The feeling that someone is choking you, or having a persistent obstruction in your throat, is medically known as globus sensation, or globus pharyngeus. This is the sensation of a lump, fullness, or tightness in the throat when no physical mass is present upon examination. It is a sensory perception rather than a true physical blockage of the airway. The symptom is common, with studies suggesting that between 22% and 45% of people experience it at least once. Understanding the underlying causes, which range from physical irritation to neuromuscular and psychological responses, helps in managing the distressing nature of the sensation.
Common Causes Related to Reflux and Irritation
One of the most frequent causes of the choking sensation is the backflow of stomach contents, commonly associated with Gastroesophageal Reflux Disease (GERD). When stomach acid travels up the esophagus, it irritates the delicate lining of the throat and voice box, a condition often called Laryngopharyngeal Reflux (LPR) or “silent reflux.” Even non-acidic contents, such as enzymes, contribute to this irritation and inflammation.
The resulting inflammation and swelling of the tissues lead to heightened sensitivity. Reflux can also trigger a vagovagal reflex, causing the muscles of the throat, particularly the Upper Esophageal Sphincter (UES), to tighten excessively. This sustained muscle contraction is interpreted as a choking or constricting sensation.
Muscular Tension and Esophageal Spasms
The feeling of a lump in the throat can also be caused by localized muscle hyper-contraction, known as a cricopharyngeal spasm. The cricopharyngeus muscle acts as the Upper Esophageal Sphincter, remaining closed except during swallowing. In this condition, the muscle is overly contracted (hypertonic), creating persistent pressure felt as tightness in the throat. This hyper-contraction is often exacerbated by underlying stress or anxiety.
The spasm is usually worse when swallowing saliva, but paradoxically, eating or drinking often provides temporary relief as the muscle is forced to relax. A related cause is a diffuse esophageal spasm, which involves uncoordinated and painful contractions along the esophagus. These intense, involuntary contractions can create chest pain and a tightening sensation that may be misidentified as a choking episode.
The Connection to Anxiety and Panic Attacks
The sensation of throat constriction is a common physical manifestation of acute psychological distress, particularly during anxiety or a panic attack. This is rooted in the body’s “fight-or-flight” response, a survival mechanism activated when a threat is perceived. Upon activation, the nervous system releases stress hormones, such as adrenaline and cortisol, preparing the body for immediate action. This surge causes muscles across the body to tense up, including those in the neck and throat, creating the distinct feeling of the throat closing or being squeezed.
Additionally, people experiencing panic often hyperventilate, leading to changes in blood gas levels that further contribute to muscle spasms and throat tightness. The heightened state of arousal also makes a person acutely aware of normal bodily functions, such as swallowing. This hyper-awareness can lead to a cycle where the physical sensation triggers more anxiety, which intensifies the muscle tension and the choking feeling. Up to 96% of people with globus sensation report that their symptoms worsen when they are under stress.
When to Seek Immediate Medical Attention
While globus sensation is usually harmless, “red flag” symptoms suggest a more serious underlying condition requiring prompt medical evaluation. A true difficulty or inability to swallow solid food or liquids, known as dysphagia, is a significant warning sign requiring immediate attention. Unlike globus, which does not interfere with eating, dysphagia indicates a physical or functional obstruction in the swallowing mechanism.
Other concerning symptoms include pain when swallowing, medically termed odynophagia, which may suggest inflammation or irritation of the esophageal lining. Unexplained weight loss, a persistent hoarse or wet-sounding voice after eating, or coughing and choking during meals are also serious indicators. If you experience any of these symptoms, a primary care physician or an Ear, Nose, and Throat (ENT) specialist should be consulted to rule out structural issues or motor disorders.