Hi all, I am a doctor (Internal Medicine, not an ENT), not affiliated in any way with Mayo. Sharing my experience because I too have been dealing with similar symptoms for almost 10 years now. I've had these same sort of dark yellow - light brown crusts, concave shape often with a "tail" of moister mucous (see photos), that seem to form on a regular basis, perhaps more often in drier environments, that feel like they are coming from midline pharynx (back of nose, upper throat). When they do fall off, I notice an unpleasant almost "yeasty" odor. Saline sprays and nasal irrigation help when it's close to falling off but is stubbornly stuck. From what I've recently read, this seems like a pretty close match for crusting-type nasopharyngeal bursitis. I think one of the strongest indicators is that it always seems to come from the same spot which is exactly midline - this makes sense for embryological reasons, as this pocket called the nasopharyngeal bursa (which in some of us seems to openly drain into our throats) is a remnant of the notochord. The notochord is a long thin tube that develops when embryos are only 3 weeks old, and forms straight down the middle of an embryo to help mark the place where our spines and spinal cords should eventually form. I've found some literature suggesting this condition is hard to diagnose since a) the area is a little too small to be seen well on CT scan, sometimes can be seen on MRI, and 2) if a crust isn't actively present the day you have your nasal endoscopy, it's probably quite hard for ENT to visually detect the opening. Anyway, it seems like the experience of folks on this forum has generally been that many ENT specialists are either unaware of this condition (which is unfortunate, as crusting-type pharyngeal bursae were first described way back in 1939), or offering procedures which may be at best unnecessary, or at worst, unhelpful. Multiple scholarly articles suggest that relatively minor procedures like electrocautery could be successful in dealing with this. Has anyone been offered or undergone this approach? This article suggests that these may sometimes heal on their own, but it sounds like thats the exception rather than the rule (good photo of a 'crust' as seen by nasal endoscopy, search for DOI: 10.1177/0145561320980189). Best to all.

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