Lump in the throat

Lump in throat is a complex of sensations, of which leading part belongs to feeling of presence of a "ball", often painful, in the throat.

[1], [2], [3], [4], [5], [6], [7]

Causes of lump in the throat

There are two options, depending on symptoms of how these feelings disrupt or alter behavior of patient:

lump in the throat, which does not affect functioning of body systems and behavior of patient;

lump in the throat, combined with fear of choking while eating food and violation of food process.

In first option, patients complain that «something is stuck in the throat" and interferes. Some patients believe that this feeling arose after taking certain food: stuck "bonelet". Others say about this specifically, but feeling of some foreign body may also occur. Typically, such patients carefully and usually without any results are examined by otolaryngologist and are treated for chronic laryngitis or pharyngitis.

Second option of a lump in the throat (fear of choking while eating) can significantly alter feeding behavior of patient. Usually there is a change in diet - patients do not eat solid food, prefer to eat at home and hardly eat in public places - canteens, cafes and restaurants. As result of such disorders body weight can significantly decrease. In this case, there is no change in body shape; there are no signs of anorexia nervosa. Meal is accompanied by pain and discomfort, anxiety, panic and phobic manifestations, associated with fear of suffocation, choking with food are enhanced.

As a rule, these emotional disorders are accompanied by autonomic manifestations, in structure of which there are hyperventilation disorders, not only playing pathogenetic role, but also having great importance in arrangement of clinical disorders. Presence of hyperventilation syndrome, among other autonomic manifestations, contributes to symptoms such as dryness in mouth, tingling and numbness of tongue, lips, perioral area.

If activation of breathing is essential during mealtime, in this mode there is real fear of choking with food, which further supports anxious-hypochondriacal fixation during process of swallowing. Therefore, careful clinical analysis not only of phenomenon of lump in the throat, but of its autonomic correlates, especially those, which are paroxysmally manifested by hyperventilation disorders, is, in some cases, very essential.

[8], [9], [10]

Diagnostics of lump in the throat

To establish diagnosis, in addition to otolaryngological and gastroenterology examination, identification of pathogenetic basis of disease of affective disorders must be done. Most often emotional disturbances are depressive, anxiety (panic) and hysterical disorders. In this case, hysterical mechanisms, in contrary to popular opinion among practitioners, (usually lump in throat is denoted as globus hystericum) may play minor, supporting role. Identification lump in throat as a hysterical phenomenon is more likely when it is combined with other hysterical stigmata: emotional disappearance of voice and sensitivity, transient disorders of movement (pseudoparesis) and coordination in patients with demonstrative (optional) features of behavior.

[11], [12], [13], [14], [15], [16]

Differential diagnosis

Differential diagnosis of disorders in some cases causes real difficulties. Symptom of lump in the throat may be an initial manifestation of many organic diseases that require exceptions. Analysis of literature gives list of diseases that can cause these symptoms: these are diseases of pharynx, esophagus, and mixed.

After exclusion of these disorders, it is necessary to conduct special psychiatric analysis to eliminate mental illness and anorexia nervosa. Pathogenesis of lump in the throat of psychogenic nature is ambiguous. Traditionally this phenomenon, as noted, was regarded as having hysterical origins. Attempts to discern certain pathophysiological, deeper basis of this phenomenon can be found in studies about tetany and spasmophilia. Lump in the throat was regarded as reduced version or equivalent of spasm of larynx, identified, during tetany of endocrine-metabolic nature. In addition, sensory and motor dysfunction of the esophagus has value. As a rule, complex of factors lies in the basis of phenomenon of lump in: emotional disorders (most often anxiety-depressive character), increased breathing, dryness in mouth, frequent swallowing with corresponding fatigue of swallowing muscles (sometimes quite painful) and increased neuromuscular excitability, dyskinetic violations of esophagus. Apparently, such multifactorial pathogenetic structure and peculiarities of individual response to occurrence of phenomenon are basis of this common and simple, at first glance, manifestation, as a lump in the throat.

Treatment of lump in the throat

Lump in the throat is treated with autonomic correction, which includes prescription of vegetotropic medicine (propranolol, obzidan, belloidum, bellaspon, piroksan). Signs of an increased neuromuscular excitability require prescription of mineral correctors (vitamin D2, calcium supplements). Important point in treatment is to eliminate signs of dysfunction of breathing and hyperventilation syndrome.