Feeling a Lump in Your Throat? Persistent Throat Discomfort - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Mr.
A-Sheng, I am employed at Hsinchu Hospital.
Please come to the outpatient clinic for an examination to understand your condition.
Attached is a document for your reference.
Hsinchu Hospital, Department of Otolaryngology, Dr.
Yeh Da-Wei: "Doctor, I feel like something is stuck in my throat.
This sensation has been bothering me for several months, and I have seen many general practitioners without any improvement.
They said you are better at diagnosing this issue, so I came to you for an examination."
"Sir, I recovered from a cold three weeks ago, but I still feel like there is 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 condition; you helped me last time.
Could you please check me?"
"Doctor, could 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 similar problem?"
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 have heard from friends and family that Dr.
Yeh at Hsinchu Hospital is the best at treating this condition, and some general practitioners even enthusiastically (or perhaps helplessly?) refer such patients to me.
I have often wondered how to respond to such praise.
Last time, when I complimented my wife on being the best banana peeler I’ve ever seen, I was cut off mid-sentence and faced her wrath.
For these patients, who should ideally be treated effectively by frontline physicians, the reality is that they often visit multiple specialists without resolution, necessitating a thorough introduction to this condition.

Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
They report a variety of complaints such as a sensation of something being stuck, 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, or psycho-organic syndrome.
To date, the etiology of this condition remains unclear, but it may be due to one or a combination of the following causes:
1) Local causes:
a.
Chronic pharyngitis: Patients may develop mucosal inflammation in the throat due to repeated colds, poor working environments, or personal habits such as smoking and drinking, leading to secretions that cause them to swallow frequently in an attempt to alleviate discomfort, which ironically exacerbates dryness, creating a vicious cycle.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can lead to post-nasal drip irritating the throat, and nasal congestion may cause patients to breathe through their mouths, resulting in mucosal congestion and inflammation.
c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is opened, the lingual tonsils are located beneath and connect to the vallecula epiglottica.
Therefore, not only can enlarged lingual tonsils cause discomfort, but any abnormal thickening, elongation, or hardness of the epiglottis may also contribute to the 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 something being stuck 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 may irritate the sympathetic nerves or directly compress soft tissues, causing 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 pay particular attention to the possibility of anemia and endocrine imbalances.
3) Psychological factors: Stress, anxiety, or "cancer phobia" due to friends or family members being diagnosed with cancer can also contribute to this condition.
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 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 during swallowing 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, one should not overlook potential accompanying psychological factors once a clear diagnosis of an obvious local organic lesion is established; comprehensive holistic care must be provided 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 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..." 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 this area soon.

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Reply Date: 2005/03/10