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 In vertebrate anatomy, the throat is the front part of the neck, internally positioned in front of the vertebrae. It contains the pharynx and larynx. An important section of it is the epiglottis, separating the esophagus from the trachea (windpip ...

when there is none. Swallowing is typically performed normally, so it is not a true case of

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liq ...

, but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.

Causes

The "lump in the throat" sensation that characterizes globus pharyngis is often caused by

inflammation Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...

of one or more parts of the throat, such as the

larynx The larynx (), commonly called the voice box, is an organ in the top of the neck involved in breathing, producing sound and protecting the trachea against food aspiration. The opening of larynx into pharynx known as the laryngeal inlet is about ...

hypopharynx The pharynx (plural: pharynges) is the part of the throat behind the mouth and nasal cavity, and above the oesophagus and trachea (the tubes going down to the stomach and the lungs). It is found in vertebrates and invertebrates, though its struct ...

, due to

cricopharyngeal spasm Cricopharyngeal spasms occur in the cricopharyngeus muscle of the pharynx. Cricopharyngeal spasm is an uncomfortable but harmless and temporary disorder. Signs and symptoms * Sensation of a 'lump' in the back of the throat * Throat feels swoll ...

gastroesophageal reflux Gastroesophageal reflux disease (GERD) or gastro-oesophageal reflux disease (GORD) is one of the upper gastrointestinal chronic diseases where stomach content persistently and regularly flows up into the esophagus, resulting in symptoms and/ ...

(GERD),

laryngopharyngeal reflux Laryngopharyngeal reflux (LPR) is the retrograde flow of gastric contents into the larynx, oropharynx and/or the nasopharynx. LPR causes respiratory symptoms such as cough and wheezing and is often associated with head and neck complaints such a ...

or esophageal versatility. In some cases the cause is unknown and symptoms may be attributed to a

psychogenic A psychogenic effect is one that originates from the brain instead of other physical organs (i.e. the cause is psychological rather than physiological) and may refer to: * Psychogenic pain *Psychogenic disease * Psychogenic amnesia *Psychogenic co ...

cause ''i.e.'' a somatoform or

anxiety disorder Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause phy ...

. It has been recognised as a symptom of depression, which responds to anti-depressive treatment. The results of recent studies have strongly suggested that GERD is a major cause of globus, though this remains under considerable debate. 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, surgically trimming the offending thyroid-cartilage provides immediate relief in all cases. 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. 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 A diagnosis of exclusion or by exclusion (''per exclusionem'') is a diagnosis of a medical condition reached by a process of elimination, which may be necessary if presence cannot be established with complete confidence from history, examination o ...

. If globus sensation is presenting with other symptoms such as pain, swallowing disorders such as aspiration or regurgitation (dysphagia), weight loss, or voice change, an organic cause needs to be investigated, typically with

endoscopy An endoscopy is a procedure used in medicine to look inside the body. The endoscopy procedure uses an endoscope to examine the interior of a hollow organ or cavity of the body. Unlike many other medical imaging techniques, endoscopes are inse ...

. 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.

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

External links

* {{Mental and behavioral disorders, selected = neurotic Symptoms and signs of mental disorders Gastrointestinal tract disorders