Persistent Throat Tightness and Foreign Body Sensation: Causes and Solutions

Persistent throat tightness and the sensation of a foreign body?

Hello doctor, six weeks ago I performed a neck stretching maneuver too forcefully, which caused me to feel nauseous and experience difficulty breathing for about three minutes.
After that, the symptoms subsided, but I was left with a sensation of a foreign body in my throat.
I didn't think much of it at the time, assuming a good night's sleep would help.
However, the next day, I found it difficult to swallow food and had a strong sensation of something stuck in my throat.
That evening, I visited an ENT clinic, where the doctor examined me with an indirect laryngoscope and noted swelling at the junction of my trachea and esophagus.
They prescribed some anti-inflammatory medication, assuring me that it would heal quickly.
After taking the medication for three days, there was still no significant improvement in the sensation of a foreign body or swallowing difficulties.
Subsequently, I went to a hospital for an ENT consultation and underwent a nasopharyngoscopy, which showed no abnormalities.
The tightness and foreign body sensation in my throat were quite uncomfortable.
I had been on anti-inflammatory drugs and antibiotics for over a week with no improvement.
I also underwent an upper endoscopy, neck ultrasound, and X-ray, all of which showed no abnormalities except for mild gastroesophageal reflux and more severe post-nasal drip.
I used a nasal spray for a week and took acid reducers for over four weeks, but there was no noticeable improvement.
Due to the discomfort from my symptoms, I sometimes feel a sense of fear when eating, as if I can't swallow properly.
It seems like I might be experiencing health anxiety, and I even visited the emergency room.
Ten years ago, I had a cyst removed from my hyoid bone, located just below my Adam's apple, which makes me wonder if it has recurred or if the forceful stretching caused a pharyngeal diverticulum.
The doctors seem to think I am normal and do not see the need for a CT scan, MRI, or swallowing study, which I would have to pay for out of pocket.
The discomfort from my symptoms has affected my sleep.
By chance, I tried taking an Alprazolam sedative, and I noticed that after taking it, the tightness in my throat significantly decreased, and I was able to swallow normally.
However, once the medication wore off, I returned to my previous state.
Doctor, is it possible that my anxiety and tension are causing the tightness and sensation of something stuck in my throat, and that these feelings are actually a result of autonomic nervous system dysregulation? Could this be an illusion? Is it necessary for me to be referred to a psychosomatic specialist for long-term medication? My symptoms severely impact my daily life, but I feel I have no clear treatment direction.

Mr. Wang, 20~29 year old female. Ask Date: 2024/01/12

Dr. Li Jiaxuan reply Otolaryngology

Mucosal damage caused by throat strain may take two to three weeks to heal.
If symptoms do not improve, further examination is recommended.
Wishing you good health.

Reply Date: 2024/01/12

More Info

Persistent throat tightness and the sensation of a foreign body in the throat can be distressing symptoms that significantly impact daily life. Based on your description, it seems that your symptoms began after a physical strain, which may have triggered a cascade of physiological and psychological responses. Let's explore the potential causes and solutions for your situation.

Possible Causes
1. Physical Injury: The initial incident where you strained your neck could have caused some inflammation or irritation in the throat area. This might explain the immediate sensations of nausea and difficulty breathing, which later evolved into a persistent feeling of tightness and foreign body sensation.

2. Gastroesophageal Reflux Disease (GERD): You mentioned having mild gastroesophageal reflux, which can lead to throat irritation and a sensation of tightness. Acid from the stomach can irritate the esophagus and throat, leading to discomfort and swallowing difficulties.

3. Anxiety and Stress: The fact that you experienced relief from symptoms after taking Alprazolam suggests that anxiety may play a significant role in your symptoms. Anxiety can lead to muscle tension, particularly in the throat and neck area, which can exacerbate feelings of tightness and discomfort. This is often referred to as "globus sensation," where individuals feel as though there is a lump in their throat, often without any physical obstruction.

4. Psychosomatic Symptoms: It is possible that your symptoms are psychosomatic, meaning they are influenced by psychological factors rather than a direct physical cause. This can happen when stress or anxiety manifests as physical symptoms, leading to a cycle of discomfort and increased anxiety about the symptoms themselves.

Diagnostic Considerations
Given that you have undergone multiple examinations (including endoscopy, imaging, and other tests) without significant findings, it may be beneficial to consider the following:
- Further Imaging: If there is a concern about structural issues, such as a recurrence of a cyst or the development of a diverticulum, a CT scan or MRI could provide more detailed information. However, if your doctors believe that your examinations have ruled out significant pathology, it may not be necessary.

- Swallowing Studies: A barium swallow study can help assess how well you are swallowing and identify any functional issues that might not be visible through other imaging techniques.

Treatment Options
1. Anxiety Management: Since you found relief with Alprazolam, it may be worthwhile to consult with a psychiatrist or psychologist who can help you explore long-term anxiety management strategies. Cognitive-behavioral therapy (CBT) is particularly effective for addressing anxiety and its physical manifestations.

2. Relaxation Techniques: Incorporating relaxation techniques such as deep breathing exercises, mindfulness meditation, or yoga can help reduce muscle tension and anxiety, potentially alleviating throat tightness.

3. Speech Therapy: A speech therapist can work with you on swallowing techniques and exercises to help manage the sensation of tightness and improve swallowing function.

4. Lifestyle Modifications: If GERD is contributing to your symptoms, dietary changes, weight management, and avoiding triggers (like spicy foods, caffeine, and alcohol) can be beneficial.

5. Medication: If anxiety is a significant factor, discussing the possibility of long-term medication with a healthcare provider may be appropriate. This could include SSRIs or other anxiolytics that can help manage anxiety symptoms more effectively than short-term use of benzodiazepines.

Conclusion
In summary, your symptoms of throat tightness and foreign body sensation may be multifactorial, involving physical, psychological, and possibly gastrointestinal components. It is essential to address both the physical and psychological aspects of your condition. Consulting with a specialist in psychosomatic medicine or a mental health professional may provide you with the comprehensive care you need to manage your symptoms effectively. Remember, you are not alone in this, and there are pathways to relief and improved quality of life.

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