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Avatar universal

Click when swallowing

Hello,

I was wondering if someone could help me.  For a few weeks now I have this click in my throat when I swallow.  Not when I am drinking water or eating, but just during normal swallowing.  It doesn't click when my head is down or up, but it clicks when I am looking straight.  If I put my fingers just above adams apple I can feel a click.

Please help me to identify what it could be.

Thank you,
B
183 Responses
Avatar universal
I have all this too! Plz help!  Started 3 weeks ago after a minor cold.  A click/pop/thump when I swallow.  Not all the time and usually spit swallowing only.  Seems to happen when my adam's apple is at its highest on a swallow.  I also feel like there is something in my throat on the right side.  No ear pain, no jaw pain....but my tongue gets a little weird sensation.

I was in a car accident 4 years ago where my head went through a windshield, but this is new to me.  I recently had a cold, and I think my lymph node on the right side under my chin is a little swollen (could be from cold).

Very scary.  I read about this popping above the adam's apple and the big bad C word came back.  Going to ENT tomorrow, I hope they give me the same results as everyone else thats its nothing, or something simple and easy to treat.
Avatar universal
I found this and it helped right away!!

"Best Answer - Chosen by Voters
when you feel the clicking get the palm of you hand rest it on your cheek (same side as the click) and gently pull your facial skin / muscles upwars towards your ear. Do it in a way that your palm runs up along your jaw line.

Other than that see what your chiro says"
1 month ago
Avatar universal
I have this too!  Except mine comes with a few other symptoms.  I only have it on the right side of my throat and it only happens when my head is turned a certain way.  My right lung also hurts sometimes, and I have so get strange headaches on random parts of only the right side of my head, as well as pain in my right trapezium.  Any help is greatly appreciated!
Avatar universal
Part 1 of 2.

I also have similar click swallow (and some other) symptoms as some of the posters especially blk133 and cindy903 and wildblue98, thndr800, jilldai. The symptoms have significantly ruined the quality of my life since early 2007. So far, I have not been able to find a definitive diagnosis or a cure or reduce or control the symptoms. I can fully empathise with the posters who have this or a similar condition and welcome those who would wish to swap experiences, ideas, partial or full remedies.  I would love to know of anyone who has obtained a confident diagnosis and cure.  I am new to the post so have not seen many of the posts except the thread starting from blk133’s post starting from Dec 1 2007.

Symptoms present:
Click on dry swallow, that fades or disappears on second, third swallow.
Sometimes the click is still noticeable when swallowing liquid or solid food.
When the click has gone after a swallow, the click can be made to return with significant magnitude immediately after clearing throat or a hard cough (to clear throat) and immediate dry swallowing (dry swallowing = with no food/liquid except saliva).
Very mild dull pain a second after swallowing – pain located in the upper oesophagus.
Some feeling of aspiration of fluid? at entrance of windpipe causing occasional need to clear throat, cough. After coughing, click swallow can be abrupt.
Sensation of something stuck in lower throat (below Adam’s apple and level with where the neck joins the chest, and a feeling of something stuck in the upper part of the oesophagus).  
Occasional production of phlegm but not frequent.
Dry retching. The globus sensation of something stuck is not always present but when present, causes periods of retching to the point of violent choking. The retching episodes are short bursts of a few seconds and can occur once or several times a day, but not every day. The retching frequency slowly builds up over a period of several weeks where the frequency of retching maximises then subsides after violent retching.

I cannot correlate the throat click or the globus sensation or retching with anxiety for these symptoms can occur with significant intensity at times of reduced exposure to stress, e.g. when on holiday, doing pleasurable leisure activities, resting.

Symptoms absent: (I include “symptoms absent” here because it may help doctors and other readers to eliminate potential conditions rather than just indicating the existing symptoms): Heartburn, indigestion, burning sensations from acid reflux [if acid reflux is present, it has to be silent reflux.  Several months of PPI have no effect, whether I take them or not. On that basis, I would have thought if acid reflux was the cause of the symptoms, PPI would have curbed or eliminated it, but they haven’t.  A hiatus hernia was observed but both nocturnal and daytime (upright) abrupt liquid reflux is absent].
Weight loss absent.  Regurgitation absent. Sore throat and bad breath absent.
No evidence of acid reflux effects on teeth confirmed by dentist (although not a 100% diagnostic indicator of the absence of acid reflux).

