Throat Discomfort: Causes and Concerns Explained - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Dear Sir, please visit the ENT outpatient clinic to determine the nature of your problem.
Regarding the sensation of a foreign body in your throat, I am providing you with an article for reference from the Hsinchu Hospital of the Ministry of Health and Welfare, authored by Dr.
Yeh.

"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 suggested that you are the best at diagnosing this issue, 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 kind of condition; you helped me last time.
Could you please examine me?"
"Doctor, could you check 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 have a similar problem?"
In the ENT outpatient clinic at Hsinchu Hospital, I spend the most time with patients suffering from what is referred to as "globus sensation." Many patients claim that their friends and family have mentioned Dr.
Yeh at Hsinchu Hospital as the best for this condition, and even fellow practitioners have kindly (or perhaps reluctantly) referred such patients to me.
I often wonder how to respond to such praise.

For patients who "should" be properly diagnosed and treated by frontline physicians, it is concerning that they often end up seeking care from specialists without resolution.
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.
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 attributed 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 working environments, or personal habits such as smoking and drinking, leading to secretions that prompt swallowing to alleviate discomfort, creating a vicious cycle of dryness.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can lead to post-nasal drip irritating the pharynx and prolonged mouth breathing due to nasal obstruction, 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 opened, the lingual tonsils are located beneath and connected to the vallecula epiglottica.
Thus, not only can enlarged lingual tonsils cause a sensation of a foreign body, but any abnormal thickening, elongation, or hardness of the epiglottis may also contribute.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors causing gastroesophageal reflux can lead to a sensation of a foreign body in the throat.
e.
Bone disorders of the head and neck: Conditions like Eagle's syndrome, where the styloid process is elongated, can irritate the glossopharyngeal nerve, while cervical spine deformities may stimulate the sympathetic nerves 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 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 imbalances.
3) Psychological factors: Stress, anxiety, or "cancer phobia" due to friends or family members being diagnosed with cancer can also contribute to this condition.
In treating this condition, the physician's attitude is crucial.
It is essential not to hastily attribute the cause to psychological factors before fully hearing the patient's medical history, as the answers often lie within that history.
If the patient reports not only discomfort while swallowing saliva but also dysphagia or odynophagia, or points to a specific area of pain, a thorough examination to rule out various possible organic lesions is necessary.
Conversely, if the patient only experiences mild discomfort while swallowing saliva without other symptoms, it is likely a functional disorder.
As previously mentioned, the cause of this condition remains unclear, and it may stem from one of the three categories or a combination thereof.
Similarly, even after confirming a diagnosis of a significant organic lesion, one should not overlook the potential accompanying psychological factors.
Comprehensive, holistic care is essential to avoid reducing the patient to merely a "condition" rather than a "person."
We must understand 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 comprehension of the objective world is built upon an endless cycle of "local-whole-local-whole..." differentiation.
In this context, both "local" and "whole" are merely experiential concepts; transcending this dichotomy of "local" and "whole" to embrace the "whole" is the rational concept.

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 together, so we may master this art of healing.

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Reply Date: 2006/10/25