Is Your Throat Feeling Tight? Possible Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Sir, your issue requires a clinical examination to determine the problem.
My outpatient hours are Monday, Wednesday, Thursday, and Friday mornings.
Here is a reference document from the Hsinchu Hospital of the Ministry of Health and Welfare regarding abnormal throat sensations by Dr.
Yeh Da-Wei.
"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 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 lodged in my throat—tight, dry, and sometimes warm.
My uncle was just diagnosed with throat cancer; could I have a similar issue?"
In the ENT outpatient clinic at Hsinchu Hospital, I spend the most time with patients suffering from what is termed "abnormal throat sensation." Many patients claim that 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 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 her banana peeling skills, I was met with an unrelenting rebuttal before I could finish my sentence.
For patients who "should" be properly diagnosed and treated by frontline physicians, it is often the case that they end up visiting multiple specialists without resolution, 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, warmth, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling of something lodged in the throat or 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 repeated colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that prompt them to swallow saliva in an attempt to alleviate discomfort, which paradoxically 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 pharynx and cause nasal congestion, resulting in prolonged mouth breathing, which can cause congestion and inflammation of the pharyngeal mucosa.
c.
Enlarged lingual tonsils: While the palatine tonsils are visible when the mouth is opened, the lingual tonsils are located below and connect to the vallecula epiglottica.
Thus, not only can enlarged lingual tonsils cause discomfort, but any abnormalities in the vallecula or epiglottic cartilage that are thickened, elongated, or hardened can also contribute to the sensation of a foreign body.
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 (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 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 "cancer phobia" due to friends or family members suffering from cancer can also contribute to this condition.
When 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; 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 a specific area of discomfort, a thorough investigation 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 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 or a combination thereof.
Similarly, once a clear diagnosis of an obvious local organic lesion is established, one must not overlook the potential accompanying psychological factors; comprehensive holistic care is essential to avoid becoming "disease-focused rather than patient-focused."
We must recognize that a diagnosis made without considering the whole patient 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.

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Reply Date: 2005/04/11