Feeling of a Lump in Throat: Causes and When to Seek Further Help - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Mr.
Xiang, regarding your question, I provide this article for your reference.
Dr.
Yeh Da-Wei from the Hsinchu Hospital of the Ministry of Health and Welfare states, "Doctor, I feel like something is stuck in my throat.
This has been going on for several months, and I've seen many general practitioners without improvement.
They said you are better at diagnosing this, so I came to have you check it out." "Sir, I recovered from a cold three weeks ago, but I still feel like there's something in my throat.
Is it possible that my cold didn't fully resolve? My grandmother said you are the best at treating this kind of condition; you helped me last time.
Could you please examine me?" "Doctor, could you check me? I constantly feel like something is blocking my throat—tight, dry, and sometimes even warm.
My uncle was just diagnosed with throat cancer; could I have a problem too?"
In the ENT outpatient clinic at Hsinchu Hospital, the condition known as "globus sensation" occupies most of my time and attention with patients.
Many patients claim they heard from friends and family that Dr.
Yeh from Hsinchu Hospital's ENT department is the best at treating this condition, and some fellow practitioners even refer such patients to me out of goodwill (or perhaps helplessness?).
I have often wondered how to respond to such praise.
The last time I complimented my wife on being the best banana peeler I’ve ever seen, I was swiftly reprimanded before I could finish my sentence.
For these patients, who should ideally be treated effectively by frontline doctors, the reality is that they often visit multiple specialists without finding relief.
It is essential to properly introduce this condition.
The primary challenge for physicians is that these patients often struggle to articulate their discomfort.
Their complaints can range from feelings of tightness, warmth, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling of something being stuck, or even the sensation of a bug crawling.
In medical literature, this condition is referred to as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, or psycho-organic syndrome.
To date, the etiology of this condition remains unclear, but it may stem from one or a combination of the following causes:
1) Local causes:
a.
Chronic pharyngitis: Patients may develop mucosal inflammation due to recurrent colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that prompt swallowing to alleviate discomfort, which paradoxically exacerbates dryness, creating a vicious cycle.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can cause post-nasal drip that irritates the pharynx, and nasal congestion may lead to prolonged mouth breathing, both of which can cause mucosal congestion and inflammation.
c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is open, the lingual tonsils are located beneath and connected to the vallecula epiglottica.
Therefore, not only can enlarged lingual tonsils cause discomfort, but any abnormalities in the epiglottis or its cartilage can also contribute to the sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, incomplete relaxation, spasms, or various causes of gastroesophageal reflux can lead to sensations of a foreign body in the throat.
e.
Head and neck bone disorders: Conditions like Eagle's syndrome (elongated styloid process) can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate the sympathetic nervous system or directly compress soft tissues, leading to a sensation of a foreign body.
f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may be associated with the sensation of a foreign body.
2) Systemic causes: These can include anemia (especially iron deficiency anemia), endocrine disorders, and autonomic nervous system dysregulation.
Middle-aged women should particularly be aware of the potential for anemia and endocrine imbalances.
3) Psychological factors: Stress, anxiety, or fear of cancer due to a family member's diagnosis can contribute to psychological factors affecting these patients.
In treating this condition, the physician's attitude is paramount.
It is crucial not to hastily attribute the cause to psychological factors before the patient has fully described their medical history.
Often, the answers lie within the history itself.
If the patient reports not only discomfort when swallowing saliva but also dysphagia (difficulty swallowing), odynophagia (painful swallowing), or points to specific areas of discomfort, a thorough examination to rule out various potential local organic lesions is necessary.
Conversely, if the patient only experiences mild discomfort when swallowing saliva without other symptoms, it is more likely to be a functional disorder.
As mentioned earlier, the cause of this condition is unknown, and it may stem from one of the three categories or a combination thereof.
Similarly, once a clear diagnosis of an obvious local organic lesion is confirmed, it is essential not to overlook the potential accompanying psychological factors.
Comprehensive, holistic care is necessary to avoid the pitfall of "seeing the disease but not the person."
We must recognize that a diagnosis lacking a holistic perspective is merely one-sided; likewise, an understanding of the whole without in-depth differential diagnosis of local lesions is also misleading.
Our understanding of the objective world is built on this endless dialectic of "local-whole-local-whole..." where both "local" and "whole" are experiential concepts.
Only by transcending this dichotomy of "local" and "whole" can we arrive at the rational concept of "the whole." This holistic way of thinking is the key to genuinely caring for patients and effectively treating this condition.
I hope to encourage all frontline physicians (especially those who have kindly referred patients to me) to cultivate this skill and achieve mastery in due time.

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Reply Date: 2004/02/27