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Ear, Nose, and Throat Disorders

`Lump` in Throat

12/13/1999

Question:

In March of 1999 I went to my Dr. complaining of a "lump in my throat", difficulty in swallowing. I requested a complete physical the results of which showed a very low iron count. We immediately started heavy-duty iron supplement and by July my count was normal again. However, the feeling of slow swallowing and lump in my throat continued. I saw an ENT specialist who looked at my throat (using an instrument that looked like a piece of cooked spaghetti inserted up my nose and down my throat). He indicated that he saw nothing abnormal and suggested that I take over-the-counter antacids to see if it helps. I have never had any problems with heart-burn, etc. and this approach hasn`t as yet, helped. I still have the difficulty swallowing (especially certain foods; ie granola bars, chicken, licorce...). I don`t know how else to describe the feeling except to say a "lump in my throat" that is there all the time. When eating it feels as if the food is at the top of my throat and moves very slowly down. What is your thinking? Where should I go next?

Answer:

There can be many causes for a lump sensation in the throat. It is possible that one could get a foreign body lodged in the throat; there could be a tumor present, a large thyroid can cause this complaint. The most common cause of this problem tends to be gastroesophageal reflux disease; acid reflux from the stomach. This condition causes many symptoms, some of which are confused with sinus disease. The most common symptoms of acid reflux are heartburn and indigestion. However most of the patients that Ear, Nose and Throat doctors see never complain of these symptoms. More commonly they will complain of frequent throat clearing, mucus in the throat (believed to be sinus drainage), lump sensation in the throat, occasional hoarseness, recurring sore throat, cough, occasional choking sensation, acid or sour taste and bad breath. Not everyone complains of all of these. Usually people will complain of one or two in mild cases, 3-6 in more severe cases. Most people don`t believe this to be their problem when told. They often believe that the mucus in the throat is a result of sinus disease. It seems impossible that something could come up from the stomach rather than down from the nose (or sinuses). Believe me, acid coming up into the throat area is a very common problem. We know that certain foods can make this problem worse. Acid foods like oranges and tomatoes can be a problem. Fatty foods like burgers and French Fries may set it off. Alcoholic beverages and chocolate are other substances that can make matters worse. The best way to fix this problem is with lifestyle and dietary changes. First if you are overweight, weight loss will significantly improve this condition. Identifying and either eliminating or decreasing your intake of certain foods and beverages that make this problem worse would be very helpful. Foods that are spicy or greasy or high in carbohydrates. Which ever ones seem to make this problem worse. Elevating the head of the bed about 6 inches would be helpful, use books, bricks or blocks. Also, do not lie down for 3 hours after you eat. This is particularly difficult for people at night. The most effective treatment is to take acid suppression medication. The more effective medications require a prescription from your doctor. Over the counter medications are not strong enough. This is a problem that usually exists for many years. Therefore, it usually takes about 3-6 months before you start to feel normal again. Significant improvement can be appreciated after about 2-3 weeks of taking the medication. As always, I recommend discussing these issues with you doctor. Good luck and be well.

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Response by:

Keith M Wilson, MD Keith M Wilson, MD
Associate Professor of Otolaryngology, Director of Head and Neck Division
College of Medicine
University of Cincinnati