Persistent Throat Discomfort: Seeking Solutions for Foreign Body Sensation

Foreign body sensation in the throat?

About five years ago, while eating, I accidentally swallowed a small piece of squid without chewing it properly because I was eating too quickly.
Unfortunately, the transparent cartilage inside the squid got stuck in my throat and esophagus.
The next day, I went to a private clinic for an examination, and the doctor advised me to take medication and observe for one to two weeks, suggesting that it would likely dislodge on its own.
However, after two weeks, I still felt the sensation of a foreign object, so I returned to the clinic, and the doctor informed me that I needed to go to a larger hospital for further examination.
Due to work commitments, I waited about another month before visiting Changhua Christian Hospital.
The doctor there said that the foreign object had likely fallen out and that I was probably just experiencing throat inflammation, so I was prescribed another two weeks of medication.
After finishing the medication, the sensation of a foreign object still did not go away.
Shortly after that, I went into military service.
Now, about five years later, I have visited several large hospitals, and each doctor I consulted said it was impossible for a foreign object to remain and that it was likely just inflammation, prescribing me more medication.
Despite taking so many medications, the sensation of a foreign object has not disappeared.
I would like to ask the doctor if this could be a psychological issue or if there is indeed a foreign object still lodged in my esophagus.
If there is a foreign object, could you recommend an ENT specialist in Kaohsiung, aside from the United Hospital (which I have already visited and was given a bunch of medications to take home), who might be more experienced or could help me resolve this long-standing issue? Thank you in advance; I would greatly appreciate it.

Youxiuqiu, 20~29 year old female. Ask Date: 2004/08/26

Dr. Ye Dawei reply Otolaryngology

Mr.
The sensation of a foreign body has not disappeared, which may be due to psychological factors.
You can visit either Kaohsiung Chang Gung Memorial Hospital or Kaohsiung Medical University Hospital.
Here is an article for your reference.

Dr.
Yeh Da-Wei from the Hsinchu Hospital of the Department of Health, Executive Yuan: "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 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 hasn't fully resolved? My grandmother said you are the best at treating this kind of illness; you helped me last time.
Can you please examine me?" "Doctor! Could you check me? I constantly feel like something is blocking my throat, tight, dry, and sometimes even hot.
My uncle was just diagnosed with throat cancer; could I have a problem too?"
In the ENT outpatient clinic at Hsinchu Hospital, the condition that takes up most of my time and patients is what is referred to as "globus sensation." Many patients claim they heard from friends and family that Dr.
Yeh at Hsinchu Hospital's ENT department is the best at treating this condition, and some general practitioners even enthusiastically (or helplessly?) refer such patients to me.
I have always been unsure 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 mercilessly scolded.

For patients who "should" be properly treated by frontline doctors, it is often the case that they end up visiting renowned specialists without resolution.
It is necessary to provide a thorough introduction to this condition.
The first challenge for physicians is that these patients often cannot clearly articulate their discomfort.
Complaints vary widely, including sensations of tightness, heat, fullness, spiciness, roughness, pressure, burning, mucus sensation, foreign body sensation, or the feeling that something is stuck, and sometimes even the sensation of a bug 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 be attributed to one or a combination of the following causes:
1) Local causes:
a.
Chronic pharyngitis: Patients may develop inflammation of the pharyngeal mucosa due to recurrent colds, poor working environments, or personal habits of smoking and drinking, leading to secretions that cause them to swallow frequently in an attempt to alleviate discomfort, which ironically exacerbates dryness and creates a vicious cycle.

b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions may lead to postnasal drip irritating the pharynx, and nasal congestion may cause patients to breathe through their mouths, resulting in congestion and inflammation of the pharyngeal mucosa.

c.
Enlarged lingual tonsils: The palatine tonsils are visible when the mouth is opened, while the lingual tonsils are located beneath and connect to the vallecula epiglottica.
Therefore, not only can enlarged lingual tonsils cause discomfort, but any abnormal enlargement, length, or hardness of the epiglottis or its cartilage involved in swallowing can also lead to a sensation of a foreign body.

d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors causing gastroesophageal reflux can lead to a sensation of a foreign body in the throat.

e.
Bone disorders of the head and neck: Conditions like Eagle's syndrome (elongated styloid process) can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate sympathetic nerves or directly compress soft tissues, causing a sensation of a foreign body.

