Throat Issues: What to Do When You Feel a Membrane - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

---

Sir, if time permits, please come to the clinic for a laryngoscopy examination.
It will provide a clearer understanding of your issue.

Dr.
Da-Wei Yeh from the Hsinchu Hospital, Department of Otolaryngology, Ministry of Health and Welfare: "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 the best at diagnosing this, and advised me to come see you."
"Sir, ever since I recovered from a cold three weeks ago, 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.
Could you please examine me?"
"Doctor, could you check me? I constantly feel like something is blocking my throat—it's tight, dry, and sometimes feels hot.
My uncle was just diagnosed with throat cancer; could I have a problem too?"
In the otolaryngology clinic at Hsinchu Hospital, I spend the most time with patients suffering from what is known as "globus sensation." Many patients claim that their friends and family have mentioned Dr.
Yeh at Hsinchu Hospital as the best for treating such conditions, and some general practitioners even refer these 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 met with a swift reprimand before I could finish my sentence.
For patients who "should" be adequately treated by frontline doctors but instead find themselves shopping around for specialists without relief, it is essential to properly introduce this condition.

Firstly, what troubles 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, and sometimes 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 repeated 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 irritating the pharynx, and nasal congestion may lead to prolonged mouth breathing, resulting in mucosal congestion and inflammation.
c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is opened, the lingual tonsils connect to the vallecula epiglottica.
Thus, 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 lead to a foreign body sensation.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors causing gastroesophageal reflux can lead to a sensation of something stuck 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 may stimulate the sympathetic nervous system 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 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 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.
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 a specific area of discomfort, it is essential to carefully rule out various possible local organic lesions.
Conversely, if the only complaint is a slight foreign body sensation while swallowing without other symptoms, it is more likely a functional disorder.
As mentioned earlier, the cause of this condition remains unclear, and it may stem from one of the three categories or a combination thereof.
Similarly, even after confirming a diagnosis of a clear local organic lesion, one must not overlook the potential 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 in-depth 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 healing 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: 2005/04/05