Throat Degeneration Issues in the Elderly - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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You can take the elderly person to the ENT department at China Medical University Hospital to see Dr.
Tsai Ming-Hsiu.
Here is a reference document from the Hsinchu Hospital of the Department of Health, Executive Yuan, regarding abnormal throat sensations.

"Doctor, I feel like something is stuck in my throat.
It has been like this for several months, and I have seen many general practitioners without improvement.
They said you are better at diagnosing this, so I came to have you check it."
"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 didn't fully resolve? My grandmother said you are the best at treating this condition, and you helped me last time.
Could you please examine me?"
"Doctor, could you check me? I always feel like something is blocking my throat, tight and dry, 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 the most time and attention is this so-called "abnormal throat sensation." Many patients claim that they heard from friends and family that Dr.
Yeh at Hsinchu Hospital is the best at treating this condition, and some fellow practitioners have even referred such patients to me out of goodwill (or perhaps helplessness).
I have often wondered how to respond to such praise.

For patients who should ideally be treated by frontline physicians, the reality is that they often visit multiple specialists without finding a solution, which necessitates a thorough introduction to this condition.

Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
Complaints range from feelings of tightness, heat, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling that something is stuck or that there is a bug crawling in their throat.
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 inflammation of the pharyngeal mucosa due to repeated colds, poor working environments, or personal habits like 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 can lead to post-nasal 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: While the palatine tonsils are visible when the mouth is open, the lingual tonsils are located below 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 lesions: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors that may cause gastroesophageal reflux can lead to sensations of a foreign body in the throat.

e.
Bone lesions in the head and neck: Conditions such as Eagle's syndrome (elongation of the styloid process) can irritate the glossopharyngeal nerve, while cervical spine deformities may stimulate the sympathetic nerves or directly compress soft tissues, leading to sensations of a foreign body.

f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may also be related to sensations of a foreign body.

2) Systemic causes: These can be categorized into anemia (especially iron deficiency anemia), endocrine disorders, and autonomic nervous system disorders.
Middle-aged women should particularly be aware of the possibility of anemia and endocrine disorders.

3) Psychological factors: Issues such as stress, anxiety, or fears stemming from friends or family members having cancer (cancer phobia) can also contribute to these sensations.

In treating this condition, the physician's attitude is crucial.
It is essential not to hastily attribute the cause to psychological factors before the patient has fully described their medical history; patience in listening to the patient's account often reveals the answers within their history.
If the patient reports not only discomfort when swallowing saliva but also dysphagia (difficulty swallowing), odynophagia (painful swallowing), or points to specific areas of discomfort, a thorough examination to rule out various possible local organic lesions is necessary.
Conversely, if the only complaint is a slight sensation of a foreign body when swallowing saliva without other symptoms, it is more likely 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, even after confirming a diagnosis of a clear local organic lesion, one should not overlook the potential accompanying psychological factors; comprehensive, holistic care is essential to avoid becoming a physician who sees only the "disease" and 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..." where both "local" and "whole" are 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 effectively treating this condition.
I hope to encourage all frontline physicians (especially those who have kindly referred patients to me) to cultivate this skill soon.

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Reply Date: 2005/04/06