Persistent Throat Foreign Body Sensation: Causes and Next Steps - Otolaryngology

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The sensation of a persistent foreign body in the throat, often described as a lump or tightness, can be quite distressing and is a common complaint among patients. Given your detailed history of evaluations, including multiple endoscopies and imaging studies that have returned normal results, it is important to consider several potential causes and next steps.


Possible Causes
1. Chronic Pharyngitis: Chronic inflammation of the throat can lead to persistent sensations of discomfort or a foreign body feeling. This can be exacerbated by allergies, irritants, or gastroesophageal reflux disease (GERD).

2. Gastroesophageal Reflux Disease (GERD): Even if you have been treated with medications, GERD can sometimes present with atypical symptoms, including a sensation of a lump in the throat (globus sensation). It might be worthwhile to revisit this diagnosis, especially if you experience heartburn or regurgitation.

3. Muscle Tension Dysphonia: Stress and anxiety can lead to muscle tension in the throat, which can create a sensation of tightness or discomfort. This is often overlooked but can be a significant contributor to throat symptoms.

4. Postnasal Drip: Allergies or sinus issues can lead to postnasal drip, which can irritate the throat and create a sensation of something being stuck.

5. Psychogenic Causes: Sometimes, the sensation can be related to anxiety or stress, where the body manifests these feelings as physical symptoms.


Next Steps
1. Re-evaluation by an ENT Specialist: Since you have already seen an ENT multiple times, it may be beneficial to have a thorough re-evaluation, especially if your symptoms have changed or worsened. Discuss your concerns about the left-sided sensation and any new symptoms.

2. Consider a Gastroenterology Consultation: If GERD is suspected, a gastroenterologist may recommend further evaluation, such as a 24-hour pH monitoring test, to assess acid reflux more accurately.

3. Speech Therapy: If muscle tension dysphonia is suspected, working with a speech therapist who specializes in voice disorders can help alleviate symptoms through relaxation techniques and vocal exercises.

4. Allergy Testing: Given your history of nasal allergies, it might be helpful to undergo allergy testing to identify any specific triggers that could be contributing to your throat discomfort.

5. Psychological Evaluation: If stress or anxiety is a factor, speaking with a mental health professional could provide strategies to manage these feelings, which may, in turn, alleviate physical symptoms.


Conclusion
While the concern for serious conditions such as tumors is understandable, the normal results from your extensive evaluations are reassuring. However, persistent symptoms warrant further investigation to identify the underlying cause. It is essential to communicate openly with your healthcare providers about your ongoing symptoms and any changes you notice. They can guide you through the next steps and help you find relief from this distressing sensation. Remember, you are not alone in this experience, and many individuals face similar challenges with throat sensations.