Question: I have the strangest feeling of something getting stuck in my throat. It happened once a year or so ago and then went away on its own. It started again last night and I’m feeling nauseous. I can eat and drink with no problems. What is it and how do I get rid of it?
dr Grant replies: It sounds like you suffer from a common condition called “globus sensation,” which is a feeling of a lump or foreign object in your throat. This condition accounts for up to 5 percent of new referrals to ear, nose and throat (ENT) departments. It is likely that several factors contribute to the abnormal feeling in the throat. Something as simple as recent weight gain can cause hypertrophy (enlargement) at the base of the tongue.
Fortunately, you don’t suffer from difficulty swallowing food or liquids, as these symptoms indicate true dysphagia (difficulty swallowing). If you had dysphagia, certain medical conditions such as underlying structural problems with the throat, gastroesophageal reflux disease (GERD), a mucosal abnormality, or an esophageal dysmotility need to be ruled out.
Your GP would first examine your throat for lumps or lymph nodes and look inside your mouth to assess the base of the tongue, floor of the mouth, mucosa, tonsils, uvela, and epiglottis. It is also possible to examine the nasal passages for enlargement (hypertrophy), nasal polyps, inflammation, discharge, and the ears to assess the eardrum, since ear pain (otalgia) can cause pain in the throat due to a shared sensory nerve supply.
Otalgia, weight loss, history of smoking, excessive alcohol consumption, previous radiation therapy or head and neck surgery, and persistent hoarseness or worsening voice changes are all warning signs that should be referred to an ENT. A quick camera test in the nose and throat performed by the ENT surgeon is enough to rule out some of the more serious conditions.
GORD is common and it is the reflux of stomach contents that can lead to inflammation of the throat. The presence of stomach acid in the distal esophagus (gullet) is abnormal and can lead to increased tone in the upper esophageal sphincter muscle, resulting in globus sensation. Empirical (ie without a formal diagnosis but high clinical suspicion) treatment with a proton pump inhibitor for the prevention of GORD can often be started if the patient’s history suggests this condition.
Chronic pharyngitis or sinusitis with some postnasal drip can also cause this globus sensation. Some people are unaware of the constant flow of mucus from the nose and down the throat. This mucus can be seen during a throat exam at your GP’s. It is worth trying empiric treatment with a steroid nasal spray for a few weeks to see if this provides symptomatic relief.
Finally, allergies are a possible cause of globus sensation. In this condition, both the muscles and the lining of the esophagus are affected, making it more susceptible to acid reflux, and associated symptoms include abdominal pain, nausea, and coughing. If you suspect this, you should consider seeing a medically trained allergist.
dr Jennifer Grant is a GP at Beacon HealthCheck
https://www.independent.ie/life/health-wellbeing/health-features/ask-the-doctor-i-have-the-strangest-sensation-that-something-is-stuck-in-my-throat-help-41880627.html Ask the Doctor: I have the strangest feeling of something getting stuck in my throat. Help!