Dr. Syed Peerzada Tehmid Ul Haque
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
I have a feeling of mucus or something in my throat for the last three weeks. For a week I had a feeling of swallowing issues, where I felt not all of it was sticking to my throat. Now that sensation has more or less gone away, I still do feel like grain in my throat after finishing the meal. I have a lot of dry coughs and my throat feels like irritated constantly. I am not sure if its due to GERD or LPR. I am taking Prevacid 30 mg since last week. I am not sure if that is the reason for my swallowing getting better, but the sensation is still there. Now I am worried that this could be some neurological issue. I am going to see an ENT, but that is a month from now. My question is how is muscle weakness of the throat diagnosed? Is my issue more of an indication of some neurological issues or anxiety and GERD? I also feel like the mucus or the foreign object sometimes interferes with my breathing. When I am tensed or anxious it feels like a ball, when I am calm I do seldom feel it. But when I take a big swallow I feel something in the middle of my throat. I have done an endoscopy, pH and manometry test which does not show much. My doctor diagnosed me with IBS.
Hello,
Welcome to icliniq.com.
The symptoms you are experiencing classically fit into globus pharyngeus. Manometric studies, endoscopy being normal, organic causes are ruled out. Hypo or hypomotility disorders would present in a typical manner and manometric studies would have shown something. Neurological or neuromuscular afflictions would have other symptoms. Globus sensation can be a headache to deal with. Nervous dyspepsia, IBS (irritable bowel disease) globus sensation are all parts of a spectrum of conditions involving gut-brain axis. Cutting down on anxiety is of prime importance.
Patient's Query
Thank you doctor,
Do you think this is due to muscle spasm of my throat? Whenever I swallow normal mucus I can feel the tightness in my throat. I have had the thing for more than three weeks now. The swallowing issue has gone but still every now and then I have the feeling of something like rice sticking to the middle or right of my throat. Do you think I should get a barium swallow done? How long in general the sensations last and how long does it take to go away? Mine is pretty much constant, I also have a dry cough and throat irritation. So with throat muscle weakness what are the symptoms which kind of point towards a muscle issue of the throat? What tests can we do to rule out neurological issues? Do you think this a common complaint amongst people like persistent throat tightness or feeling of something in the throat? Also, when I get up in the morning along with the throat tightness I also get a sore throat and irritated throat. Do you think this is something to be worried about or it is very common? Can anxiety cause these symptoms? My swallowing is improved, does that mean it points away from anything neurological but my throat tightness is not improving.
Hello,
Welcome back to icliniq.com.
Anxiety is the first and foremost cause for globus sensation. The typical complaint of patients is the presence of lump in a throat which does not clear even on repeated swallowing. GERD (gastroesophageal reflux disease) LPR (laryngopharyngeal reflux) both are important causes of globus sensation. The symptoms can both be intermittent or persist for long periods. Neuromuscular would present with symptoms like dysphagia, regurgitation of food, heartburn, voice changes, and even choking at times. Since endoscopy and manometric studies were normal, barium swallow is not likely to yield much. Though there is no wrong in getting barium swallow done in various phases swallowing to rule out functional as well as organic causes.
Patient's Query
Thank you doctor,
When you say organic issues, what do you really mean by that? Also what is a functional issue? Do you think I have spasticity in throat is it possible to have spasticity in the throat because I have this feeling of throat tightness? Also, do you suspect in my case based on what I have said to be anything to do with neurological issues? Or is it more to do with GERD and anxiety? So this feeling could last for weeks to months? Could this be persistent or come and go?
Hello,
Welcome back to icliniq.com.
Organic causes refer to physical lesions like growth or mass, ulcers or any narrowing, strictures, etc. Functional causes include increased or decreased gut motility disorders or neuromuscular conditions. Do you have difficulty with any particular foods like more for liquids or more for solids? Do you have regurgitation or reflux? Do you have any heartburn? Your symptoms do not suggest any neurological condition. It is more likely due to your IBS and GERD. Your anxiety is of course worsening it. You need to cut on your anxiety and simultaneously take care of your GERD and IBS.
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Otolaryngology (E.N.T)
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