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What Can Be Done For Chronic Sensation Of Something Prickly Stuck In The Throat Despite All Test Results Being Normal?
Posted on
Mon, 9 Apr 2018
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Mon, 9 Apr 2018
Answered on
Thu, 27 Jul 2023
Last reviewed on
Question : Dear Doctor,
I live in XXXX. I'm suffering form the non-stop heavy symptom of feeling something prickly stuck in my throat making me can't lead normal life at all. It is recurrence after a stomach flu two years ago. I have seen many doctors and tried many medications & treatment without any effect to release or reduce my symptom. Since my illness history is kind of complicated and I have many medical reports, I prepared a 6-page summary to make it clear of my situation that I've uploaded with the name of doc of "summary wrtten by patient 0000". I would really appreciate if you can review this doc I prepared that I think it clearer and easier than reading those large amount of original medical reports.
Based on my experiences of seeing doctors, medication trial and symptom, you can see that several illness can be ruled out as the reason of my current throat symptom. I think my situation is rare. Now I doubt that the symptom is caused by cricopharyngeal spasm or other phyrnx-related illness and I may need to do Botox injection or dilation etc.
Based on my situation, do you have any input and advice for me?
Thanks & best regards,
XXXX
I live in XXXX. I'm suffering form the non-stop heavy symptom of feeling something prickly stuck in my throat making me can't lead normal life at all. It is recurrence after a stomach flu two years ago. I have seen many doctors and tried many medications & treatment without any effect to release or reduce my symptom. Since my illness history is kind of complicated and I have many medical reports, I prepared a 6-page summary to make it clear of my situation that I've uploaded with the name of doc of "summary wrtten by patient 0000". I would really appreciate if you can review this doc I prepared that I think it clearer and easier than reading those large amount of original medical reports.
Based on my experiences of seeing doctors, medication trial and symptom, you can see that several illness can be ruled out as the reason of my current throat symptom. I think my situation is rare. Now I doubt that the symptom is caused by cricopharyngeal spasm or other phyrnx-related illness and I may need to do Botox injection or dilation etc.
Based on my situation, do you have any input and advice for me?
Thanks & best regards,
XXXX
Brief Answer:
Possible laryngeal spasm, anxiety manifestation or something else.
Detailed Answer:
Hello,
* There are many possible reasons like laryngeal spasm, anxiety manifestation of underlying stress or others.
* Guidelines at present are:
- Provide your summary at YYYY@YYYY and ask them to
forward it to Dr. Bhagyesh Patel (as here there is no uploaded file visible as an attachment)
- Do not go for Botox injection at present
- Gargle with lukewarm water added peppermint oil 3 times a day
I shall await your response.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Possible laryngeal spasm, anxiety manifestation or something else.
Detailed Answer:
Hello,
* There are many possible reasons like laryngeal spasm, anxiety manifestation of underlying stress or others.
* Guidelines at present are:
- Provide your summary at YYYY@YYYY and ask them to
forward it to Dr. Bhagyesh Patel (as here there is no uploaded file visible as an attachment)
- Do not go for Botox injection at present
- Gargle with lukewarm water added peppermint oil 3 times a day
I shall await your response.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
Thanks a lot for consulting for me. I've uploaded my summary on this website and sent it to YYYY@YYYY asking them to forward it to you as well.
I look forward to your reply.
XXXX
Thanks a lot for consulting for me. I've uploaded my summary on this website and sent it to YYYY@YYYY asking them to forward it to you as well.
I look forward to your reply.
XXXX
Brief Answer:
Follow up.
Detailed Answer:
Hello,
* As per my clinical experience, this suggests partly because of cricopharyngeal spasm of systemic manifestations due to anxiety.
* Salient guidelines at present are:
- Almost everything is done from investigations point of view to medicines trials, but I think the holistic approach will prove much beneficial here.
- Drink more liquids.
- Gargle with salted lukewarm water 2 times a day.
- Deep breathing exercises, Bhramari pranayam, Kapal bhati and Anulom Vilom
YOGA is quite supportive.
- Avoid exposure to pollen, dust.
- Avoid smoking, alcohol if consuming.
- Avoid stress, anxiety.
- Maintain regular sound sleep of 7-8 hours.
