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How can lump sensation and choking in neck persistent even after thymectomy be treated ?

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Internal Medicine Specialist
Practicing since : 1998
Answered : 1579 Questions
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Last October I experienced a "lump sensation" in my neck, right around the adam's XXXXXXX (but I am female). At first it was vague, and would come and go, and eventually it was all the time and extremely uncomfortable/painful. I was told it was more likely a Globus sensation and that it would eventually go away on its own. It did not. Got an MRI and a mass was identified in my neck below the clavicle head. I had the mass the removed 10 days and it turned out to be my thymus gland, but now I am still have the "lump/ pressure/ and choking" sensation just as before. I am completely devastated that I have not had any relief from the thymectomy. Is this a result of residual swelling from surgery? Or could nerve damage be at play? Please help. I am desperate. I cannot function any longer with this feeling. My surgeon is impossible to get ahold of, and won't answer my calls. questions.
Posted Thu, 3 May 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Jasvinder Singh 32 minutes later
Hello,

Thanks for posting your query.

It is true that suergry is often associated with complications like infection, post residual swelling which likely goes away in 15-20 days or nerve damage but at this area, there is recurrent laryngeal nerve which if damaged cause voice changes. It does not look like any nerve injury during or after surgery.

Since you had the surgery 10 days prior, it will take around two- three weeks for initial recovery from thymectomy. I suggest you to follow up with your operating surgeon and take the prescribed medicines regularly.

There are less chances of a nerve injury and hence it is better to consult your operating doctor only.

Secondly this choking feeling can be due to globus hystericus also. The most common cause is gastro esophageal reflux disease – GERD (gastroesophageal reflux disease). It is diagnosis is by fibroptic laryngoscopy or barium swallow.

For this try the following lifestyle measures:

1) Try raising the head of your bed about four inches with blocks.
2) It also might help to avoid eating or drinking for two hours before you lie down.
3) To help control the stomach acid, one should not drink alcohol or drinks with caffeine in them, or eat chocolate or spicy or greasy foods.
4) Also take some antacid but if the symptoms are severe, then you may need drugs like proton pump inhibitors like omeprazole after consulting your doctor.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us.

I will be happy to answer your queries.

Wishing you good health.


Above answer was peer-reviewed by
 
Follow-up: How can lump sensation and choking in neck persistent even after thymectomy be treated ? 1 hour later
Thank you for your quick response. I realize I should f/u with my doctor but my surgery was 10 days ago and my dr has been virtually unavailable since then to answer/ call me back. And his PA is useless. My post op appt isn't until next Tuesday, and I have just been so stressed I needed answers. In response to the GERD I have had a barium swallow following my MRI to R/O any other dysfunctions, but that came back completely normal. This feeling is so unbearable, and people look at me when I describe it like I'm crazy, but it has greatly hindered my ability to enjoy life. Can Globus be caused by something other than GERD? And if so, are there other things I can try? Thank you again.
 
 
Answered by Dr. Jasvinder Singh 13 minutes later
Hello,

Thanks for posting writing back.

Apart from GERD, globus can be caused by stress and anxiety, inflammation of one or more parts of the throat, such as the larynx or hypopharynx, due to Cricopharyngeal Spasm, gastroesophageal reflux or oesophageal dysmotility.

Although the barium swallow is normal, yet an upper GI endoscopy, esophageal manometry and videofluorography may be required.

If globus sensation is due to oesophageal spasm then it may respond to calcium-channel blockers (e.g. diltiazem) or nitrates (e.g. isosorbide mononitrate). But for this, firstly the cause of globus needs to be ascertained.

Hope this answers your query. If you have additional questions or follow up queries then please do not hesitate in writing to us.

I will be happy to answer your queries.

Wishing you good health.

Regards.

Above answer was peer-reviewed by
 
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