Causes of Tightness of Throat and Treatment Options

Tightness in the throat is distinctly different from other types of throat pain, such as a sore throat related to the common cold. When your throat feels tight, you often feel that the passageway of the throat is narrowed.

You might describe it as feeling a lump in your throat, and you may have difficulty swallowing or breathing. That’s because the anatomy of the throat includes both the esophagus (the tube that carries food from the back of the throat to the stomach) and the trachea (the tube that carries oxygen from the nasal passageways to the lungs).

Other anatomical structures that can contribute to throat tightness include the muscles, connective tissue, and thyroid gland (goiters or growths on the thyroid may cause throat tightness).

The causes of throat tightness range in severity from a life-threatening allergic reaction to a panic attack or acid reflux, which may feel awful but are common and not medically emergent.

Man experiences throat tightness

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Common causes of throat tightness are listed in order of most to least common.

GERD or Acid Reflux

Gastroesophageal reflux disease (GERD) is extremely common throughout the world, and the incidence is escalating in the United States. Since 2010, it has particularly increased among individuals 30–39 years of age. The prevalence is approximately 18.1% to 27.8% in North America.

GERD causes stomach acid to reflux into the esophagus, sometimes even reaching the back of the throat. Stomach acid is very damaging to the tissue of the esophagus and throat. This creates symptoms such as heartburn, sore throat, coughing, hoarseness, and in some cases, throat tightness.

A narrowing of the esophagus can occur when the tissue is damaged and scar tissue is formed. This can make it difficult to swallow, create a feeling of tightness in the throat, or make it feel like you constantly have a lump in your throat. Food may also become lodged in the esophagus.


An estimated 40 million adults in the United States live with an anxiety disorder, and six million of those have been diagnosed with panic disorder.

Anxiety disorders can result in what is called anxiety or panic attacks. During these episodes, you may feel an overwhelming sense of anxiety and fear, which causes your heart to pound and you to over-breathe (hyperventilate).

The rapid, shallow breathing that occurs during these episodes can dry out your throat; make you feel dizzy, lightheaded, or like you can’t get enough air; or create a sensation of tightness in the throat. You may get sweaty, have chills, tremble, or even feel as if you are dying. Although it feels like a medical emergency, it actually isn’t.


Tonsillitis refers to any inflammation of the tonsils (usually the palatine tonsils) and is an extremely common condition, although the exact incidence is unknown.

Many people aren’t aware that the second set of tonsils, called the lingual tonsils, is located in the throat below the palatine tonsils. While less common, the lingual tonsils can also become swollen and inflamed.

Some consider the adenoids to be the third set of tonsils, but they are located above the other two sets of tonsils and are unlikely to be the culprit of throat tightness.

Tonsillitis can be acute or chronic and has a myriad of underlying causes, including bacterial infections such as strep throat, viral infections such as mononucleosis, and allergies.

Symptoms of tonsillitis include sore throat, red throat, and difficulty swallowing. In rare cases, when the tonsils become very large, you may feel throat tightness or even have difficulty breathing.

Muscle Tension Dysphonia (MTD)

Muscle tension dysphonia (MTD) is a condition where the muscles surrounding the larynx (the voice box) become so tight that they fail to function properly. Symptoms of MTD include hoarseness, voice straining, a sore and tender neck, feeling like there’s a lump in your throat, and feeling like you need to clear your throat a lot.

Muscle tension dysphonia may be more prevalent than researchers think since there is evidence it is common in people who have severe asthma.


A goiter is a benign (non-cancerous) enlargement of the thyroid gland. It is more common outside of the United States, in areas where there are iodine-deficient soils and table salt is not enriched with iodine, but it occurs in the United States also.

If the thyroid becomes too large, it can compress the trachea and/or esophagus and create problems with breathing and swallowing, as well as throat tightness.

Allergic Reaction

Anaphylaxis is a life-threatening allergic reaction that can cause a dangerous swelling in your throat, closing off your airway and preventing you from swallowing and breathing properly.

It usually occurs as a result of allergies to insect bites and stings, certain foods and medications, or latex. While allergies to these substances are very common, anaphylaxis (thankfully) is less so.

Anaphylaxis is a medical emergency. You should get help and use epinephrine (if you carry it) as soon as signs and symptoms appear. These include severe itching, redness, swelling of the tongue or difficulty talking, swelling of the lips, tightness in the throat or chest, or difficulty breathing or swallowing.

When to See a Healthcare Provider

Throat tightness that does not impair your ability to breathe or swallow is not a medical emergency, although you should see a healthcare professional and have it checked out. For example, in rare cases, untreated strep throat can lead to kidney and heart problems.

Anytime you have unexplained, persistent throat tightness, you should consult a healthcare professional for proper diagnosis and treatment. If you are unsure, go ahead and give a professional a call. Often, a nurse or medical assistant can discuss your symptoms with you over the phone and give you a better idea of what steps you need to take.

With the exception of an identified panic or anxiety attack (more on this under the treatment section), any throat tightness that impairs your ability to breathe or swallow is a medical emergency, and you should call 911 or go to your nearest emergency room.

If you carry epinephrine and go into anaphylaxis, you should still call 911 or go to the emergency room even after giving yourself epinephrine, as further treatment is usually necessary. It is possible to go back into anaphylaxis even hours after your initial symptoms have subsided.