- Regular basis use of basil leaves, clove, turmeric in skimmed milk & pure honey support many spasms condition with antimicrobial and immunity mediated mechanics.
- Botox usefulness will be questionable in your case.
Hope this information will help you. I wish you fine health. I welcome further doubts too.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Follow up.
Detailed Answer:
Hello,
* As per my clinical experience, this suggests partly because of cricopharyngeal spasm of systemic manifestations due to anxiety.
* Salient guidelines at present are:
- Almost everything is done from investigations point of view to medicines trials, but I think the holistic approach will prove much beneficial here.
- Drink more liquids.
- Gargle with salted lukewarm water 2 times a day.
- Deep breathing exercises, Bhramari pranayam, Kapal bhati and Anulom Vilom
YOGA is quite supportive.
- Avoid exposure to pollen, dust.
- Avoid smoking, alcohol if consuming.
- Avoid stress, anxiety.
- Maintain regular sound sleep of 7-8 hours.
- Regular basis use of basil leaves, clove, turmeric in skimmed milk & pure honey support many spasms condition with antimicrobial and immunity mediated mechanics.
- Botox usefulness will be questionable in your case.
Hope this information will help you. I wish you fine health. I welcome further doubts too.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Dear Dr. XXXXXXX
Thanks for your reply and I will take your constructive advices. FYI, I have no exposure to pollen or dust, no smoking, alcohol and good night time sleep. I lead very regular lifestyle and pay attention to my diet to avoid spicy food and food hard to digest. Besides, I have little stress except that I recently start to worry that my heavy throat symptom will never recover making me can't lead normal life and take care of my daughter since it has been going on for two years after the recurrence.
I still have some question as followings to seek for your professional opinion:
1. As far as I know, cricopharyngeal spasm is usually caused by stress or reflux. I know somebody who have globus sensation purely due to stress and her symptom & situation is quite different from me. Since my throat symptom happened again due to a stomach flu that triggered my previous reflux and I didn't take PPI on time after the stomach flu to control the reflux. I think it indicates that the reflux is the reason of my current cricopharyngeal spasm instead of stress. Do you agree or not?
2. According to my psychiatrist who used to release me from the this symptom 3 years ago with the medication of valium, he said that "the muscle relaxant activity is more effective than the antianxiety activity of this medication(valium)". Besides, I read from several articles that valium is the first and and best choice to treat cricopharyngeal spasm that I believe it the reason why I recovered when I first took it in Mar 30 2015. Here is the link of one of the articles: https://laryngopedia.com/cricopharyngeal-spasm/
3. Why do you say that Botox usefulness is questionable in my case? Is there any clinical experiences to support this?
4. You mentioned laryngeal spasm in your first time reply. May I ask the difference of cricopharyngeal spasm from laryngeal spasm?
5. I'm thinking to wear a NG tube from my nose into my esophagus to release me from my current heavy throat symptom so that I can lead normal life. As you can read from my summary, I used to do 24hr PH study three times when I had this symptom. Each time when the tube was placed inside, my symptom disappeared but came back when the tube was taken out. Do you think it feasible?
6. Do you think I need to do a barium swallow test in order to clearly diagnose my illness?
7. I've done neck ultrasound 5-6 times in Toronto after the thyroid surgery in May 2014 and it showed everything normal each time. Do you think I should do neck MRI or CT scan?
Thanks a lot,
XXXX
Thanks for your reply and I will take your constructive advices. FYI, I have no exposure to pollen or dust, no smoking, alcohol and good night time sleep. I lead very regular lifestyle and pay attention to my diet to avoid spicy food and food hard to digest. Besides, I have little stress except that I recently start to worry that my heavy throat symptom will never recover making me can't lead normal life and take care of my daughter since it has been going on for two years after the recurrence.
I still have some question as followings to seek for your professional opinion:
1. As far as I know, cricopharyngeal spasm is usually caused by stress or reflux. I know somebody who have globus sensation purely due to stress and her symptom & situation is quite different from me. Since my throat symptom happened again due to a stomach flu that triggered my previous reflux and I didn't take PPI on time after the stomach flu to control the reflux. I think it indicates that the reflux is the reason of my current cricopharyngeal spasm instead of stress. Do you agree or not?
