tension, including in the throat area. This can create a sensation of tightness or a lump in the throat, often referred to as "globus sensation." You mentioned experiencing increased anxiety due to academic pressures, which could exacerbate this symptom.

2. Gastroesophageal Reflux Disease (GERD): You also mentioned a history of gastrointestinal issues, including bloating and constipation. GERD can cause acid to flow back into the esophagus, leading to irritation and a sensation of tightness in the throat. This condition can also cause hoarseness and difficulty swallowing.

3. Muscle Tension: Given your history of neck and spinal issues, muscle tension in the neck and shoulders can contribute to throat tightness. Poor posture, especially when studying or working on a computer, can lead to muscle imbalances and tension that may affect the throat area.

4. Chronic Inflammation: Conditions like chronic pharyngitis or laryngitis can cause persistent throat discomfort. If there was an incident of choking or severe coughing, it could have led to inflammation or irritation in the throat that persists.

5. Psychosomatic Symptoms: Sometimes, physical symptoms can arise from psychological stress. This means that even if there is no identifiable physical cause, the stress and anxiety can manifest as physical discomfort.

Solutions and Recommendations
1. Consult a Specialist: Since you have already seen multiple specialists without a definitive diagnosis, it may be beneficial to consult an otolaryngologist (ENT) who specializes in throat issues. They can perform thorough examinations, including endoscopy, to rule out any physical abnormalities.

2. Gastroenterology Evaluation: If GERD is suspected, a gastroenterologist can perform tests such as an esophageal pH monitoring or an upper endoscopy to evaluate for reflux or other gastrointestinal conditions.

3. Psychological Support: Since anxiety seems to play a significant role in your symptoms, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing anxiety and its physical manifestations.

4. Relaxation Techniques: Incorporating relaxation techniques such as deep breathing exercises, mindfulness meditation, or yoga can help reduce muscle tension and anxiety. These practices can also help you become more aware of your body and its responses to stress.

5. Physical Therapy: A physical therapist can help address any musculoskeletal issues related to your neck and shoulders. They can provide exercises to improve posture and relieve muscle tension.

6. Medication Review: If you are currently on medication for anxiety or gastrointestinal issues, discuss with your healthcare provider whether adjustments are needed. Sometimes, the side effects of medications can contribute to feelings of discomfort.

7. Lifestyle Modifications: Pay attention to your diet and lifestyle. Avoiding trigger foods that exacerbate GERD, staying hydrated, and maintaining a regular exercise routine can improve overall well-being.

8. Follow-Up: Since you have experienced some improvement with previous treatments, it may be worth revisiting those options or exploring new ones with your healthcare provider.

Conclusion
Your symptoms of throat tightness are likely a combination of anxiety, potential gastrointestinal issues, and musculoskeletal tension. It is essential to approach this problem holistically, addressing both the physical and psychological aspects. By working closely with healthcare professionals and incorporating stress management techniques, you can find relief from your discomfort. Remember, it’s crucial to communicate openly with your healthcare providers about your symptoms and concerns to develop an effective treatment plan.

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