HNY Policy and Pathway Repository - York

Abnormal throat sensation that is worse with a dry swallow but does not interfere with swallowing food or liquid. Other sensations typically described: tickle, tightness, mucous. Not a primary manifestation of sinus disease but can be caused by post nasal drip, which itself can be caused by silent reflux.

• Constant hoarseness >3 weeks
• Risk factors > 50 year old, smoker, excess alcohol
• Neck lump > 3 weeks
• Recent onset dysphagia (difficulties swallowing)
• Odynophagia (painful swallowing)
• Regurgitation
• Unilateral pain in head or neck and/or otalgia but normal otoscopy
• Objective weight loss

Examine the neck and throat for swellings or lymph glands.

Is there a cough?

Are symptoms intermittent?

Are symptoms related to night time or day time?

Consider non-ENT causes (stress, anxiety)

Advise on possible “lifestyle” factors (smoking, alcohol, caffeine, spicy foods, large meals, high BMI, habitual carbonated drinks but low clear fluid intake etc.).

Consider a trial of Peptac® (+/- a PPI) for up to eight weeks for intermittent symptoms, dry nonproductive cough, worse at night

Indications for referral

Refer potential at-risk patients, if conservative primary care treatment has not helped, and/or highly worried patients, who can expect to have a nasal endoscopy etc. done in clinic. If nothing is found but the symptoms persist despite treatment, the patient may require a referral to gastroenterology for a gastroscopy.
 

Information to include in referral letter

• Time line
• Fluctuation or continuum of symptoms
• Any abnormal findings at examination
• Possible emotional element
• Medical trial done so far and outcome 
• Current smoking / alcohol intake / BMI
• Current regular medication
   

Investigations prior to referral

None, unless chronic cough for > four weeks: CXR

Patient information leaflets/ PDAs

https://patient.info/health/globus-sensation-leaflet
 

Reference / resource

http://www.learning.bmj.com/learning/module-intro/lump-throat.html|?moduleId=10051991