Generality
The hysterical bolus - also called " lump in the throat " - is a clinical condition in which the patient perceives a sensation of a foreign body at the level of the throat. This feeling can greatly affect the quality of life of the individual, as it can make swallowing difficult.
Causes
Generally, the hysterical bolus is perceived by the patient as the sensation of having a lump in the throat, even if there are no real pathological conditions to cause it.
Very often, the origin of the hysterical bolus lies in a psychological cause and represents the symptom of anxiety and depressive disorders, since nothing is really obstructing the throat.
In some cases, however, the sensation of a foreign body in the throat can be caused by dry mouth and frequent swallowing resulting from states of emotional stress, as can happen in case of distress.
The exact causes of the onset of the hysterical bolus, therefore, are still unknown, but some authors affirm that the appearance of this disorder poses to correlate to an abnormal esophageal motility, or to a high pressure at the level of the upper esophageal sphincter.
In other cases, however, the hysterical bolus does not constitute a purely psychological sensation, but the symptom or clinical manifestation of other diseases. These include: gastroesophageal reflux, esophageal spasms, esophageal achalasia, idiopathic dyskinesias, neuromuscular disorders (such as myasthenia gravis) and benign or malignant neoplasms of the pharynx and esophagus. However, in these cases, rather than hysterical bolus, we prefer to speak of a hypopharyngeal bolus .
Diagnosis
The diagnosis of the hysterical bolus is a fundamental tool for excluding the possible presence of other pathologies, including very serious ones, such as, for example, tumors of the esophagus and pharynx.
After a careful evaluation of the symptoms carried out through the interview with the patient, the doctor can perform palpation of the neck and throat to check for the presence or not of swelling and / or nodules. Moreover, usually the otolaryngologist analyzes the oropharyngeal tract through the use of special endoscopes, so as to identify the presence of any pathologies.
Symptoms
The hysterical bolus consists in the perception of a sense of obstruction in the throat, which seems to be caused by the presence of a foreign body. Often, this feeling is accompanied by an intense concern on the part of the patient, who fears that the disorder may be triggered by serious pathologies. In reality, in most cases the problem is psychological and the intensity of the phenomenon tends to increase with increasing concern of the patient himself. Naturally, this does not mean that the origin of the disorder must always be adequately investigated with medical support.
The main symptom related to the hysterical bolus consists in the difficulty in swallowing which, sometimes, could also be painful.
When to worry?
As mentioned, the hysterical bolus is a disorder that in most cases is related to anxiety states or to the patient's emotional stress. Nevertheless, it should not be treated superficially, especially when it is manifested consistently over time.
It is advisable to consult a doctor immediately when symptoms occur, such as:
- Presence of a palpable and / or visible mass at the throat level;
- Difficulty in swallowing accompanied by pain and feeling of suffocation;
- Sore throat and / or neck pain;
- Anorexia;
- Body weight loss;
- Gradual worsening of symptoms.
Treatment
Unfortunately, at the moment there is no drug able to counter the hysterical bolus. The physician's task, therefore, is to identify what is the triggering factor for the disorder and to direct the patient towards treatment and symptom control.
In light of what has just been said, for example, if the hysterical bolus is due to depression, anxiety or emotional stress, the therapeutic strategy must be based on the treatment of these disorders.
In the event that the hysterical bolus is caused by serious states of anxiety and depression - in addition to a targeted drug therapy with antidepressant and anxiolytic drugs - the doctor, if deemed necessary, can advise the patient to also resort to psychotherapy.
