Throat Lumps: Symptoms, Diagnosis, and Treatment Options

Could you please provide more details about the throat lump?

Hello Dr.
Chen,
In mid-2007, I accidentally felt a small hard lump in the center of my throat.
I went to the hospital's endocrinology department for an ultrasound examination.
At that time, the lump was about 0.2 cm.
The doctor recommended a referral to an otolaryngologist for further evaluation.
Due to various personal matters and not taking it too seriously, I delayed this until August 2008.
For about two months, I experienced an unusual taste at the tip of my tongue (similar to the taste of metal, which is hard to describe, sorry).
I also noticed strange odors through my nose.
I returned to the otolaryngology department for another examination.
The doctor performed a nasal endoscopy but found no abnormalities.
An X-ray was also taken, which showed no signs of sinusitis.
I informed the doctor about the hard lump in my throat, and after examination, he suggested it seemed like a benign lump, so we left it at that.
Gradually, I began to notice my voice becoming increasingly hoarse, along with frequent headaches radiating around my eyes and episodes of dizziness.
The frequency and intensity of these symptoms have increased.
Recently, touching the lump has become painful (sometimes it hurts even without touching it), and I feel like there is phlegm stuck.
During a recent thyroid ultrasound, it was discovered that the lump has grown to 1.1 cm.

Dr.
Chen, could this be a tumor? I consulted with the endocrinology department, and they advised me to see an otolaryngologist.
I have already seen an otolaryngologist, who mentioned it might be related to lymph nodes.
Could you please help clarify and provide some recommendations? Thank you very much!
P.S.
1.
I have had T4 and T5 tests done, which showed no hyperthyroidism or hypothyroidism, but there are cysts on both sides.
The lump I mentioned is located in the center of my throat, similar to a male Adam's apple.
It was previously not visible to the naked eye, but now it is slightly protruding.
When I touch it, I can feel that the hard lump has small hard lumps growing above and below it, connected to it.
2.
I have a history of gastroesophageal reflux disease.

Ms. Tsai, 40~49 year old female. Ask Date: 2009/02/19

Dr. Chen Jianzhi reply Otolaryngology

Dear Ms.
Tsai,
Hello.
Based on your literal inquiry, it may be lymphadenopathy; however, you also describe that it is increasing in number and accompanied by many symptoms, which is indeed quite unusual.
I find it difficult to answer your question, and I apologize for that! How about this: would you like to come to the Taoyuan Hospital of the Department of Health for a consultation? I have outpatient clinics every Wednesday afternoon, and Tuesday and Thursday mornings.
Let me take a look at your actual condition.
Sincerely,
Dr.
Chien-Chih Chen
Attending Physician, Department of Otolaryngology
Taoyuan Hospital, Department of Health
Lecturer, School of Medicine, Fu Jen Catholic University

Reply Date: 2009/02/19

More Info

When it comes to throat lumps, particularly those that have been present for an extended period and have shown signs of growth or changes, it is essential to approach the situation with caution and thorough evaluation. Based on your description, you have a hard lump in the center of your throat that has increased in size from 0.2 cm to 1.1 cm over the course of a year, along with accompanying symptoms such as a metallic taste, hoarseness, headaches, dizziness, and pain upon touching the lump. These symptoms warrant a comprehensive assessment to determine the underlying cause and appropriate treatment options.

Symptoms and Initial Diagnosis
The symptoms you describe, including the sensation of a lump, changes in taste, hoarseness, and pain, can be indicative of several conditions. The lump could be a benign growth, such as a thyroid nodule or a lymph node enlargement, especially given your history of thyroid issues. However, the presence of pain, changes in voice, and the lump's growth raises concerns that should not be overlooked.

Diagnostic Approach
1. Physical Examination: A thorough examination by an Ear, Nose, and Throat (ENT) specialist is crucial. They will assess the lump's characteristics, including its size, consistency, and mobility.
2. Imaging Studies: While you have already undergone ultrasound examinations, further imaging such as a CT scan or MRI may be necessary to get a clearer picture of the lump's nature and its relationship with surrounding structures.

3. Biopsy: If the lump is suspicious, a biopsy may be recommended. This procedure involves taking a small sample of tissue from the lump to be examined microscopically for signs of malignancy or other pathological conditions.

4. Endoscopy: Given your symptoms of hoarseness and throat discomfort, an endoscopic examination may be warranted. This allows the physician to visualize the throat and larynx directly and assess for any abnormalities.

Potential Causes
The lump you are experiencing could be due to several conditions:
- Thyroid Nodules: These are common and can be benign or malignant. Given your history of thyroid issues, this is a possibility.

- Lymphadenopathy: Enlarged lymph nodes can occur due to infections, inflammatory conditions, or malignancies.

- Benign Tumors: Conditions such as a goiter or other benign tumors can present as lumps in the throat.

- Malignancy: While many lumps are benign, the possibility of a malignant tumor cannot be ruled out, especially given the changes in size and associated symptoms.

Treatment Options
The treatment will depend on the final diagnosis:
- Observation: If the lump is determined to be benign and asymptomatic, regular monitoring may be sufficient.

- Medication: If the lump is associated with thyroid dysfunction or inflammation, appropriate medication may be prescribed.

- Surgery: If the lump is found to be malignant or if it causes significant symptoms, surgical intervention may be necessary to remove the lump and possibly surrounding tissue.

Conclusion
Given the complexity of your symptoms and the changes in the lump's size, it is crucial to follow up with an ENT specialist for a detailed evaluation. They can provide a definitive diagnosis and recommend the most appropriate treatment plan. Do not hesitate to seek a second opinion if you feel uncertain about the recommendations provided. Early intervention is key in managing any potential issues effectively.

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