2. According to my psychiatrist who used to release me from the this symptom 3 years ago with the medication of valium, he said that "the muscle relaxant activity is more effective than the antianxiety activity of this medication(valium)". Besides, I read from several articles that valium is the first and and best choice to treat cricopharyngeal spasm that I believe it the reason why I recovered when I first took it in Mar 30 2015. Here is the link of one of the articles: https://laryngopedia.com/cricopharyngeal-spasm/
3. Why do you say that Botox usefulness is questionable in my case? Is there any clinical experiences to support this?
4. You mentioned laryngeal spasm in your first time reply. May I ask the difference of cricopharyngeal spasm from laryngeal spasm?
5. I'm thinking to wear a NG tube from my nose into my esophagus to release me from my current heavy throat symptom so that I can lead normal life. As you can read from my summary, I used to do 24hr PH study three times when I had this symptom. Each time when the tube was placed inside, my symptom disappeared but came back when the tube was taken out. Do you think it feasible?
6. Do you think I need to do a barium swallow test in order to clearly diagnose my illness?
7. I've done neck ultrasound 5-6 times in Toronto after the thyroid surgery in May 2014 and it showed everything normal each time. Do you think I should do neck MRI or CT scan?
Thanks a lot,
XXXX
Brief Answer:
Follow up.
Detailed Answer:
Hi,
Kindly find sequential answers to your further doubts here.
1. Reflux is part of cause as this is a multiple factor mechanism which gives overall presentation, I still support the theory of stress at subconcious mind ( which apparently you do not know or think as such ) as major contributor. If only reflux was the reason, Lansoprazole is best molecule to deal with it.
2. I do agree with your psychiatrist and this article regarding action of Valium.
3. Botox is a nerve blocker, preventing release of acetylcholine, neurotransmitter activating muscle contractions. Botox use is considered as '' Off - label '' by FDA. You can refer to policy statement of Botox use by XXXXXXX association of Otolaryngology as well.
Strong theory to support is its a trial and error method, with possible side effects and positive effects are temporary only. So I have explained it as questionable use.
4. Laryngeal spasm is on & off involuntary spasm of vocal cord from various reasons as stress, GERD or others giving variety of presentations ranging from minor recurrent cough, irritation or others.
Cricopharyngeal spasm is related to spasm of upper esophageal sphincter. Before reading of your detailed narration, it was my possible explanation, but after thorough evaluation of 6 pages history and supportive facts, I do agree with cricopharyngeal spasm most likely.
5. You can wear NG tube for some time period, but for life time use, I do not agree until it is the last resort.
6. I agree with need of Barium swallow, which may give some additional inputs or will not harm you in other way.
7. MRI or CT scan will not be much feasible as the spasmodic conditions are related to neurological circuits which do not show up there.
* Over and above all, I predict that if you follow very sincerely deep breathing exercises and YOGA, you will get definite results with time which will require immense patience from inside.
Hope this information will be useful for you. Wish you a fine day ahead.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Follow up.
Detailed Answer:
Hi,
Kindly find sequential answers to your further doubts here.
1. Reflux is part of cause as this is a multiple factor mechanism which gives overall presentation, I still support the theory of stress at subconcious mind ( which apparently you do not know or think as such ) as major contributor. If only reflux was the reason, Lansoprazole is best molecule to deal with it.
2. I do agree with your psychiatrist and this article regarding action of Valium.
3. Botox is a nerve blocker, preventing release of acetylcholine, neurotransmitter activating muscle contractions. Botox use is considered as '' Off - label '' by FDA. You can refer to policy statement of Botox use by XXXXXXX association of Otolaryngology as well.
Strong theory to support is its a trial and error method, with possible side effects and positive effects are temporary only. So I have explained it as questionable use.
4. Laryngeal spasm is on & off involuntary spasm of vocal cord from various reasons as stress, GERD or others giving variety of presentations ranging from minor recurrent cough, irritation or others.
Cricopharyngeal spasm is related to spasm of upper esophageal sphincter. Before reading of your detailed narration, it was my possible explanation, but after thorough evaluation of 6 pages history and supportive facts, I do agree with cricopharyngeal spasm most likely.
5. You can wear NG tube for some time period, but for life time use, I do not agree until it is the last resort.
6. I agree with need of Barium swallow, which may give some additional inputs or will not harm you in other way.
7. MRI or CT scan will not be much feasible as the spasmodic conditions are related to neurological circuits which do not show up there.
