Generality
The lump in the throat is a symptom that manifests itself as the sensation of a foreign body or mass in the pharynx, larynx and / or cervical portions of the esophagus . This disorder can make swallowing difficult or even painful.
The lump in the throat is a relatively frequent manifestation, which may depend on various pathological conditions. Causes include certain emotional states, gastroesophageal reflux, muscle diseases and nodular lesions of the neck or mediastinum that cause the esophagus to compress.
In some cases, the sensation is perceived as a localized annoyance and can be attributed to quite trivial reasons (eg sadness, agitation or nervousness); at other times, the lump in the throat is similar to suffocation and indicates the need for a medical examination.
What's this
The lump or lump in the throat is a symptom of varying degrees that can range from the annoying sense of obstruction to difficult or painful swallowing. This malaise can be occasional, continuous or recurrent : in any case, it must never be neglected.
The lump, often also called globe or bole, causes that annoying sensation of having something that obstructs the throat.
Causes
The lump in the throat may depend on numerous causes, including:
- Gastroesophageal reflux disease (GERD) ;
- State of anxiety or depression;
- Pharynx tumors;
- Esophagus tumors;
- Muscle diseases.
These conditions affect swallowing and / or give rise to other symptoms, in addition to the sensation of lump in the throat. In general, these manifestations can be favored by a high cricopharyngeal pressure (due to the musculature present in the throat) or by an anomalous hypopharyngeal motility .
Gastroesophageal reflux
Often, the lump in the throat is associated with gastroesophageal reflux, a disorder characterized by the rise in acid gastric contents towards the esophagus. Within certain limits, it is a physiological phenomenon, therefore normal; however, when the reflux becomes too intense and frequent it causes a whole series of disturbances to the patient, including the lump in the throat, encroaching on the pathological. In these cases, one speaks more correctly about gastroesophageal reflux disease (GERD) .
The cause is often attributable to a malfunction of the cardias, a valve that has the task of passing the food ingested by the esophagus to the stomach, preventing it from turning back.
The sensation of lump in the throat may be accompanied by a persistent cough, retrosternal burning, regurgitation, chest pain and excessive salivation.
Hysterical globe
The lump in the throat can be felt as the presence of a mass in the larynx or a sense of suffocation, due to a strong emotion . In this case, we speak of a hysterical globe, an unpleasant manifestation that occurs in the absence of real pathological situations .
The lump in the throat can, in fact, be a symptom of nervous origin and is associated with a state of anxiety or depression : the patient feels the presence of a foreign body in the pharynx or in the front of the chest, when there is no nothing.
The subjective perception of having a knot or a mass in the throat can also derive from the frequent swallowing and dryness of the jaws associated with certain emotional states, such as anguish, pride or repression of sad feelings.
Cervical masses
Other causes are lesions occupying space in the neck that cause compression or obstruction of the upper digestive tract; this is the case, for example, of benign or malignant neoplastic pathologies of the pharynx or esophagus. Other cancers that can induce the sensation of the globe in the throat are those affecting the thyroid or upper chest.
Sometimes, even small expansive processes can cause the sensation of lump in the throat, as in the case of:
- Epiglottis cysts;
- Cricopharyngeal diverticula (upper esophagus);
- Nodules and polyps of the vocal cords.
Esophageal motor dysfunctions
The lump in the throat can originate from an increase in the tension of the muscles of the pharynx or of the region below it. In other cases, this symptom can be determined by local motor dysfunctions.
These latter conditions associated with the lump in the throat include:
- Esophageal spasms (painful muscular contractions of the esophagus);
- Achalasia (motor pathology of the esophagus in which the lower esophageal sphincter loses its ability to release);
- Idiopathic dyskinesias (alterations of esophageal motility, without any ascertained cause).
Musculoskeletal disorders
The perception of a foreign body in the throat may also depend on skeletal muscle disorders. In particular, the lump in the throat occurs under conditions such as myasthenia gravis, myotonic dystrophy, amyotrophic lateral sclerosis and polymyositis .
Smoking habit
Another factor that predisposes to the sensation of lump in the throat is the habit of smoking. In fact, this defect can promote inflammation of the esophagus, a condition that sometimes makes it difficult to swallow. Smokers are also predisposed to mucus stagnation at the level of the cilia of the hypopharynx mucosa.
Other causes
- The lump in the throat can be determined by allergies and cooling syndromes ; the congestion of the nasal cavities that occurs in these conditions, in fact, causes a drain of mucus on the posterior wall of the pharynx ( retronasal discharge ) which induces the sensation of itching (velvet) and obstruction of the throat.
- Another cause of lump in the throat may be dehydration .
- If the lump in the throat is sudden, intense and very oppressive it can be a manifestation of cardiac distress .
