Air Regurgitation During Eating: Causes and Solutions - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Sir, your issue may be esophageal stricture.
Whether surgery is needed can only be determined after a consultation and examination.
It is possible that surgery is not required.
In clinical practice, I have also encountered patients with severe funnel chest who experience eating difficulties.
Here is an article for your reference from the Hsinchu Hospital of the Ministry of Health and Welfare, regarding abnormal throat sensations by Dr.
Yeh.
"Doctor, I feel like something is stuck in my throat.
This has been going on 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 didn't fully resolve? My grandmother said you are the best at treating this condition; you helped me last time.
Can you check me?"
"Doctor, could you please examine me? I constantly feel like something is blocking my throat, tight and dry, sometimes even warm.
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 up the most time and involves the most patients is what is referred to as "abnormal throat sensation." Many patients claim that they have heard from friends and family that Dr.
Yeh at Hsinchu Hospital's ENT department is the best at treating this condition.
Some general practitioners even refer these patients to me out of goodwill (or perhaps out of helplessness?).
I have often wondered how to respond to such praise.

The last time I praised my wife for being the best banana peeler I have ever seen, I was swiftly reprimanded before I could finish my compliment.
For these patients, who "should" be properly diagnosed and treated by frontline physicians, it is concerning that they often end up shopping around for specialists without finding relief.
It is essential to provide a thorough introduction to this condition.
Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
They describe a variety of sensations such as tightness, warmth, fullness, spiciness, roughness, pressure, burning, mucus sensation, foreign body sensation, or the feeling of something being stuck, sometimes even likening it to a bug crawling.
In medical literature, this is referred to as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, or psycho-organic syndrome.

As of now, 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 experience inflammation of the pharyngeal mucosa due to repeated colds, poor working environments, or personal habits such as smoking and drinking, leading to secretions that prompt them to swallow saliva in an attempt to alleviate discomfort, which ironically exacerbates dryness in a vicious cycle.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions may cause post-nasal drip that irritates the pharynx, and nasal congestion may lead to prolonged mouth breathing, both of which can result in 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 beneath 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 can also contribute to the sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors that may cause gastroesophageal reflux can lead to a sensation of something being stuck 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 can 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 be associated with the sensation of a foreign body.
2) Systemic causes: These can be categorized into three main areas: 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: Issues such as stress, anxiety, or "cancer phobia" due to a loved one’s cancer diagnosis can also contribute to this condition.
In 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.
Listening patiently to the patient's account often reveals the answers within their history.
If the patient reports not only discomfort while swallowing saliva but also dysphagia (difficulty swallowing), odynophagia (painful swallowing), or points to specific areas of discomfort, 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 while 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 stem from one or a combination of the three categories outlined above.
Similarly, once a clear diagnosis of an obvious local organic lesion is confirmed, it is important not to overlook the potential accompanying psychological factors, and comprehensive holistic care should be provided to avoid falling into the trap of "seeing the 'disease' but not the 'person.'"
We must recognize that a diagnosis made without considering the whole patient is merely one-sided; likewise, an understanding of the whole patient without a thorough differential diagnosis of local lesions is also misleading.
Our understanding of the objective world is built upon this endless cycle of "local – whole – local – whole..." differentiation.
In this context, 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: 2005/09/15