What causes the feeling of a “lump in the throat”?

DEAR DOCTOR K: I often get the feeling that there’s a lump in my throat. Sometimes in the morning I’ll cough up mucus, but it doesn’t make the feeling go away. What can I do to get rid of this feeling?

DEAR READER: Some use the expression “a lump in my throat” to describe experiencing a strong emotion such as grief or gratitude. But, as you’ve discovered, this feeling can be an annoying and recurrent problem that has nothing to do with how you’re feeling at the moment.

Your problem is one of those minor maladies that we know only a little about, because medical research tends to focus on major diseases rather than the symptoms that constantly bug us, like this one.

Because you say you sometimes cough up mucus, I’d say the most likely explanation is that you have allergies that are causing the extra mucus. While you sleep, that mucus collects in the back of your throat. That’s why you tend to spit it up in the mornings. The treatment is allergy pills and inhalers.

Another common cause is acid reflux from your stomach into your throat. This can irritate your throat and create the feeling of a lump. A bitter taste in your mouth can be a clue that you may have reflux.

An allergy to a medication can cause irritation and swelling in the throat. Switching to another medicine can help. A food allergy is another possibility. I had a patient who got a lump in her throat and swollen lips any time she ate a mango.

Finally, there is an unusual condition in which a pouch forms in the wall of the back of the throat, where food can collect. This condition is easily diagnosed and treated, usually by an ear, nose and throat specialist.

If a patient came to me with a complaint like yours, my red-flag question would be whether this feeling is accompanied by difficulty swallowing. And if so, has this gotten progressively worse? One possible cause of feeling like there’s a lump in your throat is actually having a lump in your throat. So if trouble swallowing is one of your symptoms, and especially if it’s getting worse, see your doctor to make sure you don’t have a growth in your throat.

Doctors check for this rare possibility by using a laryngoscope, a flexible tube with a light and mirror at the end of it. You are given a local anesthetic, and then the scope is passed into the back of the throat. The doctor can see the part of your throat that’s otherwise out of sight, in your neck. That’s the part from the back of your mouth down where your Adam’s apple is. It’s a very simple test, and it almost always confirms that the “lump in the throat” is not caused by an actual harmful lump.