Throat Issues: Managing Symptoms from Medications - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

---

Ms.
Elma, the sensation of a foreign body may be due to individual physiological issues.
There are no specific medications to treat this condition.
Here is an article for your reference from the Hsinchu Hospital of the Ministry of Health and Welfare, authored by Dr.
Yeh Da-Wei.
"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 the best at diagnosing this, so I came to see you for an examination."
"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 hasn’t fully resolved? My grandmother said you are the best at treating this condition; you helped me last time.
Could you please check me?"
"Doctor! Can you examine 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, I spend the most time with patients suffering from what is termed "globus sensation." Many patients claim they heard from friends and family that Dr.
Yeh at Hsinchu Hospital is particularly skilled in treating this condition, and some fellow practitioners even refer such patients to me out of goodwill (or perhaps helplessness?).
I often wonder how to respond to such praise.
Last time, I complimented my wife on being the best banana peeler I’ve ever seen, and before I could finish my sentence, I was met with a swift reprimand.

For patients who "should" be adequately treated by frontline physicians, it is often the case that they end up seeking out specialists without resolution.
It is essential to properly introduce this condition.

Firstly, the challenge for physicians is that these patients often cannot clearly articulate their discomfort.
Complaints vary widely, including sensations of tightness, warmth, fullness, spiciness, roughness, pressure, burning, mucus sensation, foreign body sensation, or even the feeling of something crawling.
In medical literature, this is described as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, psycho-organic syndrome, etc.

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 experience inflammation of the pharyngeal mucosa due to recurrent colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that prompt swallowing to alleviate discomfort, creating a vicious cycle of dryness.
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 inflammation of the pharyngeal mucosa.
c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is open, the lingual tonsils connect to the vallecula epiglottica below.
Therefore, not only can enlarged lingual tonsils cause discomfort, but any abnormal thickening, elongation, or hardness of the epiglottis or its cartilage during swallowing can also contribute to the sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, incomplete relaxation, spasms, or any factors causing gastroesophageal reflux can lead to a sensation of a foreign body in the throat.
e.
Head and neck bone disorders: Conditions like Eagle’s syndrome, where the styloid process is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate the sympathetic nervous system or directly compress soft tissues, leading to a foreign body sensation.
f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may be related to 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 "cancer phobia" due to friends or family members suffering from cancer can also contribute to this condition.
When 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 expressed their medical history.
Listening patiently to the patient's description often reveals the answers within their history.
If the patient reports not only discomfort when swallowing saliva but also dysphagia or odynophagia, or points to specific areas of pain, it is essential to carefully rule out various possible local organic lesions.
Conversely, if the only complaint is a slight sensation of a foreign body while swallowing saliva without other symptoms, it is more likely to be a functional disorder.
As mentioned earlier, the cause of this condition remains unclear, and it may be one of the three categories or a combination thereof.
Similarly, once a clear diagnosis of an obvious local organic lesion is confirmed, it is important not to overlook the accompanying psychological factors.
Comprehensive, holistic care is necessary to avoid becoming "disease-focused rather than patient-focused."
We must recognize that a diagnosis lacking a holistic perspective is merely one-sided; likewise, an understanding of the whole without thorough differential diagnosis of local lesions is also misleading.
Our understanding of the objective world is built upon this endless dialectic of "local-whole-local-whole..." where both "local" and "whole" are experiential concepts.
Only by transcending the 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 together, so we may soon master this art.

---

Reply Date: 2004/06/28