Rare Causes for Foreign Body Sensation in Throat: When Old Outlook Meets New Novelty

from mass. Though looks as a simple presentation, it has diverse branches in a variety of fields of medicine that is yet to be explored or in the process of being discovered. Usual causes for this symptom have been come across on day to day basis and are treated accordingly [1]. In this study, I have tried to bring to focus the uncommon causes for foreign body sensation of throat which these days have become common. Plus, also to highlight & emphasis on one of the finding/ cause which I have encountered in patients nowadays when rest of the ENT examination seems within normal limits particularly in my short practical experience and exposure so far, that is “EpiConTon”. As I have not come across any such study done so far in my review of literature for foreign body sensation in the throat. Abstract Introduction: Foreign body sensation in throat is one of the commonest presentations in ENT. It can be simple & easy to treat but at times can be complex & alarming. Here, is a study exploring the uncommon causes of this symptom which is taking over the charts clinically in the routine mundane of life. Aims & Objectives: To ascertain rare causes for foreign body sensation in throat in all possible mediums and how patient’s ideologies sum up to instilled seeds of cancer in their minds. Methodology: 196 patients with rare causes for foreign body sensation in the throat over a year was clinically assessed, evaluated & treated after analyzing the source for the condition. Results: Nearly 40% of new novelty causes i.e., GERD & “EpiConTon” superseded old outlook causes with female preponderance and stress topping the list of risk factor. Conclusion: Time is said to things but life at times could throw on us new challenges & consequences in present changing lifestyle. People should crave a


Introduction
Foreign body sensation in the throat is a vague symptom at times, but can be an alarming sign as well. There are different perspectives to this symptomatology which can range from a simple Globus sensation syndrome to complicated, malignant Laryngeal mass. Though it looks as a simple presentation, it has diverse branches in a variety of fields of medicine that is yet to be explored or in the process of being discovered. Usual causes for this symptom have been come across on day to day basis and are treated accordingly [1]. In this study, I have tried to bring to focus the uncommon causes for foreign body sensation of throat which these days have become common. Plus, also to highlight & emphasis on one of the finding/ cause which I have encountered in patients nowadays when rest of the ENT examination seems within normal limits particularly in my short practical experience and exposure so far, that is "EpiConTon". As I have not come across any such study done so far in my review of literature for foreign body sensation in the throat.

Aims & Objectives
a) To list out rare causes for foreign body sensation in the throat encountered at ENT OPD. b) To group the rare causes based on which category they belong to.

c)
To look for if these causes have an association with the neuropathic pain d) To find out gender and age-group predilection of the causes that lead to this symptom. e) To categories the risk factors which have synergism with these causes that lead to this symptom.
Objectives: To highlight the specifics and sometimes the "out of the box" approach for the various probable causes for foreign body sensation in the throat in Indian population as it is at times way beyond "mystery of malignancy". given. In this case, reassurance to the patient plays a major and a very crucial role. Injection is given at the root of the nerve origin as mentioned above.

Gastro
On follow up, patients showed good response to treatment provided to them. Psychological factors play a major role in these conditions.
Increased reporting of stressful life events prior to development of symptoms have an exacerbation of symptoms during times of emotional intensity. Informed written consent were taken from the patients during the study period. Institutional Ethics Committee has given clearance before the start of the study.

Results
The results of the study are depicted below Figures 1-7.

