Throat Constriction and Cough: When to Seek Help

Throat constriction cough issue?

Hello Doctor: I am 38 years old, a non-smoker and non-drinker.
Recently, I have been experiencing occasional mild coughing, with the sensation originating in my throat near the neck and the inward concave area of the larynx.
It feels like there is a contraction or twitching, which seems to occur primarily during intense exercise, climbing stairs, or times of emotional stress and fluctuations.
Occasionally, I might cough once or twice a day, or I may not cough at all but still feel the contraction or twitching in the inward area.
This sensation is less frequent when I am lying down to sleep.

I recently visited a cardiologist for an examination.
I had a comprehensive check-up in August 2017, which included both dynamic and static electrocardiograms, a 24-hour Holter monitor, and an echocardiogram, all of which showed no issues.
However, recently, while on the MRT, I experienced frequent contractions and twitching, accompanied by intermittent mild coughing, prompting me to visit the emergency department at National Taiwan University Hospital.
The doctor conducted blood tests related to cardiovascular health, a chest X-ray, and an ECG on-site, all of which did not reveal any problems.
The doctor prescribed medication for anxiety and arrhythmia for three days, which provided slight improvement, but the symptoms have started again.
I later visited a family medicine doctor who listened to my heart and lungs but did not detect any issues.
He suggested that I might have gastroesophageal reflux disease (GERD) and prescribed medication for GERD or esophageal motility disorders, but there has not been much improvement.
I would like to know which specialty I should consult.
What exactly is this condition? I am unsure how to communicate this to my doctor.
Thank you.

Xiao Guan, 30~39 year old female. Ask Date: 2018/05/16

Dr. Chen Bozhang reply Family Medicine

Dear Mr.
Xiao Guan,
I understand that you have been experiencing occasional coughs recently.
You have undergone thorough cardiac examinations, blood tests, and chest X-rays, all of which did not reveal any issues.
Additionally, you have taken medication for gastroesophageal reflux without significant improvement.

Have you had a detailed examination by an otolaryngologist? If the source of your cough is related to lesions in the head and neck or within the larynx and trachea, it would require the expertise of an ENT specialist.
I recommend that you visit an ENT outpatient clinic for a comprehensive evaluation, as this may help identify the underlying cause.
Sincerely,
Dr.
Chen Bozhang
Department of Family Medicine
Keelung Hospital, Ministry of Health and Welfare

Reply Date: 2018/05/16

More Info

It sounds like you are experiencing a complex set of symptoms that could be related to several underlying conditions. Given your description of throat constriction, occasional coughing, and the circumstances under which these symptoms occur (during intense physical activity or emotional stress), it is essential to consider a few potential causes and the appropriate specialists to consult.

Possible Causes
1. Gastroesophageal Reflux Disease (GERD): Your family physician's suggestion of GERD is plausible. GERD can cause throat irritation, a sensation of constriction, and coughing, particularly when lying down or after eating. The acid can irritate the esophagus and throat, leading to symptoms that mimic those of respiratory issues.

2. Anxiety and Stress: The episodes of constriction and coughing during periods of emotional stress or physical exertion could indicate a psychosomatic response. Anxiety can manifest physically, leading to muscle tension in the throat and chest, which may cause a sensation of tightness or constriction.

3. Asthma or Exercise-Induced Bronchoconstriction: Given that your symptoms worsen with physical activity, it’s also worth considering asthma or exercise-induced bronchoconstriction. This condition can cause wheezing, coughing, and a feeling of tightness in the chest or throat during or after exercise.

4. Muscle Spasms: The sensation of "twitching" or spasms in the throat could be due to muscle tension or spasms, which can occur in response to stress or anxiety.

5. Throat or Laryngeal Issues: Conditions affecting the throat or larynx, such as laryngopharyngeal reflux (LPR), could also cause similar symptoms. This condition is often overlooked and can lead to throat discomfort and cough.

When to Seek Help
Given the complexity of your symptoms, it is advisable to consult with a few specialists:
1. Ear, Nose, and Throat (ENT) Specialist: An ENT can evaluate your throat and larynx for any structural issues, inflammation, or other abnormalities that could be causing your symptoms.

2. Gastroenterologist: If GERD or LPR is suspected, a gastroenterologist can perform tests such as an upper endoscopy or pH monitoring to assess for acid reflux and its effects on your throat.

3. Pulmonologist: If asthma or other respiratory issues are suspected, a pulmonologist can conduct pulmonary function tests to evaluate your lung function and response to exercise.

4. Psychiatrist or Psychologist: If anxiety is a significant factor, consulting a mental health professional may be beneficial. They can help you develop coping strategies and may recommend therapy or medication if necessary.

Recommendations
- Keep a Symptom Diary: Document when your symptoms occur, their duration, and any potential triggers (food, stress, physical activity). This information can be invaluable for your healthcare providers.

- Lifestyle Modifications: If GERD is a concern, consider dietary changes (avoiding spicy, fatty, or acidic foods) and lifestyle adjustments (elevating the head of your bed, avoiding large meals before lying down).

- Relaxation Techniques: If anxiety plays a role, practices such as deep breathing, meditation, or yoga may help alleviate symptoms.

- Follow-Up: Since you have already seen multiple specialists, ensure you follow up with them based on their recommendations. If your symptoms persist or worsen, don’t hesitate to seek further evaluation.

In summary, your symptoms could stem from a combination of factors, including GERD, anxiety, or respiratory issues. A multidisciplinary approach involving an ENT, gastroenterologist, pulmonologist, and mental health professional may provide the most comprehensive care. Don't hesitate to advocate for yourself and seek further evaluations until you find the underlying cause of your symptoms.

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