Chronic Dry Cough: Causes and Diagnosis in ENT Care - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Miss Hsiao-Yu, here is the translated content for your reference.
Department of Otolaryngology, Hsinchu Hospital, Ministry of Health and Welfare
Dr.
Da-Wei Yeh
"Doctor, I feel like there's something stuck in my throat.
It's been like this for several months, and I've seen many general practitioners without improvement.
They said you are better at diagnosing this, so I came to see you."
"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 condition; you helped me last time.
Can you check me?"
"Doctor, could you please examine me? I constantly feel a sensation of something blocking my throat—tight, dry, and sometimes warm.
My uncle was just diagnosed with throat cancer; could I have a problem too?"
In the otolaryngology 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 is the best at treating this condition, and some general practitioners even refer such patients to me out of goodwill (or perhaps helplessness?).
I often wonder 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 quickly met with a playful reprimand.

For these patients, who should ideally be treated effectively by frontline physicians, it is often the case that they end up visiting various specialists without finding relief.
It is essential to provide a thorough introduction to this condition.

Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
Their complaints range from feelings of tightness, warmth, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling of something lodged in the throat, or sometimes as if a bug is 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 develop mucosal inflammation in the throat due to recurrent colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that cause them to swallow frequently, which in turn exacerbates dryness—a vicious cycle.

b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can lead to post-nasal drip irritating the throat and prolonged mouth breathing due to nasal congestion, both of which can cause congestion and inflammation of the throat mucosa.

c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is opened, the lingual tonsils connect to the vallecula epiglottica below.
Thus, not only can enlarged lingual tonsils cause discomfort, but any abnormal thickening, elongation, or hardness of the epiglottis or its cartilage involved in swallowing can also lead to a foreign body sensation.

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

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

f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may also 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: Stressful life situations, anxiety, or fears stemming from friends or family members having cancer can contribute to a "cancer phobia."
When treating this condition, the physician's attitude is paramount.
It is crucial not to hastily attribute the patient's symptoms to psychological factors before they have fully described their medical history.
Often, the answers lie within the patient's history.
If the patient reports not only discomfort when swallowing saliva but also dysphagia or odynophagia, or points to specific areas of pain, a thorough examination for various possible local organic lesions is necessary.
Conversely, if the patient only experiences a slight foreign body sensation when swallowing saliva without other symptoms, it is more likely to be a functional disorder.

As previously mentioned, the causes of this condition remain unclear, and the etiology may be one of the three categories mentioned above 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 a 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..." and both "local" and "whole" are merely experiential concepts.
Only by transcending the opposition 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 healing 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 soon.

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Reply Date: 2004/11/08