Globus pharyngeus is the subjective feeling of a lump in the throat which can have a variety of causes. In modern practice globus is often evaluated by flexible nasoendoscopy in the first instance since many patients present to otolaryngology services. If no cause is identified or if nasoendoscopy cannot be tolerated patients are frequently referred for fluoroscopic swallowing studies.
Often referred to as simply globus, it is sometimes misleadingly dubbed globus hystericus, which historically refers to a subjective sensation of a lump in the throat that is traditionally ascribed to anxiety. This is slightly outdated as previously cases of globus with no identifiable cause were ascribed to "hysteria". Current approaches focus on treating underlying causes where possible and developing strategies to manage the condition.
It is difficult to ascertain the prevalence of this symptoms but in one study up to 45% of people reported a sensation of globus at least once. It is thought to constitute up to 4% of otolaryngology clinic visits 1. It has an equal prevalence among men and women.
The pathogenesis of globus is not understood. Authors have suggested visceral hypersensitivity, enlarged tonsils, gastro-oesophageal reflux, upper oesophageal sphincter disease, and mental health conditions as being implicated. While isolated cases of malignancy have been reported in associated with globus there is no consensus established in the literature to suggest globus is sensitive or specific for an underlying malignancy. There is evidence to suggest that when there is an associated malignancy there are often accompanying red flag signs of neoplastic disease 2.
Fluoroscopy forms the mainstay for imaging patients with dysphagia. This is usually in the form of barium swallow, which can be extended to include assessment of the stomach and duodenum. A water soluble contrast agent can be used in the place of barium if there is a risk of, or suspected aspiration.
- filling defect or mucosal irregularity may be seen in the the pharynx or upper oesophagus if there is a neoplasm, though this is very rare
- evidence of gastro-oesophageal reflux may be noted
- pharyngeal pouch may be demonstrated
- 1. Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Can Med Assoc J. 1982;126 (1): 46-8. Free text at pubmed - Pubmed citation
- 2. Cashman EC, Donnelly MJ. The natural history of globus pharyngeus. Int J Otolaryngol. 2010;2010: 159630. doi:10.1155/2010/159630 - Free text at pubmed - Pubmed citation
- 3. Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World J. Gastroenterol. 2012;18 (20): 2462-71. doi:10.3748/wjg.v18.i20.2462 - Free text at pubmed - Pubmed citation