Lump in the Throat Sensation (Base of Tongue Problems)

by , last modified on 4/14/21.

The lump or foreign body sensation in the throat (also known as globus pharyngeus), is a common complaint that many patients have when presenting to their physician (if you can actually see or feel a mass in your neck, click here for more information). The course of evaluation and treatment is radically different depending on where this abnormal sensation is precisely located. If this sensation is BELOW your Adam's Apple, the following information does not pertain to you and one should click here for relevant information. Should this abnormal sensation be located between your chin and top of your Adam's Apple (or voicebox), than the following information may be relevant. If it is located in the mouth, click here.

base of tongue

Other symptoms a patient may or may not have concurrently with this lump or foreign body sensation are as follows:

  • Trouble swallowing
  • Gag sensation is more prominent
  • Repeated swallowing does not resolve sensation
  • Mild burning or sandpaper-like sensation
  • Change in the resonance of your voice (muffled)
  • Ear discomfort

There are a variety of things that may cause these particular symptoms, but most are related to the base of your tongue region. Believe it or not, the tongue in your mouth is only HALF of your total tongue. The tongue actually continues to curve down into your throat and ends at the top of the Adam's Apple. On the surface of this base of tongue region, there are normal lumpy growths called lingual tonsils (arrow in the model) which are related to "regular" tonsils that people often have removed. One may refer to the lingual tonsils as the fourth tonsil (adenoids and the two tonsils in the back of the mouth being the other 3). In the photo below, the bottom half is the base of tongue region. The bumps all around this region are the lingual tonsils.

base of tongue

Arrow pointing to the base of tongue region where the lingual tonsils are found.

base of tongue

The bottom half of the picture is the base of tongue. The lingual tonsils are the lumpy masses found in this region and is normal. This view is obtained using a fiberoptic endoscope.

base of tongue
Note the enlarged lingual tonsils compared
to normal appearance above.

These lingual tonsils may become enlarged due to a variety of pathologic processes leading to the symptoms described above. Why would these base of tongue tonsils become enlarged? It could be due to infection, reflux (including non-acidic mucus reflux), food allergies, abnormal growth/cyst, and cancer. If they become large enough, they will start touching the epiglottis and cause the unusually sensitive gag reflex as well as difficulty swallowing and change in voice quality (muffled). Lingual tonsils, if persistently bothersome and unresponsive to medications, can also be removed. Watch animation of lingual tonsillectomy here.

Other possible explanations for a lump in throat sensation include extremely large tonsils, epiglottic mass (cancer), and an enlarged uvula. An enlarged uvula may occur due to an allergic reaction, infection, reflux, or even severe snoring. One simply needs to open the mouth widely and see if the uvula is larger than normal.

The ONLY way to determine what may be going on is to see your local ENT who will perform a physical examination as well as a special procedure called fiberoptic laryngoscopy. After this examination, a diagnosis can be made with appropriate treatment.

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