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 be categorized into anemia (especially iron deficiency anemia), endocrine disorders, and autonomic nervous system dysregulation.
Middle-aged women should particularly be aware of the possibility of anemia and endocrine disorders.

3) Psychological factors: Stressful life situations, anxiety, or fear of cancer due to a family member's diagnosis can contribute to psychological factors.

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.
Listening patiently to the patient's account often reveals the answers within their history.
If the main complaint includes not only discomfort when swallowing saliva but also dysphagia or odynophagia, or if the patient points to a specific area 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 when swallowing saliva without other symptoms, it is more likely to be a functional disorder.

As previously mentioned, the cause of this condition remains unclear, and it may be one of the three categories or a combination thereof.
Similarly, even after confirming a diagnosis of a clear local organic lesion, one should not overlook the potential accompanying psychological factors, and comprehensive holistic care must be provided to avoid becoming "disease-focused rather than patient-focused."
We must understand 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 illusory.
Our understanding of the objective world is built upon this endless dialectic of "local-whole-local-whole..." and within this, both "local" and "whole" are merely experiential concepts.
Only by transcending the opposition of "local" and "whole" can we reach the rational concept of "the whole." This holistic way of thinking is the key to genuinely caring for patients and healing this condition.
I hope to encourage all frontline physicians (especially those who have kindly referred patients to me) to cultivate this skill soon.

Reply Date: 2004/08/26

More Info

Persistent throat discomfort, particularly the sensation of a foreign body, can be a distressing experience. Your history of swallowing a piece of soft cartilage from a squid and the subsequent discomfort that has persisted for five years raises several important considerations.
First, it is essential to understand that the sensation of a foreign body in the throat can stem from various causes. While it is possible that the cartilage did cause an initial injury or irritation, the ongoing sensation may not necessarily indicate that a physical object remains lodged in your esophagus. Instead, it could be related to several other factors, including:
1. Esophageal Inflammation: Chronic inflammation of the esophagus (esophagitis) can occur due to various reasons, including acid reflux, allergies, or infections. This inflammation can lead to a sensation of tightness or the feeling of something being stuck.

2. Muscle Spasms: The esophagus is a muscular tube that can experience spasms, leading to discomfort and the sensation of a foreign body. Stress and anxiety can exacerbate these spasms.

3. Psychological Factors: Given the duration of your symptoms, psychological factors may play a role. Conditions such as anxiety or somatic symptom disorder can manifest as persistent physical sensations without a clear medical cause.
4. Structural Issues: Although less common, structural abnormalities such as strictures (narrowing of the esophagus) or webs can cause similar sensations. These would typically be identified through imaging studies or endoscopy.

5. Neurological Factors: Sometimes, nerve-related issues can cause altered sensations in the throat, leading to discomfort without any physical obstruction.

Given that you have already consulted multiple healthcare providers without resolution, it may be beneficial to seek a comprehensive evaluation from a specialist in otolaryngology (ear, nose, and throat specialist) who has experience with esophageal disorders. In addition to examining your throat, they may recommend diagnostic procedures such as an endoscopy, which allows direct visualization of the esophagus and can help rule out any structural abnormalities or persistent foreign bodies.

As for recommendations for specialists in Kaohsiung, I cannot provide specific names or hospitals, but I suggest looking for a medical center with a strong reputation in gastroenterology or otolaryngology. You might also consider seeking a second opinion from a different hospital or a specialized clinic that focuses on swallowing disorders or esophageal conditions.

In the meantime, managing any potential anxiety or stress related to your symptoms may also be beneficial. Cognitive-behavioral therapy (CBT) or mindfulness practices can help address the psychological aspects of your discomfort.

In summary, while the initial incident may have caused a physical issue, the persistence of your symptoms suggests that a multifactorial approach may be necessary. Consulting with a specialist who can conduct thorough evaluations and possibly recommend treatments tailored to your specific situation will be crucial in finding relief from this long-standing discomfort.

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