Unilateral Throat Sensation: Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Dear Sir/Madam,
Please refer to the following article.
If you still have concerns, please visit our outpatient clinic for an endoscopic examination.

Dr.
Yeh Da-Wei from the Hsinchu Hospital, Department of Otolaryngology, Executive Yuan Health Department:
"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 better at diagnosing this, so I came to see you."
"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 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—it's tight, dry, and sometimes feels warm.
My uncle was just diagnosed with throat cancer; could I have a problem too?"
In the otolaryngology outpatient clinic at Hsinchu Hospital, the condition that takes up most of my time and patients is what is referred to as "globus 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 general practitioners even refer these patients to me with a sense of helplessness.
I often wonder how to respond to such praise.
The last time I complimented my wife on her banana peeling skills, I was met with a swift rebuttal before I could finish my sentence.

For these patients, who should ideally be treated effectively by frontline doctors, it is concerning that they often end up visiting multiple specialists without resolution.
It is essential to properly introduce this condition.

Firstly, the challenge for physicians is that these patients often cannot clearly articulate their discomfort.
Complaints vary widely, including sensations of tightness, warmth, fullness, spiciness, roughness, pressure, burning, mucus sensation, foreign body sensation, or even the feeling of something crawling.
In medical literature, this is described as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, or psycho-organic syndrome.

To date, the etiology of this condition remains unclear, but it may be due to 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 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 paradoxically exacerbates dryness and creates a vicious cycle.

b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions may 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 connect to the vallecula epiglottica below.
Therefore, 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 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 a foreign body in the throat.

e.
Bone disorders of the head and neck: Conditions such as Eagle's syndrome, where the styloid process of the temporal bone is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities may irritate the sympathetic nerves or directly compress soft tissues, causing a foreign body sensation.

f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may be associated with 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 be particularly vigilant for the possibility of anemia and endocrine disorders.

3) Psychological factors: Stress, 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 of utmost importance.
It is crucial not to jump to conclusions about psychological factors before the patient has fully described 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, a thorough evaluation for 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 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 a significant local organic lesion is established, it is essential not to overlook the potential accompanying psychological factors.
Comprehensive, holistic care is necessary to avoid a "seeing the 'disease' but not the 'person'" approach.

We must recognize that a diagnosis made without considering the whole patient is merely one-sided; likewise, an understanding of the whole patient that lacks 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..." and within this, both "local" and "whole" are merely 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 together, so we may soon master this art.

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Reply Date: 2005/07/29