Throat Pain and Hard Lumps: A Guide for Expats - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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Subject: Abnormal Sensation in the Throat and Tonsils
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 better 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 condition.
Can you please examine me?" "Doctor, could you check me? I constantly feel like something is blocking my throat—it's tight, dry, and sometimes feels warm.
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 involves the most patients is what is referred to as "globus sensation." Many patients claim they heard from friends and family that Dr.
Yeh at Hsinchu Hospital is the best at treating this condition, and some fellow practitioners have even referred such patients to me out of goodwill (or perhaps helplessness?).
I have always been unsure 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" ideally be treated effectively by frontline physicians, the reality is that they often end up seeking out specialists without finding relief.
It is necessary to provide a thorough introduction to this condition.
The first challenge for physicians is that these patients often cannot clearly articulate their discomfort.
Their complaints can range from feelings of tightness, warmth, fullness, spiciness, roughness, pressure, burning sensations, mucus sensations, foreign body sensations, to the feeling of something lodged in the throat, or sometimes even the sensation of 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 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 work environments, or personal habits such as smoking and drinking, leading to secretions that prompt them to swallow saliva in an attempt to alleviate discomfort, which paradoxically exacerbates dryness and creates a vicious cycle.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions can lead to post-nasal drip irritating the pharynx, and nasal congestion may cause patients to breathe through their mouths for extended periods, resulting in 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 connect to the vallecula epiglottica below.
Thus, not only can enlarged lingual tonsils cause discomfort, but any abnormal thickening, elongation, or rigidity of the epiglottis or its cartilage involved in swallowing can also contribute to the sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, incomplete relaxation, spasms, or various causes of gastroesophageal reflux can lead to sensations of obstruction in the throat.
e.
Head and neck bony disorders: Conditions like Eagle's syndrome (elongated styloid process) can irritate the glossopharyngeal nerve, while cervical spine deformities may stimulate sympathetic nerves or directly compress soft tissues, leading to sensations of obstruction.
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 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 the fear of cancer due to a loved one’s diagnosis can contribute to these sensations.
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 history.
Often, the answers lie within their narrative.
If the patient reports not only discomfort while swallowing saliva but also dysphagia (difficulty swallowing), odynophagia (painful swallowing), or identifies specific pain points, a thorough evaluation for various potential local organic lesions is necessary.
Conversely, if the only complaint is a slight sensation of a foreign body while swallowing without other symptoms, it is more likely to be a functional disorder.

As previously mentioned, the cause of this condition remains unknown, and it may stem from one of the three categories or a combination thereof.
Similarly, even after identifying a clear local organic lesion, one must not overlook the accompanying psychological factors; comprehensive, holistic care is essential to avoid the pitfall of "seeing the disease but not the person."
Dr.
Yeh Da-Wei, Director of the ENT Department, Hsinchu Hospital

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Reply Date: 2010/04/18