A lump in my throat

A lump in the throat is a complex of sensations, the leading one being the presence of a “ball”, often painful, in the throat area.

Be sure to see a doctor if you have unexplained discomfort in the throat area. The main symptom is a feeling of tension and discomfort in the throat, sometimes hoarseness or hoarseness of the voice may join.

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Causes lump in the throat

There are two variants of the symptom complex, depending on how much these sensations disrupt or alter the patient’s behavior:

• a lump in the throat that does not affect the functioning of the body's systems or the patient's behavior;
• a lump in the throat, combined with a fear of choking while eating and a disruption of the eating process.

In the first case, patients complain that "something is stuck in the throat" and is bothering them. Some patients believe that this sensation appeared after eating a certain food: a "bone" got stuck. Others talk about it so specifically, but the sensation of some foreign body can also take place. As a rule, such patients are thoroughly and usually ineffectively examined by an otolaryngologist or treated by him for chronic laryngitis or pharyngitis.

The second variant of a lump in the throat (fear of choking while eating) can significantly change the eating behavior of the patient. Usually there is a change in the diet - patients do not eat solid food, prefer to eat at home and have difficulty eating in public places - canteens, cafes, restaurants. As a result of such disorders, body weight can decrease significantly. At the same time, there are no changes in body image, no signs of nervous anorexia. Eating is accompanied by pain and discomfort, anxiety, panic and phobic manifestations associated with the fear of choking, choking on food intensify.

As a rule, the above-mentioned emotional disorders are accompanied by vegetative manifestations, in the structure of which there are hyperventilation disorders, which not only play a pathogenetic role, but also have great significance in the arrangement of clinical disorders. The presence of hyperventilation syndrome among other vegetative manifestations contributes to the emergence of such symptoms as dry mouth, tingling and numbness of the tongue, lips, and perioral region.

If during food intake the activation of breathing is significant, then in such a mode there are real fears of choking on food, which further supports the anxious-hypochondriac fixation on the act of swallowing. In this regard, a thorough clinical analysis of not only the phenomenon of a lump in the throat itself, but also its vegetative correlates, especially paroxysmally manifested by hyperventilation disorders, is of fundamental importance in a number of cases.

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Diagnostics lump in the throat

To establish a diagnosis, in addition to otolaryngological and gastroenterological examination, it is necessary to identify the pathogenetic basis of the disease of affective disorders. Most often, emotional disorders are depressive, anxious (panic) and hysterical disorders. At the same time, hysterical mechanisms, contrary to the widespread opinion among practicing doctors (most often, a lump in the throat is designated globus hystericum), can play an insignificant, secondary role. Evaluation of a lump in the throat as a hysterical phenomenon is more likely when it is combined with other hysterical stigmas: emotiogenic disappearance of voice and sensitivity, transient disorders of movement (pseudoparesis) and coordination in patients with demonstrative (not necessarily) behavioral traits.

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Differential diagnosis

Differential diagnosis of the disorders in question in some cases causes real difficulties. The symptom of a lump in the throat can be the initial manifestation of numerous organic diseases that require exclusion. An analysis of the literature provides a list of diseases that can cause the above symptoms: these are diseases of the pharynx, esophagus and mixed.

After excluding the above disorders, it is necessary to conduct a special psychiatric analysis to exclude mental illness and nervous anorexia. The pathogenesis of a lump in the throat of a psychogenic nature is ambiguous. Traditionally, this phenomenon, as noted, was regarded as having a hysterical genesis. Attempts to discern a certain pathophysiological, deeper basis for this phenomenon can be found in studies on tetany and spasmophilia. A lump in the throat was regarded as a reduced version or equivalent of laryngeal spasm, which is known to be detected in tetany of an endocrine-metabolic nature. In addition, sensory and motor disorders of the esophagus are important. As a rule, the phenomenon of a lump in the throat is based on a complex of factors: emotional disorders (most often of an anxious-depressive nature), increased breathing, dry mouth, frequent swallowing with corresponding fatigue (sometimes quite painful) of the swallowing muscles and increased neuromuscular excitability, dyskinetic disorders of the esophagus. Apparently, such a multifactorial pathogenetic structure and the characteristics of the individual's response to the occurrence of the phenomenon underlie such a widespread and simple, at first glance, manifestation as a lump in the throat.

Treatment lump in the throat

A lump in the throat is treated with vegetative correction, which includes the prescription of vegetotropic agents (anaprilin, obzidan, belloid, bellaspon, pyroxane). The presence of signs of increased neuromuscular excitability requires the prescription of mineral correctors (vitamin D2, calcium preparations). An important point in treatment is the elimination of signs of respiratory dysfunction and hyperventilation syndrome.