Discussion
Foreign body sensation in the throat is an ambiguous symptom at times, but can be an alarming as well. There are different perspectives to this symptomatology which ranges from a meek Globus sensation syndrome to malignant Laryngeal mass. Though it looks as simple the clinical presentation, it has diverse branches of presentations among population. There are many aspects for it source of symptomatology which are yet to be explored and are in the process of discovery [2]. Usual causes for this symptom have been a day to day encounter in the ENT OPD. In this study, I have tried to bring to focus the uncommon causes for foreign body sensation of throat which these days have become common. 4 such unusual causes that have been seen very common in the ENT outpatient department in the hospital so far is considered in this study. Based on history & examination, diagnosis of Globus pharyngeus is made.
Patients should be asked for how long are they facing this feeling and to describe it. The presenting complaint may be described in various ways like a lump or ball in the throat, sticky sensation in the throat, some vague swelling moving up and down the throat etc. The symptoms often come by and go but constant or worsening symptoms are more of concern. The location of symptoms and the considered as most of them are worried about cancer. In general practice, a full examination of the head and neck is important [1]. The neck should be examined for thyroid gland and cervical lymph nodes. Oral cavity & oropharynx should be considered for any ulcerations or asymmetric features, which may suggest malignancy. Nose should be examined for any sort of inflamed mucosa, polyps or pus, any post-nasal discharge which has to be considered as a cause for globus pharyngeus. An abnormal neck or oral examination should prompt urgent referral to secondary care [9]. Gastroesophageal reflux disease (GERD)/ Laryngopharyngeal reflux (LPR) occurs when contents from stomach frequently flows back into esophagus. The mucosal lining of the esophagus can get irritated and stimulated by the backlash or acid reflux of the gastric contents. It is also called acid regurgitation. It has now become the present day most common health concern in India due to urbane and deluxe lifestyle. It is very soon trending on the disease charts of occurrence due to the current regime picks [10,11].
Many people experience acid reflux from time and again these days. GERD is mild acid reflux that occurs weekly twice while moderate to severe acid reflux that occurs weekly once. Most people can manage the uneasiness of GERD with regime variations and over-the-counter medications. But few people with GERD may need stronger medical therapy to relieve them of their symptoms [12,13]. Common signs and symptoms: retrosternal sensation in the chest/ chest burn/ heartburn usually after eating, which might be worse at night, chest pain, dysphagia, reflux of gastric contents, sensation of lump in throat. If there is presence of acid reflux at night, then there may be: chronic cough, laryngitis, new or worsening asthma, disrupted sleep. Complications like esophageal stricture, esophageal ulcer, and Barrett's oesophagus. All these patients have an increased risk of esophageal cancer [13]. GERD is found to be very common these days. In the present day, when minting money has become the prime focus, very often health takes a backseat which is ignored and neglected. Hence it is better to avoid the triggering factors as far as possible and provide relieving factors at the earliest. Adapting these lifestyle modifications or measures on day to day scenario, has brought in lots of health benefits which has indirectly brought in a positive impact in the way of living and improving the way of life [14,15]. Following this sincerely on routine basis, can withhold and minimize the necessity of any medications if required and this can help lead a healthy and fit life. The points that fall under "dwell in the twelve" [16,17]    years of age with male: female ratio ~ 1:2 [18,19]. This condition is also accompanied by dysphagia, foreign body sensation in the throat, pain is triggered on chewing, swallowing, turning neck on one side, touching the back of throat and movement of jaw. There can be association of tinnitus sometimes. Its classic presentation, is only on one side but can rarely present on both the sides. It could either occur spontaneously or can arise after birth. Usually normal stylohyoid process is 2. 5-3 cm in length, but length if longer than 3 cm, it is classified as an elongated styloid process [20,21]. In  [22].
Diagnosis is suspected when a patient presents with symptoms of classic form that is unilateral neck pain, sore throat or tinnitus.
Sometimes, tip of styloid process is palpable in the tonsillar bed.
The diagnosis of the vascular type is more difficult and requires expertise. They can be relieved by infiltration of lidocaine into tonsillar bed. Because of close proximity of vascular structures in this area, this procedure should not be considered with much care [20,23]. Imaging is the diagnostic for styalgia other than clinical palpation. Picturing styloid process on 3D reconstructed CT scan is the suggested imaging technique. The enlarged styloid process may be also visible on an orthopantogram (OPG) or lateral soft tissue X ray neck or X-Ray neck( Towne' s view) [22,24]. Partial styloidectomy is the preferred approach for any form of styalgia.
In case to prevent neurological complications, repair of a damaged carotid artery is essential. Regrowth of the styloid process as well as relapse being a common occurrence is controversial. Medical management may include the use of analgesics with sedatives and anti-inflammatory medications, antidepressants, and/ or corticosteroids. The success rate for treatment (medical or surgical) is about 80% [18,21]. Among the rare causes for foreign body sensation in the throat in 233 pts, the top 3 causes based on the frequency of occurrence in this study are: GERD in 62 pts that is 27%, Globus pharyngeus in 38 pts that is 16% and EpiConTon in 29 pts that is 12%. So, among them the tendency for new category of causes among these 3 is nearly 40% pts. With changing trends and lifestyle reforms, new category of rare causes for foreign body sensation in the throat is seen taking over in the present scenario Of which 91 pts belonged to New category that is in 39%, next is 65pts in O+N category that is in 28% and lastly 54 pts belong to Old category that is 23%. This shows that new category is having far more pts compared to the other category. This infers that the new generation outlook is making its way in this new aged modern era. Along with foreign body sensation in the throat, the next complaint was neuropathic pain. Neuropathic pain is continuous or episodic abnormal sensations from either a painful or non-painful stimuli that can occur as a result caused by the damage or disease affecting the somatosensory nervous system. It is different from neuralgia, as in it does not cause pain due to damaged or irritated nerve. In this study 45% showed presence of this pain among 106 pts and 55% showed no presence of pain among 55%. The ratio of yes: no for the presence of neuropathic pain is nearly 1:1. As there was no abnormality detected on ENT examination, except for these 2 complaints. Hence neuropathic pain presented as secondary symptom in this study. As only adults were considered for the study between age group of 18 to 48 years of age. Among them, 31% were males that is in 73 pts and 69% is females that is in 160 pts. The ratio of M: F is 1:2. Of the 3 categories of age group, 46% belonged to 28-38 years of age in 106 pts, 30% belonged to 38-48 years of age in 71 pts and 24% belonged to 18-28 years of age in 56 pts.
The age group most affected is 28-38 years, where people are in the rat race to make money, leading a very stressful and unhealthy life, where in health is totally neglected and ignored.
Coming to the probable risk factors that could be encountered in this study where these reasons play a synergistic role that leads to this diagnosis. Among them, 37% showed stress to be the most probable risk factor in 87 pts. Next down the line are faulty and unhealthy eating habits/ dietary changes in 19% that is in 45 pts.
While, the rest of the risk factors fall under < 13% of the total pts. These risk factors are additive in nature and always form the iceberg of any condition. Habitual consumption of spirit & smoke were purposely not accounted in the study, as actually it was not found to have any role to play in this study. As per literature search, taking the new plunge which is now presently encountered. To take out the notion from the minds of Indian population that even though there is no abnormality detected but still it is very essential to find the root cause for this symptom. It is not always "cancer" that is dreadful, but even this symptom can sometime be an alarming sign for some hidden critical situation. As the fact is known that Head and Neck cancer are one of the major reasons for mortality in India, due to which they end up with a consultation when this symptom is being encountered. Indian mentality is known to believe more of mouth to mouth bit over their self-experience. The only thing ticking in their minds is that while there is no compromise in their basic necessities in life such as respire, swallow and speech, then why is it still they are facing such a symptom. Plus, with the advent of science & technology, people prefer not just prefer "media popping", "hospital hopping" along with "pharmacy shopping" till they are satisfied and convinced. So, these days along with the medications it is also become important to study the psychology of the patient and meet the needs of patient's expectations over the experience & exposure that is actually attained by the health care takers.