NHS Tayside RefGuide
There are multiple possible causes of FOSSIT or FOLIT (Feeling of Something Stuck In Throat or Feeling of Lump in Throat). These range from psychosomatic to significant laryngeal pathology. Patients with these symptoms form a large part of ENT practice and may account for about 4% of referrals to our outpatient clinics. Typically, these patients may also complain of throat irritation, soreness, dryness, catarrh, constant throat clearing, dry cough or unsatisfactory/incomplete sensation of swallow
The most important aspect is to try rule out more significant pathology.
- Is it noticed between or during meals?
- Position noticed by patient in relation to neck midline/suprasternal notch/upper chest
- Duration and is intermittent or continuous? (intermittent much more likely to be benign pathology)
- Any evidence of regurgitation of food, mealtime coughing & choking
- Recurrent Chest infections
- Red flag symptoms (odynophagia, true-dysphagia, throat pain, haemoptysis, hoarseness, weight loss (very rare), otalgia, neck mass)
- Ask about reflux symptoms such as frequent throat clearing, burning sensation, change in voice
- Social history/personal: smoking, alcohol intake (high volume/spirits); overweight/obese/snoring/OSA
- Any relevant past medical history/family history of H&N malignancies
Examination:
- Examine ENT with focus on oral cavity and tonsils
- Examine the neck for masses
Management:
- If not concerned about malignancy, please reassure patient and advise to return to you if symptoms worsen/new symptoms develop
- If symptoms of reflux, please provide lifestyle and dietary advice first (Silent Reflux advice sheet). Patient should adhere to these for 2-3 months. Only consider a trial of antacids/H2 antagonists/ PPI in clinically severe cases of laryngo-pharyngeal reflux or GORD (formulary), for a minimum of 3-6months. If in doubt, please seek advice.