A lump in throat
 

Dr. W. Ratnayake, Consultant ENT Surgeon

An unusual feeling in the throat is a very common complaint. It would take the form of a mild pain, pricking, irritation or a feeling of a lump. Often these symptoms are not disabling, but recurring, annoying and worrying.

The doctor who confronts this type of problem is sometimes in an equally difficult position. The family physician who treats his patient several times without success would then refer his patient to an ENT surgeon.

The surgeon usually gets a detailed history, and does a thorough examination, but sometimes may find nothing visibly wrong. Such situation may need lot of explanation to convince the patient that there is no serious problem. An account of the possible causes of a feeling of lump in the throat is given below which might help the sufferer to come to terms with the situation.

The 'lump' may be due to a real problem eg. large tonsils. Tonsils are small masses seen on either side of the throat formed from lymphoid tissue and help in reducing infection. They are large in children and become smaller as they grow up, but in a small percentage continue to remain in large in adulthood also. They might get inflamed sometimes causing pain.

The whole throat can get mildly congested repeatedly (pharyngitis) giving a feeling of lump. Often this is due to allergic or environmental factors. Dust, fumes and smoke at workplaces, heavy smoking and alcohol consumption, taking chilled drinks often are common causes.

Reflux of stomach secretions and acids up the gullet into the throat happens often causing congestion, leading to recurrent discomfort. Sometimes throat congestion can be secondary to catarrh and infection of sinuses around the nose.

The infected secretions trickle down through the back of the nose causing irritation, cough and soreness, mostly at night. Hence the doctor needs to know whether the patient gets nose blocking, discharge, headache, abnormal smell etc. suggestive of above conditions. Overuse of voice is another factor that can give throat discomfort.

Those frequently involved in such habits are teachers, street vendors, factory supervisors, preachers and those controlling labour force in the field. By shouting they strain the muscles around the throat so much that at the end of the day, the throat feels blocked and sore.

Asthmatics often get throat discomfort and on examination no obstruction is seen. The feeling of lump may be secondary to recurrent coughing and throat clearing, and thick phlegm produced by the lining of the respiratory passages.

Sometimes, a person who has undergone surgery in the neck eg. Thyroidectomy or radiotherapy for cancers in the neck and throat area tends to feel dryness and tightness in throat which can last for several months.

Although the above description might make the reader get into a state of complacency regarding his throat problem, one should not ignore it, as very occasionally it could be due to a cancerous lesion. Therefore it is important that a doctor should investigate to exclude a serious condition.

However, as mentioned at the outset the doctor may not find any evidence of disease. Could it all be in the mind? Possible. It may be that someone known to the patient had a throat cancer recently and there is a panic reaction causing a phobia that keeps on troubling. Is the sufferer trying to draw attention from the family members, which he feels is not adequate? Is it a presenting symptom of stress or depression? Remember the choking one gets when confronted with an emotionally shocking event or news.

Therefore a patient feeling a lump in throat needs proper investigations, treatment when indicated, change of lifestyle, habits and environment, thorough explanation of the situation and reassurance when no disease is found, and on the patient's part, readiness to accept good advice given by a well-meaning doctor, which would also avoid unnecessary medication and expenditure.