When a person develops an obsessive fear of ALS, sometimes they fixate on the bulbar-onset version of ALS. If you clicked on this article, you probably know all about bulbar-onset ALS.
People with the bulbar-onset fear often detect a lump in their throat, or the sensation that something is stuck in their throat, and worry this may be bulbar-onset ALS. In fact, any throat or mouth peculiarity sets them into a panic.
The biggest cause, however, for the throat lump, and for the sensation that something is stuck there, is ANXIETY – including anxiety over bulbar-onset ALS.
Anxiety begets the lumpy feeling in the throat. This is why, in many novels, for example, a character who’s nervous is described as feeling “a lump in her throat.” Ever notice that nervous people put their hand to their throat? It’s an automatic reaction to that lumpy feeling.
I asked an ear, nose and throat (ENT) doctor just exactly what creates the lump or stuck feeling, that can scare people into thinking they have bulbar-onset ALS or laryngeal cancer.
There are other benign causes besides anxiety, according to Steven Y. Park, M.D., author of the book, “Sleep, Interrupted: A Physician Reveals The #1 Reason Why So Many of Us Are Sick And Tired,” Dr. Park is Clinical Assistant Professor of Otolaryngology at the New York Medical College.
Though I don’t know how common the fear of laryngeal cancer is, due to throaty lump sensations or feeling something is stuck there, but fear of bulbar-onset ALS is fairly common, as evidenced by the hundreds of postings on various neurology help sites. Many of the forum participants express fear of bulbar-onset ALS due to feeling the lump or something stuck in the throat.
Ironically, these forum participants don’t fear laryngeal cancer, even though these sensations are more likely to be laryngeal cancer than bulbar-onset ALS! But the bigger picture is, these sensations almost always are neither laryngeal cancer of bulbar-onset ALS, but rather, just plain anxiety and stress.
What causes the lump-in-the-throat feeling?
Dr. Park: This a very common problem that I see almost every day. The most common reason for this is due to laryngopharyngeal reflux disease (LPRD), but there can be other reasons such as a foreign body, neurologic conditions and rarely, laryngeal cancer.
The most common symptoms of LPRD include chronic throat clearing, hoarseness, post-nasal drip, a lump sensation, pain, cough, mucous, burning, tightening or phlegm. You can have one or all of the above.
The “lump” sensation is called a globus sensation, or a ball-like feeling. In our field, we treat LPRD with aggressive PPI therapy (such as Prilosec or Nexium) for 1-3 months, but it only works sometimes.
One of the main reasons for this high rate of failure is that there’s something else that suctioning up your stomach contents into your throat.
So the acid reflux medications don’t really prevent reflux-they only lower the acidity of the stomach juices. You also have bile, digestive enzymes and bacteria that come up and irritate the delicate voice box tissues.
A stressed person swallows differently than a relaxed person. The altered swallowing mechanics somehow cause the lumpy feeling in the throat, or the sensation that something is stuck in the throat. How does this happen?
Dr. Park: If you change your swallowing mechanics due to any reason, whether from allergies, post-nasal drip, a scratch from a bone, or acid reflux, you will feel pain, discomfort or a foreign body sensation.
Vigorous rubbing of opposing mucous membranes and cartilages can definitely irritate your throat temporarily. This can cause a raw surface on the mucous membranes that takes a few days to heal.
The cricopharyngeus muscle (the upper esophageal sphincter) can go into spasm and cause a tightening sensation when under stress. It’s also been shown that under stress, due to dysfunction of the upper esophageal sphincter, stomach contents can leak up and cause irritation of the throat structure, aggravating the condition.
If you have microscopic stomach contents in the throat, the mucous secreting glands in this area try to dilute and clear out this area, so you’ll feel mucous, hoarseness, and post-nasal drip. There will be generalized inflammation in the throat, which can also go up into the nose.
And there you have it: Why, when you worry about bulbar-onset ALS or laryngeal cancer, you suddenly start feeling scary things going on with your throat! So relax … and realize that the mind is a very powerful force.