Throat Pressure: When to See an ENT or Gastroenterologist

Regarding throat compression issues?

Hello, Dr.
Chen! I would like to ask you about the issue of a sensation of pressure in the throat.
A few months ago, my friend visited a doctor due to this sensation.
During the first visit, the doctor mentioned "Helicobacter pylori" and performed an endoscopy.
After two treatment courses, there was no improvement.
For the second visit, he switched to another clinic, where the doctor diagnosed him with esophagitis but still prescribed medication for gastroesophageal reflux, which he took for over a month without any improvement.
On the third visit, he changed to yet another doctor, who suggested trying traditional Chinese medicine.
After more than a month of treatment, the sensation of pressure seems to have improved slightly, but it has not completely resolved.
Essentially, he does not experience pain in the throat, has no issues with eating, and does not have stomach pain; he just continues to feel this persistent pressure.
He plans to undergo a comprehensive health check-up this time to see if the cause can be identified.
Should we focus on examinations of the throat or the stomach? Which specialty should we consult? Thank you!

Evonne, 20~29 year old female. Ask Date: 2009/01/11

Dr. Chen Jianzhi reply Otolaryngology

Dear Evonne,
Hello.
Based on your literal inquiry, it seems to be "globus sensation." It would be best to have both the throat and esophagus examined together.
If you reside in Taoyuan, you can visit the ENT department at the Taoyuan Hospital of the Department of Health.
Our department has considerable experience in the integrated diagnosis and treatment of this condition.

Sincerely,
Dr.
Chien-Chih Chen
Lecturer, Department of Medicine, Fu Jen Catholic University
ENT Department, Taoyuan Hospital, Department of Health

Reply Date: 2009/01/11

More Info

When it comes to throat pressure, it can be a perplexing symptom that may arise from various underlying issues, and determining the right specialist to consult is crucial. Based on your friend's experience, it seems that they have already seen multiple doctors, including gastroenterologists, who have provided different diagnoses and treatments. The symptoms of throat pressure can be related to both gastrointestinal and ENT (ear, nose, and throat) issues, making it essential to approach this problem holistically.

Understanding Throat Pressure
Throat pressure can manifest as a sensation of tightness or constriction in the throat area. This feeling can be caused by several factors, including:
1. Gastroesophageal Reflux Disease (GERD): This condition occurs when stomach acid flows back into the esophagus, leading to symptoms such as heartburn, regurgitation, and a sensation of pressure in the throat. It can also cause inflammation of the esophagus (esophagitis), which may explain the diagnosis your friend received.

2. Esophageal Disorders: Conditions such as esophageal spasms or strictures can lead to a feeling of pressure or tightness in the throat. These disorders can affect swallowing and may require specific diagnostic tests, such as an esophageal motility study.

3. Anxiety and Stress: Psychological factors can significantly contribute to physical symptoms. Anxiety can lead to muscle tension in the throat, causing a sensation of pressure. This is often referred to as "globus sensation" and is not uncommon in individuals experiencing high levels of stress.

4. Infections or Inflammation: Conditions such as pharyngitis or laryngitis can cause swelling and discomfort in the throat, leading to a feeling of pressure. While your friend does not report pain, inflammation can still occur without significant discomfort.

5. Allergies or Postnasal Drip: Allergic reactions can lead to swelling in the throat and a sensation of pressure. Postnasal drip, where mucus drips down the back of the throat, can also create discomfort and a feeling of fullness.

When to See a Specialist
Given the complexity of the symptoms, it may be beneficial for your friend to see both an ENT specialist and a gastroenterologist. Here’s how to approach this:
- ENT Specialist: An ENT can evaluate the throat for any structural abnormalities, infections, or signs of inflammation. They may perform a laryngoscopy to visualize the throat and vocal cords directly.

- Gastroenterologist: Since your friend has already undergone an endoscopy, it may be worthwhile to revisit a gastroenterologist, especially if GERD or esophageal issues are suspected. They can conduct further tests, such as pH monitoring or esophageal motility studies, to assess how well the esophagus is functioning.

Recommendations for Your Friend
1. Comprehensive Evaluation: Since your friend is planning a full-body health check, it would be wise to include both ENT and gastroenterology evaluations in this process. This dual approach can help identify any overlapping issues.

2. Keep a Symptom Diary: Documenting when the pressure occurs, any associated symptoms, dietary habits, and stress levels can provide valuable information for healthcare providers.

3. Consider Psychological Factors: If anxiety is suspected to be a contributing factor, consulting with a mental health professional may be beneficial. Techniques such as cognitive-behavioral therapy (CBT) can help manage anxiety and its physical manifestations.

4. Lifestyle Modifications: Encourage your friend to adopt lifestyle changes that may alleviate symptoms, such as avoiding trigger foods (spicy, acidic, or fatty foods), practicing stress-reduction techniques, and maintaining a healthy diet.

In conclusion, throat pressure can stem from a variety of causes, and a multidisciplinary approach involving both ENT and gastroenterology specialists may yield the best results. By addressing both physical and psychological aspects, your friend can work towards finding relief from this persistent symptom.

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