Globus sensation is a subjective feeling of a lump or foreign body in the throat. It is sometimes called globus pharyngeus. The term globus hystericus was previously used because of the belief that psychogenic factors were involved and that globus sensation was just a type of somatisation disorder presenting with pseudoneurological symptoms. However, it is now widely considered that globus sensation can have underlying physiological or anatomical causes.
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Globus sensation is thought to be a common symptom. It accounts for around 5% of new referrals to ear, nose and throat (ENT) outpatient clinics. Old surveys suggest that up to 46% of apparently healthy people complain of the symptom. There is no difference in prevalence between the sexes. However, it is thought that women, more frequently than men, visit a doctor because of the symptom.
A multifactorial aetiology is likely. Suggested causes include:
- Gastro-oesophageal reflux disease. Reflux of gastric contents may lead to irritation and inflammation of the laryngopharynx, or increased tone in the upper oesophageal sphincter may be triggered by either distention, or acid, in the distal oesophagus.
- Raised upper oesophageal sphincter pressure.
- Oesophageal motor disorders.
- Conditions causing irritation or inflammation of the pharynx - for example, pharyngitis, tonsillitis, and postnasal drip secondary to chronic sinusitis. It is thought that such problems lead to increased sensitivity of the pharynx.
- Hypertrophy of the base of the tongue.
- A retroverted epiglottis.
- Psychological factors. Some studies have shown that stress may exacerbate symptoms of globus. However, others have not supported psychological factors as a cause.
The symptom of a lump in the throat tends to come and go. It is usually felt in the front of the neck and can move up and down. It does not affect eating and drinking and in fact, symptoms may be alleviated by this. There is no pain. Symptoms are often noticed when swallowing saliva.
The differential diagnoses are the causes of true dysphagia. See separate article Dysphagia for further details.
- Careful history taking is important to try to differentiate between a globus sensation symptom and true dysphagia. Be alert to red flag symptoms including weight loss, dysphagia, throat pain and hoarseness.
- Physical examination of the neck and outpatient nasolaryngoscopy in an ENT clinic may be all the investigation that is needed if there are typical symptoms of globus sensation with no red flag symptoms or signs.
- Other investigations may be carried out if diagnosis is uncertain, including:
There are no agreed standards for the management of globus sensation.
- Empirical therapy with a proton pump inhibitor may be started if there is suspicion of gastro-oesophageal reflux disease and if history taking, neck examination and nasolaryngoscopy have not revealed any red flag symptoms or abnormal findings. If symptoms persist then further investigation may be needed (as under 'Investigations', above).
- Referral to a speech and language therapist may be helpful. They can suggest neck, shoulder and voice exercises as well as relaxation techniques that may help to relieve symptoms.
- Cognitive behavioural therapy and antidepressants may be helpful for some people with concomitant psychiatric disorders.
Not many long-term follow-up studies have been carried out. One small study following 74 patients found that 45% still had persistent symptoms after around seven years. Another small study showed that symptoms had improved in 60% of patients after five years, with the best outcome being in male patients who had globus sensation symptoms for less than three months with no other associated throat symptoms.
Further reading & references
- Drossman DA, Li Z, Andruzzi E, et al; U.S. householder survey of functional gastrointestinal disorders. Prevalence, Dig Dis Sci. 1993 Sep;38(9):1569-80.
- Batch AJ; Globus pharyngeus (Part I). J Laryngol Otol. 1988 Feb;102(2):152-8.
- Krem MM; Motor conversion disorders reviewed from a neuropsychiatric perspective. J Clin Psychiatry. 2004 Jun;65(6):783-90.
- Lee BE, Kim GH; Globus pharyngeus: A review of its etiology, diagnosis and treatment. World J Gastroenterol. 2012 May 28;18(20):2462-71.
- Owen W; ABC of the upper gastrointestinal tract. Dysphagia. BMJ. 2001 Oct 13;323(7317):850-3.
- Cashman EC, Donnelly MJ; The natural history of globus pharyngeus. Int J Otolaryngol. 2010;2010:159630. Epub 2010 Dec 27.
- Moloy PJ, Charter R; The globus symptom. Incidence, therapeutic response, and age and sex Arch Otolaryngol. 1982 Nov;108(11):740-4.
- Koufman JA; The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a Laryngoscope. 1991 Apr;101(4 Pt 2 Suppl 53):1-78.
- Tokashiki R, Funato N, Suzuki M; Globus sensation and increased upper esophageal sphincter pressure with distal Eur Arch Otorhinolaryngol. 2010 May;267(5):737-41. Epub 2009 Nov 1.
- Harris MB, Deary IJ, Wilson JA; Life events and difficulties in relation to the onset of globus pharyngis. J Psychosom Res. 1996 Jun;40(6):603-15.
- Harar RP, Kumar S, Saeed MA, et al; Management of globus pharyngeus: review of 699 cases. J Laryngol Otol. 2004 Jul;118(7):522-7.
- Rowley H, O'Dwyer TP, Jones AS, et al; The natural history of globus pharyngeus. Laryngoscope. 1995 Oct;105(10):1118-21.
- Timon C, O'Dwyer T, Cagney D, et al; Globus pharyngeus: long-term follow-up and prognostic factors. Ann Otol Rhinol Laryngol. 1991 May;100(5 Pt 1):351-4.
|Original Author: Dr Laurence Knott||Current Version: Dr Michelle Wright||Peer Reviewer: Dr John Cox|
|Last Checked: 15/08/2012||Document ID: 1610 Version: 22||© EMIS|
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