Globus pharyngis

Globus pharyngis or globus sensation is the persistent but painless sensation of having a pill, food bolus, or some other sort of obstruction in the throat when there is none. Swallowing is typically performed normally, so it is not a true case of dysphagia, but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.[1][2]

Globus pharyngis
Other namesGlobus pharyngeus, globus sensation, globus, globus hystericus, lump in one's throat
SpecialtyENT surgery

Causes

The "lump in the throat" sensation that characterizes globus pharyngis is often caused by inflammation of one or more parts of the throat, such as the larynx or hypopharynx, due to cricopharyngeal spasm, gastroesophageal reflux (GERD), laryngopharyngeal reflux or esophageal versatility.[3] In some cases the cause is unknown and symptoms may be attributed to a psychogenic cause i.e. a somatoform or anxiety disorder. It has been recognised as a symptom of depression, which responds to anti-depressive treatment.[4][5]

The results of recent studies have strongly suggested that GERD is a major cause of globus, though this remains under considerable debate.[6]

A less common cause, distinguished by a "lump in the throat" accompanied with clicking sensation and considerable pain when swallowing, may be due to thyroid-cartilage rubbing against anomalous asymmetrical laryngeal anatomy e.g. the superior cornu abrading against the thyroid lamina,[7][8] surgically trimming the offending thyroid-cartilage provides immediate relief in all cases.[3] However this cause is frequently misdiagnosed, despite requiring a simple clinical examination involving careful palpation of the neck side to side which elicits the same click sensation (laryngeal crepitus) and pain as when swallowing, most cases are due to prior trauma to the neck.[3] High resolution computed tomographic (CT) or MRI scan of the larynx is usually required to fully understand the anomalous laryngeal anatomy. Anterior displacement of the thyroid ala on the affected side while swallowing can help resolve symptoms.

Diagnosis

As globus sensation is a symptom, a diagnosis of globus pharyngis is typically a diagnosis of exclusion. If globus sensation is presenting with other symptoms such as pain, swallowing disorders such as aspiration or regurgitation (dysphagia), weight loss, or voice change,[9] an organic cause needs to be investigated, typically with endoscopy. Barium swallows are not recommended as a diagnostic tool as although they are less invasive than endoscopy and may be reassuring to the patient, they commonly miss sinister causes. It is very rare that globus sensation presenting with no other symptoms has a sinister cause and therefore endoscopy is not recommended in this case.[9][10]

Differential diagnosis

Differential diagnosis must be made from Eagle syndrome which uses the patient's description of "something caught in my throat" as a diagnostic tool. Eagle syndrome is an elongation of the styloid process causing irritation to nerves and muscles in the region resulting in a number of unusual symptoms.

Management

Reassurance of the patient is recommendable when no cause can be found. If a cause is identified, treat the cause symptomatically or, if possible, systemically.

References
  1. Robson KM, Lembo AJ. "Globus Sensation". UpToDate. Retrieved 2019-08-31.
  2. Jones D, Prowse S (October 2015). "Globus pharyngeus: an update for general practice". The British Journal of General Practice. 65 (639): 554–55. doi:10.3399/bjgp15X687193. PMC 4582871. PMID 26412835.
  3. Smith ME, Berke GS, Gray SD, Dove H, Harnsberger R (September 2001). "Clicking in the throat: cinematic fiction or surgical fact?". Archives of Otolaryngology–Head & Neck Surgery. 127 (9): 1129–31. doi:10.1001/archotol.127.9.1129. PMID 11556866.
  4. Cybulska EM (1997). "Globus hystericus – a somatic symptom of depression? The role of electroconvulsive therapy and antidepressants". Psychosomatic Medicine. 59 (1): 67–69. doi:10.1097/00006842-199701000-00009. PMID 9021868. S2CID 24181148.
  5. Cybulska EM (August 1998). "Globus hystericus or depressivus?". Hospital Medicine. 59 (8): 640–41. PMID 9829059.
  6. Lee BE, Kim GH (May 2012). "Globus pharyngeus: a review of its etiology, diagnosis and treatment". World Journal of Gastroenterology. 18 (20): 2462–71. doi:10.3748/wjg.v18.i20.2462. PMC 3360444. PMID 22654443.
  7. Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace AR (July 2006). "Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review". The Journal of Laryngology and Otology. 120 (7): 608–09. doi:10.1017/S0022215106001125. PMID 16681864. S2CID 20575227.
  8. Lin D, Fischbein N, Eisele DW (2005). "Odynophagia secondary to variant thyroid cartilage anatomy". Dysphagia. 20 (3): 232–34. doi:10.1007/s00455-005-0012-2. PMID 16362512. S2CID 8595093.
  9. Kortequee S, Karkos PD, Atkinson H, Sethi N, Sylvester DC, Harar RS, et al. (2013). "Management of globus pharyngeus". International Journal of Otolaryngology. 2013: 946780. doi:10.1155/2013/946780. PMC 3725834. PMID 23935629.
  10. Manabe N, Tsutsui H, Kusunoki H, Hata J, Haruma K (2014). "Pathophysiology and treatment of patients with globus sensation – from the viewpoint of esophageal motility dysfunction". Journal of Smooth Muscle Research = Nihon Heikatsukin Gakkai Kikanshi. 50: 66–77. doi:10.1540/jsmr.50.66. PMC 5137314. PMID 26081369.
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