The click swallow started after a gastroscopy (oesophagogastroduodenoscopy OGD) in Mar 2007. During the procedure, under normal sedation, I started to choke on the scope fully inserted. This was not the normal gagging reflex expected of some people having an OGD but rather a violent choking. Whilst on the table choking, I was knocked out completely with an additional, heavy dose of sedation.  I awoke later in the recovery ward.  It was not a case of amnesia of me “thinking” I had been knocked out because I couldn’t remember, - the additional mid procedure heavy dose of sedation was stated on the report.  I’ve had the click swallow ever since.  The purpose of the OGD was to look for the presence of a foreign object in my throat causing retching.  I had suspected a tooth brush bristle because my tooth brush had been loosing a few bristles and a couple had got caught in my mouth whilst cleaning teeth. I thought that an unnoticed bristle may have been partially swallowed and became lodged in the larynx or oesophagus as this retching came on suddenly overnight. No bristle was found though a colourless bristle is quite a small object to see.

Prior to the OGD, two months earlier, I had swallowed a small piece of soft cooked chicken.  Severe painful stomach spasm hiccups started which resulted in vomiting colourless fluids over a period of several hours.  I rested and recovered over the next 1-2 weeks.  10 days later, retching started suddenly and unexpectedly and took me by surprise. This lead to the OGD two months later after 2 months of intermittent retching where at times I was frantic with the sensation of something stuck and causing involuntary retching.

I have found a number of medical papers that indicate arytenoid dislocation and subluxation (AS) as rare laryngeal injuries usually thought to occur as complications of upper aerodigestive tract instrumentation.  One of the posters to this forum referred to corniculate subluxation. “Arytenoid dislocation refers to complete separation of the arytenoid cartilage from the joint space.  It usually results from severe laryngeal trauma. Arytenoid subluxation is likely a lesser injury and refers to partial displacement of the arytenoid within the joint.”  Patients with AS present with hoarseness; breathy vocal quality, vocal fatigue. But dysphagia, odynophagia, sore throat and cough are less common. (ref  Arytenoid Dislocation.  Joshua S Schindler, Yvette V Leslie, Jan 27, 2007. http://www.emedicine.medscape.com/article/866464). Unfortunately since I obtained this document, the link I provide doesn’t seem to work directly to the paper itself but takes you to the proper web site. Searching it from the web site given the authors and title resulted in a registration page.

see part 2
Avatar universal
Part 2 of 2.
Although I have been seen by an ENT earlier in the year, I am unsure whether such subluxations/dislocations can be seen with a visible ENT nasendoscope - (if that’s the cause of my click swallow?) – can anyone say? The paper referenced above indicates that a thorough laryngeal exam should be performed. Whether the ENT’s “less than 15 second view”, would be regarded as thorough I am unsure – perhaps someone could say to compare?  In my view, although disappointing because I myself put a lot of dedication and detail into my own work as a scientist, this particular ENT’s body language told me he wasn’t interested and he said he couldn’t do anything for the click, then sent me on my way to continue with the debilitating symptoms.  

I do have some hoarseness but it is intermittent, possibly related to coughing (and all my life I have never been a cougher except for during colds/flu and even then it was limited). But I am told by relatives and friends that my voice has changed to a more gravely sound, although this may be because on those occasions when they listen, the throat needs to be cleared frequently and the sound may be due to interference from fluids/secretions that need to be moved out of the way of the vocal chords?

The other paper which describes a cause of foreign body sensation in the throat is “ Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review”  SK Nadig, S Uppal, GW Back, AP Coatsworth, AR Grace. J. Laryngol Otol, 2006 July; 120 (7): 608-9. Epub 2006 May 9.  I only have the abstract of this paper, which is available free on the internet.
Search at http://www.ncbi.nlm.nih.gov/pubmed/12649827.  I intend to buy the paper.

There is another relevant paper, which I do not have except for the abstract:
Clicking in the throat: cinematic fiction or surgical fact?
Smith ME, Berke GS, Gray SD, Dove H, Harnsberger R.
Division of Otolaryngology-Head and Neck Surgery, National Center for Voice and Speech, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.   Arch Otolaryngol Head Neck Surg. 2001 Sep;127(9):1129-31.


