Throat Sensitivity: Causes and Concerns in ENT Health - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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1.
Is this related to the nervous system, which may cause increased sensitivity below the Adam's apple? Dryeh.
It could be.
2.
Or is it a symptom of thyroid inflammation? Dryeh.
It doesn't seem like it.
3.
Could excessive tension also cause discomfort in the throat? Dryeh.
I will attach a reference article from the Hsinchu Hospital of the Ministry of Health and Welfare regarding abnormal throat sensations by Dr.
Yeh Da-Wei.

"Doctor, I feel like there's something 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 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 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 always feel like something is blocking my throat; it's tight, dry, and sometimes feels hot.
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 most of my time and patients is what is referred to as "abnormal throat sensation." Many patients claim they heard from friends and family that Dr.
Yeh at Hsinchu Hospital is the best at treating this condition, and even some fellow practitioners have enthusiastically (or perhaps helplessly?) referred such patients to me.
I have 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 before I could finish my sentence.

For these patients, who "should" be properly treated by frontline doctors, it is often the case that they end up visiting multiple specialists without resolution, making it necessary to provide a thorough introduction to this condition.
The first challenge for physicians is that these patients often cannot clearly articulate their discomfort.
Complaints can range from feelings of tightness, heat, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling of something being stuck or even the sensation of insects crawling.
In medical literature, this is described 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 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 recurrent colds, poor working environments, or personal habits like smoking and drinking, leading to secretions that prompt them to swallow to alleviate discomfort, which paradoxically exacerbates dryness, creating 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 cause 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 abnormalities in the vallecula epiglottica or epiglottic cartilage that are thickened, elongated, or hardened can also lead to a sensation of a foreign body.

d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or various causes of 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 of the temporal bone is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities can stimulate the sympathetic nerves or directly compress soft tissues, causing a sensation of a foreign body.

f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may be related to the sensation of a foreign body.

2) Systemic causes: These can be categorized into 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: Stressful life situations, anxiety, or "cancer phobia" due to friends or family members being diagnosed with cancer can also contribute to this condition.

The most important aspect of treating this condition is the physician's attitude.
It is crucial 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 specific areas of discomfort, a thorough examination to rule out 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 a functional disorder.

As previously mentioned, the cause of this condition remains unclear, and it may be one of the three categories mentioned above or a combination thereof.
Similarly, once a clear diagnosis of significant local organic lesions is established, it is essential not to overlook the potential accompanying psychological factors, and comprehensive holistic care must be provided to avoid reducing the patient to merely their "disease."
We must understand that a diagnosis lacking a holistic perspective is merely one-sided; likewise, an understanding of the whole that lacks in-depth differential diagnosis of local lesions is also illusory.
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 this dichotomy of "local" and "whole" can we arrive at the rational concept of "the whole." A holistic approach is the key to genuinely caring for patients and healing this condition.
I hope to encourage all frontline physicians (especially those who have kindly referred patients to me) to cultivate this skill and achieve mastery in this art soon.

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Reply Date: 2006/08/29