A year ago I experienced severe throat pain. It felt as if something was caught in my throat. I had difficulty swallowing. At irregular intervals a small chunk of what looked like undigested food would come up. I went to an ENT, who eventually discovered that excessive scar tissue around my tonsils was trapping food and mucus. When I asked him what I could do about the bad breath and choking, he said that the only cure he knew was to take out my tonsils, but he said he wouldn't recommend it because this wasn't a life-or-death situation. Can you offer any opinions or suggestions?

D.M.

Assuming your ENT (ear, nose and throat specialist) was correct -- and this is a pretty big assumption -- tonsillectomy (removal of your tonsils) should not be dismissed so quickly. The key question is, how much is this problem bothering you? Did it happen only once, one year ago, or has it happened repeatedly since then? If this is a recurrent problem, and if you are in reasonably good health, tonsillectomy might be a very good option.
I am very doubtful of your ENT's diagnosis, however. Of course, he has the advantage of having examined you, but there's just something phony about his explanation. I have never seen "scar tissue around tonsils," let alone scar tissue capable of trapping food.

No, I think a more likely explanation for what you experienced is something known as esophageal spasm. To understand spasm, you need to understand a bit about how the esophagus works. Food does not descend into your stomach by gravity. (In fact, with a little practice, you can swallow while standing on your head -- a great party trick!) Rhythmic muscular contractions propel a wad of chewed food (bolus is the medical term for this lump) down the esophagus into the stomach. If the muscles of the esophagus cramp, or spasm, the bolus becomes lodged in place. This is very painful. Often, the bolus of food cannot be washed down with water, and it must be vomited back up. Occasionally, it must be surgically removed.

There are many other possible explanations for what happened to you. For example, a Zenker's diverticulum is an outpouching from the esophagus that can trap food. The outpouching is thought to arise from a weakness in the muscle of the wall of the esophagus. People with this problem may spit out bits of undigested food even hours after a meal. This is not typically painful. More worrisome still, tumors of the esophagus can cause a variety of swallowing problems, as can tumors in other structures close enough to the esophagus to press on it.

Your next step should be to discuss this problem with your internist. He or she will need to perform a thorough history and physical exam and will probably also order an X-ray swallowing study (such as a barium swallow). Most swallowing problems are very treatable, so I would not delay in pursuing further care.