Glossopharyngeal Neuralgia: Causes and Treatment Options - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Mr.
If your concerns about tumors or bacterial infections have been ruled out, then pain relief through analgesics is the next step.
For your reference, this is from Dr.
Yeh Da-Wei at the Hsinchu Hospital of the Ministry of Health and Welfare 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 the best at diagnosing this, so I came to see you."
"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 condition; you helped me last time.
Can you please check me?"
"Doctor, could you examine me? I constantly feel like something is blocking my throat—tight, dry, sometimes warm.
My uncle was recently diagnosed with throat cancer; could I have a similar issue?"
In the ENT outpatient clinic at Hsinchu Hospital, the condition known as "abnormal throat sensation" occupies most of my time with patients.
Many claim that Dr.
Yeh from the ENT department is the best at treating this condition, and some general practitioners even refer these patients to me out of goodwill (or perhaps helplessness?).
I often wonder how to respond to such praise.

Patients often express vague discomforts such as tightness, warmth, swelling, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, or even feelings of insects crawling.
In medical literature, this is described as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, or psycho-organic syndrome.

Currently, 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 recurrent colds, poor work environments, or personal habits like smoking and drinking, leading to secretions that cause them to swallow frequently, creating a vicious cycle of discomfort.
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: The palatine tonsils are visible when the mouth is open, but the lingual tonsils are located beneath and connect to the vallecula epiglottica.
Thus, not only can enlarged lingual tonsils cause discomfort, but any abnormalities in the vallecula or epiglottic cartilage can also contribute to a sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors causing gastroesophageal reflux can lead to sensations of a foreign body in the throat.
e.
Bone disorders in the head and neck: Conditions like Eagle's syndrome, where the styloid process is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate the sympathetic nerves or directly compress soft tissues, leading to a sensation of a foreign body.
f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may be associated with sensations 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 possibility of anemia and endocrine imbalances.
3) Psychological factors: Stress, anxiety, or fears related to cancer (cancer phobia) due to friends or family members being diagnosed with cancer can also contribute to these sensations.
When treating this condition, the physician's attitude is crucial.
It is essential not to hastily attribute the symptoms to psychological factors before fully hearing the patient's history.
Often, the answers lie within their narrative.
If the patient reports not only discomfort when swallowing saliva but also dysphagia or odynophagia, a thorough examination to rule out various local organic lesions is necessary.
Conversely, if the only complaint is a slight sensation of a foreign body without other symptoms, it is likely a functional disorder.
As mentioned, 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 the pitfall of "seeing the disease but 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..." and both "local" and "whole" are merely experiential concepts.
Only by transcending the dichotomy of "local" and "whole" can we arrive at the rational concept of "the whole."
This holistic approach 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: 2005/07/14