Your journey to a proper medical diagnosis will be individualized according to your symptoms and circumstances. A physical examination and one or more of the following tests may be used to diagnose the disorders that can cause tightness in the throat:

Some conditions, including anxiety disorders and MTD, do not have specific or definitive diagnostic tests but are diagnosed by carefully considering your symptoms, medical history, and then ruling out other similar conditions that could be causing your symptoms.


The treatment will depend on the cause of your throat tightness.

GERD or Acid Reflux

While antacids such as Tums (calcium carbonate) may be adequate for treating occasional heartburn, they probably won’t cut it if your symptoms are severe enough that you’re experiencing tightness in the throat.

Medications such as H2 blockers (famotidine, cimetidine) or proton-pump inhibitors (omeprazole, pantoprazole) are better at reducing acid and facilitating the healing of damaged esophageal tissue. Even though many of these medications are available over-the-counter, it is recommended that you consult a healthcare provider before taking them.

Severe cases of GERD may warrant treatment with surgery. The esophagus can be dilated via endoscopy to improve swallowing, or other procedures such as fundoplication may be needed.


Treatment for anxiety disorders may include talking to a therapist, joining a support group, cognitive behavioral therapy (CBT), and medications including anti-anxiety medications, antidepressants, or even beta blockers. Adequate treatment can help to reduce the frequency of panic attacks.

If you know you are having a panic attack, you should sit down so that you don’t pass out and injure yourself. Try to make yourself comfortable in an area where you will be safe and not hit your head if you faint.

A quiet area that you find calming is helpful, but it is also not a bad idea to have another person with you in the rare event that you do need medical attention.

Focus on taking slow deep breaths. If you cannot slow your breathing down, you can try breathing through pursed lips or into a paper bag to treat hyperventilation.

Don’t breathe into a paper bag if it increases your anxiety, however. You may feel that you are unable to breathe or that you are having a heart attack, but this is not actually the case. Most panic attacks last between 5 and 20 minutes.

If you or a loved one is struggling with panic attacks, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.


While the treatment for tonsillitis may vary depending on the cause (antibiotics for strep throat, for example), the actual swelling in the tonsils can be treated with steroid medications in some cases. For chronic tonsillitis, a complete tonsillectomy may be necessary.

Muscle Tension Dysphonia

Voice therapy is the most common treatment for MTD. In some cases, botox injections are used to stop muscle spasms.


The treatment for thyroid goiter varies depending on the root cause. For example, if the cause is iodine deficiency, then iodine supplements may help. In other cases, you may need thyroid hormone supplements. When the goiter cannot be reduced with medications, surgery may be necessary.

Allergic Reaction

The most important treatment for a serious allergic reaction is epinephrine. If you don’t carry epinephrine with you, you must call 911 or get to a hospital right away to get this crucial medication.

In addition to epinephrine, you may also be treated with oxygen, IV fluids, antihistamines, and steroid medications, but these are all secondary to the prompt administration of epinephrine. Never delay emergency medical care if you suspect you are having a severe allergic reaction.

If you are at risk of a severe allergic reaction, keep your epinephrine auto-injector (EpiPen) handy at all times.

Home Remedies

There are a few simple things you can do at home to help relieve throat tightness. If you have acid reflux, for example, taking an over-the-counter antacid may provide some immediate relief.

You should also keep your head elevated rather than lying down flat to sleep at night so that stomach acid is less likely to travel up the esophagus. Pay attention to what foods trigger your symptoms so you can avoid them in the future.

Swollen tonsils can respond to cold food and fluids, or you can put an ice pack on your neck. It may also be helpful to sleep with a cool mist humidifier next to your bed at night.


Not all causes of throat tightness are easily prevented, but there are things you can do to lower your risk. Use the following tips to prevent throat tightness:

  • If you have been diagnosed with one of the conditions above known to cause throat tightness, make sure you work with a qualified healthcare professional to develop a good treatment regimen and then stick to it.
  • If you have allergies and risk anaphylaxis, talk to your healthcare provider about carrying epinephrine.
  • Wash your hands and stay away from people who are sick to prevent throat infections. Get plenty of sleep and exercise to bolster your immune response.
  • Pay attention to potential triggers such as allergies or foods that bring on your symptoms so that you can avoid them.
  • If you have anxiety, note potential triggers as well as things that alleviate your symptoms. Practice deep breathing techniques. Consider support groups.
  • If you have acid reflux, avoid lying down flat and instead keep your head elevated. Avoid overeating and instead opt for smaller, more frequent meals.
  • Protect your voice by not overusing or straining it.

Frequently Asked Questions

  • What causes a throat muscle spasm?

    Throat muscle spasms can be caused by muscle tension dysphonia (MTD), a condition that occurs when muscles around the larynx tighten too much.

    Otherwise, throat spasms might be a cricopharyngeal spasm, which is when a muscle in the throat contracts too much and causes a tightening or choking sensation.

  • Why does my throat feel strained when talking?

    Muscle tension dysphonia (MTD) can cause strained throat or voice straining. Other symptoms include hoarseness, a sore and tender neck, the sensation of a lump in the throat, and feeling the need to clear the throat often.

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