Chronic Throat Discomfort: Seeking Relief and Expert Care in Taipei - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Mr.
1.
It could be pharyngitis.
2.
No.
3.
No.
Here is an article for your reference from the Hsinchu Hospital of the Ministry of Health and Welfare, written by Dr.
Yeh Da-Wei.
"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 any 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'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 kind of illness; 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, and sometimes warm.
My uncle was just diagnosed with throat cancer; could I also have a problem?"
In the ENT outpatient clinic at Hsinchu Hospital, the condition that takes up most of my time and involves the most patients is what is referred to as "globus sensation." Many patients claim they have heard from friends and family that Dr.
Yeh at Hsinchu Hospital's ENT department is the best at treating this condition, and even some general practitioners have kindly (or perhaps helplessly?) referred such patients to me.
I have often wondered how to respond to such praise.

This condition, which should ideally be managed by frontline physicians, often leads patients to seek out specialists without finding relief.
It is essential to properly introduce this condition.

Firstly, what troubles physicians is that these patients often cannot clearly articulate their discomfort.
They report a variety of complaints, such as a feeling of tightness, warmth, fullness, spiciness, roughness, pressure, burning sensation, mucus sensation, foreign body sensation, or the feeling that something is stuck, sometimes even likening it to a bug 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 develop inflammation of the pharyngeal mucosa due to recurrent colds, poor work environment, or personal habits like smoking and drinking, leading to secretions and a cycle of swallowing to alleviate discomfort, which in turn exacerbates dryness.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can cause post-nasal drip that irritates the pharynx, and nasal congestion may lead to prolonged mouth breathing, causing 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.
Thus, not only can enlarged lingual tonsils cause a foreign body sensation, but any abnormal thickening, elongation, or hardness of the epiglottis can also contribute.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any causes of gastroesophageal reflux can lead to a sensation of something being stuck in the throat.
e.
Bone disorders of the head and neck: Conditions like Eagle's syndrome (elongation of the styloid process) can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate the sympathetic nerves or directly compress soft tissues, causing 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 disorders.
3) Psychological factors: Stress, anxiety, or fears stemming from friends or family members having cancer can lead to "cancer phobia."
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.
Often, the answers lie within the history itself.
If the patient reports not only discomfort when swallowing saliva but also dysphagia or odynophagia, or points to a specific area of pain, a thorough examination to rule out various possible local organic lesions is necessary.
Conversely, if the patient only experiences a slight foreign body sensation 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 mentioned or a combination thereof.
Similarly, even after confirming a diagnosis of a significant 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 made without considering the whole patient is merely one-sided; likewise, a lack of in-depth differential diagnosis of local lesions leads to a distorted understanding of the whole.
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 this 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: 2006/06/05