Persistent Throat Foreign Body Sensation: Causes and Solutions

Sensation of a foreign body in the throat?

Hello Doctor, I have been experiencing a severe sensation of a foreign body in my throat for over a month.
The symptoms include a pulsating feeling in the pharyngeal wall, which I am not entirely sure about, but when I use a cotton swab to touch the uncomfortable area, it does cause pain.
Additionally, I experience sharp pain in my throat, particularly at the base of my left tongue, and there is a slight stabbing sensation when swallowing saliva or eating.
A few days ago, I underwent an upper gastrointestinal endoscopy, and the reflux of gastric acid was found to be very mild.
The doctor believes this is not the primary cause of my throat discomfort.

It has been about four months since I had a bilateral tonsillectomy, and I had a mild sensation of a foreign body even before the surgery.
I have returned for follow-ups three or four times and mentioned my symptoms to the doctor.
Initially, they attributed it to the surgical sutures, but after three months, the doctor suggested it might be related to gastric acid reflux.
Now that the endoscopy has been performed, it does not seem to be a gastric issue.
I am concerned because when I palpate the area of my pharyngeal wall down to the base of my tongue, it feels hard, as if there is something or a bony structure inside.
Is this normal? I have also felt many hard protrusions at the back of the base of my tongue.
Could this be causing the sensation of a foreign body in my throat? There are no obvious abnormalities when I look in my mouth, but sometimes I feel a sensation of inflammation and pulsation in the entire area behind the uvula.
I had an endoscopy at the end of June, which indicated swelling in the throat area and inflammation at the left base of my tongue.
I would like to know what tests can clearly identify any abnormalities in areas of the throat that are not visible.
Would a neck ultrasound be sufficient, or would a head and neck MRI provide more detailed information? This persistent stabbing and inflammatory sensation is very uncomfortable, and the worst part is that I cannot pinpoint the exact location of the discomfort, which is becoming unbearable.
I have read many articles but cannot find symptoms similar to mine.
The closest match seems to be pharyngitis, but I do not have the typical symptoms of inflammation in my oral cavity.
Sometimes, pressing on certain areas of my throat also causes sharp pain.
Over the past few months, I have taken various medications, including antibiotics and anti-inflammatory drugs, but there has been no improvement, even with gastric medications.
I am genuinely worried that there might be something growing that is not visible to the eye.
Could you please help analyze my situation or suggest what further tests I should undergo? I have noticed that the symptoms are milder for the first one or two minutes after waking up in the morning, but then they become significantly worse.
If the symptoms were caused by a tumor or something malignant, would there be any relief? I have attached photos of the painful areas I have circled.
Additionally, is it normal for the area of the pharyngeal wall that I have circled to feel hard when pressed? Thank you very much.

Ms. Lin, 40~49 year old female. Ask Date: 2021/07/16

Dr. Zheng Jueyi reply Otolaryngology

Hello, the area you are touching is the lymphoid tissue of the posterior pharyngeal wall.
If it feels hard, you may be palpating the cervical vertebrae behind it.
If multiple physicians have examined you and found no significant abnormalities, it is reasonable to preliminarily rule out malignancy.
Long-term discomfort is often associated with chronic inflammation.
In addition to regular follow-up appointments and medication, it is important to enhance lifestyle adjustments and reduce anxiety to improve your condition.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/07/16

More Info

The sensation of a persistent foreign body in the throat, often described as a feeling of tightness or irritation, can be quite distressing and may stem from various underlying causes. Given your detailed description of symptoms, including pain, discomfort upon swallowing, and the presence of hard areas in the throat, it is essential to consider several potential factors that could contribute to your condition.

Possible Causes
1. Post-Surgical Changes: Since you mentioned having had a tonsillectomy, it is possible that the surgical site is still healing. Scar tissue can sometimes create sensations that feel like a foreign body. The inflammation and healing process can lead to discomfort, especially if there are any residual stitches or tissue changes.

2. Gastroesophageal Reflux Disease (GERD): Although your recent endoscopy indicated only mild acid reflux, even minimal reflux can irritate the throat and lead to sensations of discomfort or a lump in the throat. This is often referred to as "globus sensation."
3. Inflammation or Infection: Chronic inflammation or infection in the throat can lead to swelling and discomfort. Conditions such as pharyngitis or laryngitis can cause similar symptoms, including pain and a sensation of something being stuck in the throat.

4. Neuropathic Pain: Sometimes, nerve irritation or damage can lead to abnormal sensations in the throat. This could be due to previous inflammation or surgical trauma affecting the nerves in the area.

5. Muscle Tension: Anxiety and stress can lead to muscle tension in the throat, which may exacerbate feelings of discomfort or tightness. This is particularly relevant if you notice that symptoms worsen during stressful periods.

6. Structural Abnormalities: While less common, structural issues such as growths (benign or malignant) or other anatomical changes could lead to sensations of obstruction.

Recommended Investigations
To further evaluate your symptoms, consider the following diagnostic approaches:
1. Laryngoscopy: A direct examination of the throat and larynx using a flexible scope can provide detailed visualization of the throat's interior, allowing for the identification of any abnormalities that may not be visible through a standard oral examination.

2. Neck Ultrasound: This imaging technique can help assess the soft tissues of the neck and identify any masses or abnormalities that could be contributing to your symptoms.

3. MRI of the Head and Neck: An MRI can provide a comprehensive view of the soft tissues, nerves, and structures in the throat and neck, which may help identify any underlying issues that are not visible through other imaging modalities.

4. Referral to a Specialist: Given the complexity of your symptoms, a consultation with an otolaryngologist (ENT specialist) would be beneficial. They can perform specialized tests and provide targeted treatment options.

Management Strategies
While awaiting further evaluation, consider the following strategies to manage your symptoms:
- Hydration: Ensure you are drinking plenty of fluids to keep the throat moist, which may help alleviate discomfort.

- Humidification: Using a humidifier can help maintain moisture in the air, which may soothe throat irritation.

- Avoid Irritants: Stay away from smoking, strong odors, and other irritants that may exacerbate throat discomfort.

- Dietary Adjustments: Eating softer foods and avoiding spicy or acidic foods may help reduce irritation.

- Stress Management: Techniques such as mindfulness, meditation, or gentle yoga can help manage anxiety and muscle tension, which may contribute to your symptoms.

Conclusion
Persistent throat discomfort can be multifactorial, and it is crucial to pursue a thorough evaluation to determine the underlying cause. While some causes may resolve on their own, others may require specific treatment. Engaging with healthcare professionals who can provide a comprehensive assessment will be key to finding relief and addressing your concerns effectively.

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