I have also come across a paper which describes a physical cause of globus pharyngeus where the epiglottis tip is curled backward towards and touches the base of the back of the tongue causing the sensation of a foreign body.   Earlier this year, I first noticed my epiglottis sometimes becomes visible above the horizon made by the back of the tongue. This sometimes appears when clearing the throat but before swallowing. On swallowing, there is a click then the epiglottis disappears.  I don’t know if I am choking on my own epiglottis or if it is unrelated. I only started seeing the epiglottis two years after the problems began and I had been looking into my throat since Jan 2007 and had never noticed the epiglottis before.  Does anyone know if it is possible for an epiglottis to become stretched or dislodged from its normal “equilibrium” location as a result of a problem (such as dislocation) of the structures in the larynx that are eventually connected to the epiglottis?  I don’t know if the epiglottis can eventually start to appear due to arytenoid subluxation or corniculate cartilage subluxation?


For me, the two problems may be related or unrelated: Click swallow has been present all the time since the gastroscopy in early 2007.  
Sensation of something stuck in the lower throat/and or beginning of the oesophagus or trachea occurs intermittently, and can cause periods of debilitating retching and choking.

Some questions to ask readers or to provoke further discussion and sharing of knowledge:

1. Is it possible that the click swallow has been caused by the throat clamping down on the gastroscope during the difficult gastroscopy? or, the retching?
2. Can a gastroscopy which involves choking actually cause a hiatus hernia e.g. caused by pumping air into the stomach causing abrupt rises in stomach pressure due to choking and coughing during the procedure? I ask this question because I did not have a hiatus hernia at all 14 months before the gastroscopy so it had just occurred in that interim period or during that one bout of vomiting or during the gastroscopy?
3. Is it possible that for a patient taking PPI, that acid reflux can still occur but yet not cause any indigestion or heartburn or burning feelings, but that such acid could cause oesophageal spasm that could be the cause of click swallow? My personal feeling is that PPI should completely halt acid reflux and pH would be controlled such that if any tiny amount of acid leaked during the night, its pH would not be so aggressive to cause oesophageal spasm interfering with the swallowing contractions. I want to rule out acid reflux as a potential cause of click swallow. Personally, I believe my click swallow is a mechanical physical problem with one or more cartilages in the larynx.

I have found bronchial mixture to be of some temporary relief of throat sensations. However, this is probably due to the temporary local anaesthetic effect, which after it wears off, symptoms are still present.

I wish all those who have click swallow, good luck in finding remedies. I’d be interested to hear from you.

I have needed to put this post into two parts, but thought that the references provided would be of use.



652360 tn?1264492519
I find your medical information very interesting as I recently underwent surgery at UCLA for a clicking noise in my throat. In my case the clicking in the throat was occuring every time I turned my head and was from the elongation of the superior cornu of the thyroid cartilage. The very article you intend to read: Clicking in the throat: cinematic fiction or surgical fact?
Smith ME, Berke GS, Gray SD, Dove H, Harnsberger R.
Division of Otolaryngology-Head and Neck Surgery, National Center for Voice and Speech, University of Utah School of Medicine, Salt Lake City, UT 84132, USA.   Arch Otolaryngol Head Neck Surg. 2001 Sep;127(9):1129-31.

Well, believe it or not my surgeon was one of the authors in this article who is familiar with the clicking throat condition. In my case they were able to get rid of the clicking of the thryoid cartilage against the tranverse process every time I turned my head, unfortunately I also have a clicking greater cornua of the hyoid bone that must be operated on now. I find your case interesting though because it reminds me a lot of the sufferers in the "clicking throat article" who had their symptoms come on from surgical intubation. It sounds like you very well may have injured part of your thyroid cartilage which is clicking against a nearby structure either the hyoid bone or tranverse process. There are other things that could cause a click it really depends on the region you are feeling it but from what I have read in the medical literature it seems that clicks from swallowing are most common due to thyroid cartilage abnormalities rubbing against the hyoid bone or tranverse process. The way you describe the onset of yours reminds me of the elongated superior cornua thyroid cartilage sufferers mentioned in the "clicking throat study". If you provide me an email address (message me) and I will be glad to email you the article I have it saved on my computer.
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