Persistent Throat Discomfort: Causes and Remedies - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Miss, it may be pharyngitis.
Here is an article for your reference.
Dr.
Yeh Da-Wei from Hsinchu Hospital, Department of Otolaryngology: "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 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 hasn’t fully resolved? My grandmother said you are the best at treating this kind of illness; you helped me last time.
Can you please examine me?" "Doctor, could you check me? I always feel like something is blocking my throat; it feels tight, dry, and sometimes hot.
My uncle was just diagnosed with throat cancer; could I have a problem too?"...
In the otolaryngology outpatient clinic at Hsinchu Hospital, the condition I spend the most time addressing and seeing the most patients for is what is referred to as "globus sensation." Many patients claim they’ve 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’ve 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 rebuttal.
For these patients, who "should" be properly treated by frontline physicians, it is often the case that they end up visiting specialists without resolution, so it is necessary to thoroughly introduce this condition.
Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
They describe a variety of complaints such as a sensation of something being stuck, warmth, fullness, spiciness, roughness, pressure, burning sensation, mucus sensation, foreign body sensation, or the feeling of something crawling.
In medical literature, this is referred to 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 recurrent colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that prompt them to swallow 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 may cause postnasal drip that irritates the pharynx, and nasal congestion may lead to prolonged mouth breathing, both of which can cause congestion and inflammation of the pharyngeal mucosa.
c.
Enlarged lingual tonsils: The palatine tonsils are visible when the mouth is opened, while the lingual tonsils connect to the vallecula epiglottica below.
Therefore, not only can enlarged lingual tonsils cause discomfort, but any abnormal enlargement or rigidity of the epiglottis or surrounding structures involved in swallowing may also contribute to the sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, incomplete relaxation, spasms, or any causes of gastroesophageal reflux can lead to a sensation of something being stuck in the throat.
e.
Bone disorders in the head and neck: Conditions like Eagle’s syndrome, where the styloid process of the temporal bone is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities may stimulate the sympathetic nervous system 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 "cancer phobia" stemming from friends or family members being diagnosed with cancer can also contribute to this condition.
When treating this condition, the physician's attitude is crucial.
It is important 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 or odynophagia, or points to a specific area 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 when swallowing saliva without other symptoms, it is more likely to be a functional disorder.
As mentioned earlier, the cause of this condition remains unclear, and it may be one of the three categories listed above or a combination thereof.
Similarly, once a clear diagnosis of an obvious local organic lesion is established, it is important not to overlook the potential accompanying psychological factors; comprehensive, holistic care is necessary to avoid becoming "disease-focused rather than patient-focused." We must understand that a diagnosis made without considering the whole patient is merely one-sided; likewise, a lack of in-depth differential diagnosis of local lesions leads to a flawed understanding of the whole.
Our understanding of the objective world is built upon this endless cycle of "local-whole-local-whole..." differentiation, where both "local" and "whole" are experiential concepts.
Only by transcending the 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 soon.

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Reply Date: 2005/05/14