From the Guidelines
The workup for a patient with a sensation of a foreign body in their throat should begin with a thorough history and physical examination, focusing on symptoms and signs that could indicate globus pharyngeus, a functional disorder often associated with anxiety or stress, as suggested by the most recent study 1. The physical examination should include visualization of the oropharynx, indirect laryngoscopy, and palpation of the neck for tenderness or masses.
- Ask about the onset, duration, and associated symptoms like pain, dysphagia, odynophagia, or weight loss.
- Inquire about recent meals, particularly foods with bones or sharp objects.
- Flexible fiberoptic laryngoscopy is often the next step, allowing direct visualization of the pharynx, larynx, and upper esophagus. Radiographic studies may be necessary, with a soft tissue neck X-ray as an initial screening tool to identify radiopaque objects.
- For better soft tissue detail, a CT scan of the neck may be performed. If symptoms persist despite negative findings, consider barium swallow or esophagoscopy to evaluate for esophageal pathology.
- Empiric treatment with proton pump inhibitors (such as omeprazole 20mg daily for 4-8 weeks) may be appropriate if gastroesophageal reflux is suspected as the cause, as suggested by 1. It's also important to consider other potential causes of the sensation, such as chronic upper airway cough syndrome secondary to rhinosinus diseases, and to evaluate the patient's response to specific therapy, as discussed in 1. However, given the most recent and highest quality evidence, the primary focus should be on ruling out organic causes and considering globus pharyngeus as a diagnosis of exclusion, with management strategies that may include speech and language therapy, as recommended by 1.
From the Research
Workup for Foreign Body Sensation in the Throat
The workup for a patient with a sensation of a foreign body in their throat involves a thorough history, physical examination, and radiologic studies to provide a concise differential diagnosis 2. The following steps can be taken:
- Protect the airway as the first priority
- Take a thorough history to identify any underlying conditions that may be causing the sensation
- Perform a directed physical examination, including examination of the hypopharynx and neck
- Use flexible fibre-optic rhinolaryngoscopy to visualize the throat and larynx
- Consider radiologic studies, such as esophagogastroduodenoscopy or barium esophagography, to evaluate the esophagus and rule out any obstructive lesions
Common Causes of Foreign Body Sensation
Some common causes of foreign body sensation in the throat include:
- Gastroesophageal reflux disease (GERD) 3, 4
- Upper esophageal dysmotility 3
- Displacement of the superior cornu of the thyroid cartilage 3
- Eosinophilic esophagitis, triggered by food allergens 5
- Esophageal motility disorders, such as achalasia 5
- Opioid-induced esophageal dysfunction 5
Diagnostic Procedures
The most helpful diagnostic procedures for foreign body sensation in the throat include: