Globus Pharyngis

Globus pharyngis, also known as globus sensation, globus hystericus, or simply globus, is a persistent but painless sensation of having an obstruction in the throat, such as a pill or food bolus, when there is none. Though swallowing is typically normal, this sensation can be quite irritating. It is a common condition, affecting 22–45% of people at least once in their lifetime. As a symptom, globus pharyngis falls under the specialty of ENT surgery.

Causes

The "lump in the throat" sensation that characterises globus pharyngis can be attributed to various causes. Inflammation of parts of the throat, such as the larynx or hypopharynx, due to cricopharyngeal spasm, gastroesophageal reflux (GERD), laryngopharyngeal reflux, or esophageal versatility is a common cause. Psychological factors, such as anxiety or somatoform disorders, may also play a role, and globus sensation has been recognised as a symptom of depression that responds to anti-depressive treatment.

Recent studies suggest that GERD is a major cause of globus, although this is still debated. A less common cause involves a "lump in the throat" accompanied by a clicking sensation and considerable pain when swallowing. This can be due to thyroid-cartilage rubbing against anomalous laryngeal anatomy, such as the superior cornu abrading against the thyroid lamina. This condition is often misdiagnosed despite being identifiable through a clinical examination involving palpation of the neck. Trauma to the neck, thyroid nodules, or parathyroid adenomas can also cause globus sensation.

Diagnosis

As globus sensation is a symptom, a diagnosis of globus pharyngis is typically one of exclusion. If the sensation is accompanied by other symptoms such as pain, swallowing disorders, weight loss, or voice change, an organic cause must be investigated, typically through endoscopy. Barium swallows are not recommended as they often miss sinister causes despite being less invasive and potentially reassuring to the patient. It is very rare for globus sensation presenting without other symptoms to have a sinister cause, thus endoscopy is not typically recommended in such cases.

Differential Diagnosis

Differential diagnosis should consider Eagle syndrome, which involves an elongation of the styloid process causing irritation to nerves and muscles in the region. This condition can result in unusual symptoms and is diagnosed based on the patient's description of "something caught in my throat."

Management

When no specific cause can be identified, reassuring the patient is advisable. If a cause is identified, treatment should be symptomatic or systemic as appropriate.

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Self-assessment MCQs (single best answer)

What is another name for Globus Pharyngis?

Which percentage range of people experience Globus Pharyngis at least once in their lifetime?

Which of the following is NOT a common cause of Globus Pharyngis?

Which medical specialty primarily deals with Globus Pharyngis?

Which diagnostic tool is typically NOT recommended for Globus Pharyngis due to missing sinister causes?

Which condition should be considered in the differential diagnosis of Globus Pharyngis?

What recent study finding is debated as a major cause of Globus Pharyngis?

What should be the approach if no specific cause is identified for Globus Pharyngis?

Which symptom alongside Globus Pharyngis warrants investigation for an organic cause?

Which anatomical abnormality might cause a "clicking sensation" and considerable pain when swallowing in the context of Globus Pharyngis?