What causes a sensation of a foreign body in the throat?

Causes of Foreign Body Sensation in the Throat

The sensation of a foreign body in the throat is most commonly caused by gastroesophageal reflux disease (GERD), globus pharyngeus, or oropharyngeal dysphagia, but can also result from actual foreign body impaction, cricopharyngeal dysfunction, or anatomical abnormalities like a displaced superior cornu of the thyroid cartilage. 1, 2

Common Causes

Functional/Non-Structural Causes

• Globus pharyngeus: Persistent or intermittent non-painful sensation of a lump in the throat without an identifiable structural cause 2

  • Often associated with stress or anxiety
  • Typically worse with dry swallows and improves with eating/drinking

• Gastroesophageal reflux disease (GERD)

  • Acid reflux can cause inflammation in the throat leading to foreign body sensation
  • May be accompanied by heartburn, regurgitation, or throat clearing

Structural Causes

• Actual foreign body impaction

  • Common in children, elderly with cognitive impairment, and adults with intoxication 3
  • Can cause acute onset of dysphagia, odynophagia, and inability to swallow saliva
  • May present with choking, stridor, or respiratory distress in severe cases

• Cricopharyngeal dysfunction

  • Cricopharyngeal bar can create mechanical obstruction during swallowing 1
  • Results from fibrosis of the upper esophageal sphincter

• Displaced superior cornu of the thyroid cartilage

  • An uncommon but surgically correctable cause 4, 5
  • Presents as foreign body sensation specifically during swallowing
  • Can be misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux

• Oropharyngeal dysphagia

  • Dysfunction in voluntary muscles of the oropharynx 1
  • Can present as food feeling stuck in the throat

Diagnostic Approach

1. Initial evaluation:

   • Thorough history focusing on duration, associated symptoms, and aggravating/relieving factors
   • Careful examination of hypopharynx and neck

2. Laryngoscopic examination:

   • Flexible fiberoptic rhinolaryngoscopy is essential for accurate diagnosis 4, 6
   • Can identify structural abnormalities including actual foreign bodies
   • High diagnostic yield compared to radiographs

3. Imaging studies:

   • Plain radiographs have limited value with high false-negative rates (up to 47-85% for certain foreign bodies) 3, 6
   • CT scan should be considered if there's suspicion of foreign body with negative X-rays (sensitivity 90-100%) 3
   • Modified barium swallow or videofluoroscopy for suspected dysphagia 1

4. Additional testing:

   • Empirical high-dose proton pump inhibitor trial for suspected GERD-related globus 2
   • Endoscopy to rule out structural causes of dysphagia 1
   • Manometry and pH monitoring for persistent symptoms 2

Management Considerations

• For actual foreign body impaction:

  • Emergent flexible endoscopy (within 2-6 hours) for sharp objects, batteries, magnets, or complete obstruction 3
  • Urgent endoscopy (<24 hours) for other esophageal foreign bodies without complete obstruction 3
  • Manual extraction of visible items is recommended, but blind finger sweeps should be avoided 3

• For globus pharyngeus:

  • Empirical PPI therapy for suspected reflux-related symptoms 2
  • Speech therapy, antidepressants, or cognitive-behavioral therapy for persistent cases 2

• For cricopharyngeal dysfunction:

  • Endoscopic dilation or cricopharyngeal myotomy in appropriate cases 1

• For displaced thyroid cartilage cornu:

  • Surgical correction can be curative 4, 5

Important Caveats

• Foreign body sensation may be referred from abnormalities in the mid or distal esophagus 1
• Up to 55% of patients who aspirate may not exhibit protective cough reflexes, increasing pneumonia risk 1
• Silent aspiration can occur in up to 22% of patients with dysphagia 1
• Symptoms may be dismissed as psychogenic when a cause is not readily apparent, leading to delayed diagnosis 4

Remember that thorough evaluation is essential as foreign body sensation can significantly impact quality of life and may indicate serious underlying conditions requiring specific treatment.