Bitter Taste, Dry Mouth, and Throat Phlegm Issues - Otolaryngology

Dr. Ye Dawei reply Otolaryngology

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In the ENT outpatient clinic at Hsinchu Hospital, the condition that takes up the most time and involves the most patients is what is referred to as "globus sensation." Many patients claim that they have heard from friends and family that Dr.
Yeh from the ENT department at Hsinchu Hospital is particularly skilled in treating this condition, and some general practitioners even enthusiastically (or perhaps helplessly?) refer such patients to me.
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 have ever seen, she promptly retaliated before I could finish my sentence.
For these patients who "should" be properly diagnosed and treated by frontline physicians, it is concerning that they often end up shopping around for specialists without finding a solution.
Therefore, it is necessary to provide a thorough introduction to this condition.
Firstly, what troubles physicians is that these patients often cannot clearly articulate what discomfort they are experiencing.
Their complaints range from feelings of something being stuck, warmth, pressure, burning sensations, mucus sensations, a foreign body sensation, to the feeling of something crawling.
In medical literature, this is described with terms such as a lump in the throat, globus hystericus, globus syndrome, pharyngeal neurosis, and 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.
This may cause them to swallow frequently in an attempt to alleviate discomfort, which ironically exacerbates dryness in the throat, creating a vicious cycle.
b.
Chronic hypertrophic rhinitis, deviated septum, chronic sinusitis: These nasal conditions may lead to post-nasal drip irritating the pharynx, and nasal congestion may cause patients to breathe through their mouths, 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.
Therefore, 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 lead to a sensation of a foreign body.
d.
Esophageal disorders: Conditions such as esophagitis, diverticula, achalasia, spasms, or any factors that may cause 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 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, leading to a foreign body sensation.
f.
Thyroid disorders: Enlargement or dysfunction of the thyroid gland may also be related to the sensation of a foreign body.
2) Systemic causes: These can be categorized into three main areas: anemia (especially iron deficiency anemia), endocrine disorders, and autonomic nervous system dysregulation.
Middle-aged women should particularly be aware of the possibility of anemia and endocrine disorders.
3) Psychological factors: Stressful life situations, anxiety, or "cancer phobia" stemming from friends or family members being diagnosed with cancer are also psychological factors.
In treating this condition, the physician's attitude is of utmost importance.
It is crucial not to hastily attribute the cause to psychological factors before the patient has fully described their medical history.
Listening patiently to the patient's account often reveals the answers within their history.
If the main complaint includes not only discomfort when swallowing saliva but also dysphagia or odynophagia, or if the patient points to a specific painful area, a thorough examination to rule out various possible local organic lesions is necessary.
Conversely, if the only symptom is a slight foreign body sensation when swallowing saliva without other symptoms, it is more likely to be a functional disorder.
As previously mentioned, the cause of this condition remains unclear, and it may be one of the three categories or a combination thereof.
Similarly, one should not overlook the potential accompanying psychological factors after confirming a diagnosis of a clear local organic lesion; comprehensive holistic care must be provided to avoid falling into the trap of "seeing the 'disease' but not the 'person'." It is important to recognize that a diagnosis lacking consideration of the whole is merely one-sided; likewise, an understanding of the whole without in-depth differential diagnosis of local lesions is also misleading.
Our understanding of the objective world is built upon this endless cycle of "local – whole – local – whole…" differentiation, where both "local" and "whole" are merely experiential concepts.
Only by transcending the opposition of "local" and "whole" to embrace the unity of the "whole" can we arrive at a rational concept.
This holistic way of thinking 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 and achieve mastery in this area soon.

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Reply Date: 2001/08/12