* Over and above all, I predict that if you follow very sincerely deep breathing exercises and YOGA, you will get definite results with time which will require immense patience from inside.
Hope this information will be useful for you. Wish you a fine day ahead.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Above answer was peer-reviewed by :
Dr. Yogesh D
Dear Dr. XXXXXXX
Thanks a lot for your clear answers to all my questions that are definitely helpful to me.
I still have a couple of questions to seek for your opinion:
1. Why placing NG tube can release me from the throat symptom? I have no reflux since I'm taking Lansoprazole that can be supported by on-PPI 24hr PH test result. Does it mean that NG tube can remove my subconcious stress that is partly the cause of cricopharyngeal spasm?
2. I'm thinking one thing. Assuming reflux is 100% the cause of my cricopharyngeal spasm, of course I need to control reflux by taking PPI and adjusting lifestyle. However, the subsequent illness of cricopharyngeal spasm giving me current throat symptom still needs separate treatment. Previously it was valium with its muscle relaxant function. After the recurrence due to the stomach flu, valium does not work because I have tolerance to it now. Therefore I need to have other treatment to treat my cricopharyngeal spasm. I need professional doctor's guidance to see what the right treatment is. Do you have any input and advice?
3. Assuming stress is part of cause of my cricopharyngeal spasm, do you think that my cricopharyngeal spasm will recover if my stress disappears through whatever way such as relaxing myself?
Besides, thanks for your advice of deep breathing exercises and YOGA that I think are the ways of relaxing/removing stress.
Best wishes,
XXXX
Thanks a lot for your clear answers to all my questions that are definitely helpful to me.
I still have a couple of questions to seek for your opinion:
1. Why placing NG tube can release me from the throat symptom? I have no reflux since I'm taking Lansoprazole that can be supported by on-PPI 24hr PH test result. Does it mean that NG tube can remove my subconcious stress that is partly the cause of cricopharyngeal spasm?
2. I'm thinking one thing. Assuming reflux is 100% the cause of my cricopharyngeal spasm, of course I need to control reflux by taking PPI and adjusting lifestyle. However, the subsequent illness of cricopharyngeal spasm giving me current throat symptom still needs separate treatment. Previously it was valium with its muscle relaxant function. After the recurrence due to the stomach flu, valium does not work because I have tolerance to it now. Therefore I need to have other treatment to treat my cricopharyngeal spasm. I need professional doctor's guidance to see what the right treatment is. Do you have any input and advice?
3. Assuming stress is part of cause of my cricopharyngeal spasm, do you think that my cricopharyngeal spasm will recover if my stress disappears through whatever way such as relaxing myself?
Besides, thanks for your advice of deep breathing exercises and YOGA that I think are the ways of relaxing/removing stress.
Best wishes,
XXXX
Brief Answer:
Follow up.
Detailed Answer:
Hello,
Kindly find further clarifications regarding your doubts.
1. NG tube is not going to remove unconscious stress, it is relieving symptoms partly by in contact with cricopharynx and partly by diverting your mind from possible anxiety of spasm.
2. At this point, it is mind set of your subconscious mind that you need further medications against Valium, partially reflecting your dependency upon that. In my opinion, you do not need further expert advise at this point.
3. I strongly believe that with utmost relaxation practice with total dedication will take you out from this situation to unbelievable levels. And you will see its results on your own with time, have patience and just Be Positive, you will be fine for sure.
Hope I have answered your query.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Follow up.
Detailed Answer:
Hello,
Kindly find further clarifications regarding your doubts.
1. NG tube is not going to remove unconscious stress, it is relieving symptoms partly by in contact with cricopharynx and partly by diverting your mind from possible anxiety of spasm.
2. At this point, it is mind set of your subconscious mind that you need further medications against Valium, partially reflecting your dependency upon that. In my opinion, you do not need further expert advise at this point.
3. I strongly believe that with utmost relaxation practice with total dedication will take you out from this situation to unbelievable levels. And you will see its results on your own with time, have patience and just Be Positive, you will be fine for sure.
Hope I have answered your query.
Regards,
Dr. Bhagyesh V. Patel
General Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Prasad
Answered by
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