Symptoms and Complications
Depending on the triggering cause, the lump in the throat can present itself as a sporadic manifestation (associated with a single episode), continuous or recurrent (it takes until the underlying pathology is resolved). Usually, the sensation of a lump in the throat is not dangerous and does not cause complications, but it can also depend on severe pathologies affecting the esophagus, pharynx and larynx which must be investigated with careful medical evaluation.
How it manifests itself
The lump in the throat can be perceived as a sensation of mass, localized constriction or the presence of a foreign body : the way of describing it varies greatly depending on the patient.
Many people report having a laryngeal narrowing and often make movements as if they were going to eliminate something, but they do not improve their situation, except for a few minutes.
Possible associated symptoms
The lump in the throat is often accompanied by hoarseness, lowering of the tone of the voice, dry cough and the need to clear the throat. The sensation may be associated with pain during swallowing or difficulty breathing. On some occasions, however, the lump in the throat appears as the only symptom.
Diagnosis
A particularly annoying but episodic lump in the throat can be monitored for some time without being alarmed; rarely, this feeling makes it necessary to seek immediate medical attention.
If the disorder is constant and progressive, instead, a thorough clinical evaluation is necessary. Depending on the severity and nature of the lump in the throat, the doctor may suggest to wait for the symptoms to progress or to indicate to the patient further diagnostic tests.
The exams useful to define the causes are "exclusion": if the otolaryngologist specialist observes an irritation of the laryngeal or pharyngeal mucosa compatible with gastroesophageal reflux directs the patient to the gastroenterologist; if the lump in the throat is compatible with a hysterical globe, instead, a psychiatric consultation is indicated and so on.
Anamnesis and physical examination
To investigate the causes of the lump in the throat, the doctor asks the patient questions about symptoms and personal medical history, then he conducts an objective examination.
- Anamnesis : the objective of collecting the patient's anamnestic data consists in differentiating between feeling of lump in the throat and dysphagia (difficulty in swallowing). This information suggests, therefore, the presence of a structural disorder or motility (movement) of the throat or esophagus. During the anamnesis, the doctor asks the patient to clearly describe the symptoms, in particular their correlation with emotional states and swallowing disorders (eg feeling of food blocking). Furthermore, check for any other concomitant events.
- Physical examination : the otorhinolaryngological examination focuses on the mouth and neck. The doctor examines and proceeds to palpation of the oral floor and neck to check for the presence of masses that could be responsible for the sensation of lump in the throat. Subsequently, the physical examination proceeds with the evaluation of the pharynx using a flexible and thin exploration probe, in order to investigate the retropharyngeal region and the vocal cords. During the visit, the doctor may ask the patient to swallow water or a solid food, such as a biscuit or a cracker.
History and physical examination results help to decide if further tests are needed to establish the origins of the lump in the throat.
During the visit, the finding of anatomical alterations or dysphagia is suggestive of a mechanical disorder or swallowing motility. In the presence of chronic symptoms, unrelated to swallowing (in particular: absence of pain or difficulty), which arise during emotional states that can be attenuated with crying, a diagnosis of a hysterical globe is likely. In the latter case, it is rarely necessary to carry out other investigations.
Other surveys
If the diagnosis is unclear or the doctor fails to visualize the pharynx adequately, functional investigations are performed, such as esophagography (standard or video) and esophageal manometry . Other investigations useful to define the causes of the lump in the throat are the chest radiograph and the measurement of the swallowing time. Patients with typical hysterical bolus findings need no further examination.
When to seek medical attention urgently
Some symptoms associated with the sensation of lump in the throat may be suggestive of the presence of particular disorders (eg infarct) and must be interpreted as alarm bells.
Among these events we find:
- Sore throat;
- Neck pain;
- Unexplained weight loss;
- Pain, suffocation or difficulty in swallowing (dysphagia);
- Involuntary spillage of food (regurgitation);
- Muscle weakness;
- Visible or palpable mass.
The sudden onset of these warning signs or their progressive deterioration should prompt them to consult their doctor within a short time.
Treatment
As for the treatment, the options vary depending on the cause of the lump in the throat.
- The feeling of a hysterical globe requires no treatment, other than an approach of reassurance and empathic understanding . However, in case of underlying depression, anxiety or behavioral disorders, supportive therapy with psychological / psychiatric counseling is possible. Sometimes, it may be useful to explain to the patient the association between lump in the throat and state of mood.
- If the lump in the throat depends on the reflux, medical therapy is based on drugs that protect from gastric acid secretion. Generally, gastroprotectants (eg proton pump inhibitors) are used before fasting, and antacids after meals (such as alginates) are used.
- More complex cases responsible for lump in the throat - eg tumor masses and nodular lesions of the neck or mediastinum - can be tackled with endoscopic surgery (ie with a surgery performed through the mouth, without any external incision). Interventions with access from the outside (ie directly from the neck) are limited to a few specific cases.
