Globus sensation is the term used when a person has the feeling of a lump in their throat even though there is no lump present when the throat is examined. The sensation can come and go. It does not interfere with eating and drinking. The exact cause of globus sensation is uncertain. Examination and investigations may be carried out to exclude any other underlying problem. Reassurance that there is no serious underlying problem may be all that is needed in terms of treatment.
What is globus sensation and what causes it?
Globus sensation is the term used when a person has the feeling of a lump in the back of their throat when actually there is no lump present when the throat is examined. Globus sensation is sometimes called globus pharyngeus (pharyngeus refers to the throat in medical terms). It used to be called globus hystericus as it was previously thought that globus sensation was due to a psychiatric condition.
What are the symptoms of globus sensation?
The main symptom, the sensation of a lump in the throat, tends to come and go. It is usually felt in the front of the neck and can move around, usually up or down. It does not affect eating or drinking and, in fact, in some people, symptoms can be relieved by eating or drinking. There is not usually any pain present in the throat. Many people with globus sensation notice the symptoms most when they are swallowing their saliva.
How common is globus sensation and who gets it?
Globus sensation is thought to be quite common but there are not enough reliable, up-to-date studies to give specific numbers of people affected. About one in twenty people referred to an ear, nose and throat (ENT) specialist clinic have globus sensation. It affects women and men equally. It is most common in people of middle age but globus sensation can affect anyone of any age.
What causes globus sensation?
The exact cause of globus sensation is uncertain. Some specialists believe that it is due to a problem with the co-ordination of the muscles involved in swallowing. Many muscles are involved in swallowing and they need to tense and relax in the correct sequence for swallowing to occur normally. In someone with globus sensation, when they try to swallow saliva, some of the swallowing muscles may not relax fully and so the sensation of a lump in the throat occurs. However, when food is swallowed, the food stimulates the muscles in a different way and normal muscle relaxation occurs.
It is thought that reflux of acid from the stomach into the gullet (oesophagus) may also contribute to the cause of globus sensation in some cases. The theory is that the stomach acid affects the relaxation of the muscles around the throat.
In many people, stress can trigger globus sensation or make the symptoms worse; so can being very tired. Having an excess of mucus running from the nose down into the back of the throat (known as postnasal drip) may also make the symptoms of globus sensation worse.
Could globus sensation be a sign of anything else?
Many people with globus sensation are worried that it could be a sign of another problem, particularly a cancer. Globus sensation needs to be distinguished from a difficulty with swallowing (dysphagia).
When we eat, food passes from our mouth, down the gullet (oesophagus), into the stomach and then into the small and then large intestine. For people with dysphagia, there is a delay in the passage of fluids or solids from the mouth, down the gullet and to the stomach. Someone with dysphagia will notice that their foods, particularly solid foods, feel like they are getting stuck as they swallow.
There are a number of problems that can lead to the symptom of dysphagia. These include:
- Oesophageal spasm - when there is abnormal contraction of the muscles around the gullet.
- Gastro-oesophageal reflux disease - when acid from the stomach leaks up into the gullet.
- Muscle disorders like myasthenia gravis - myasthenia gravis is a condition where muscles become easily tired and weak.
- Neurological problems, including Parkinson's disease and stroke.
- Cancer of the gastrointestinal tract, including cancer of the oesophagus.
Sometimes it can be very difficult to tell the difference between globus sensation and dysphagia. As mentioned above, one clue could be that unlike someone with dysphagia, someone with globus sensation does not usually have any problems eating or drinking. Also, dysphagia can be constant and may become gradually worse over time, whereas globus sensation symptoms tend to come and go.
What investigations might be needed?
If your doctor suspects globus sensation, you will usually be referred to an ENT specialist for an examination. This is to ensure that there is no other underlying condition that could explain your symptoms. The specialist will usually examine your mouth, nose and throat in the outpatient clinic, using a flexible telescope passed via your nose. This is called nasolaryngoscopy. Globus sensation is a "diagnosis of exclusion". This means there is no specific test which confirms it. Instead the diagnosis is made after having tests to be sure you do not have a more serious condition.
Sometimes, if the diagnosis of globus sensation is not clear, various other investigations may also be suggested. These may include:
- Chest X-ray.
- Gastroscopy - this is a test to look inside the gullet (oesophagus), the stomach and the first part of the small intestine (duodenum). This is done with a thin, flexible telescope (an endoscope) that is passed through the mouth. See separate leaflet called Gastroscopy (Endoscopy) for further details.
- Barium swallow - this is a test that helps to visualise and look for problems in the gullet. The gut (gastrointestinal tract) does not show up very well on ordinary X-ray pictures. However, if you drink a white liquid that contains a chemical called barium sulfate, the outline of the upper parts of the gut (gullet, stomach and small intestines) shows up clearly on X-ray pictures. This is because X-rays do not pass through barium. See separate leaflet called Barium Swallow/Meal/Follow Through for further details.
- Oesophageal manometry - this is a test where a pressure-sensitive tube is passed via your nose and mouth into your gullet. This is to measure the pressure of the muscle contractions in the gullet.
- Videofluoroscopy - this is a bit like a barium swallow. Different drinks and foods are mixed with barium and you are asked to do various things like swallow, move your head, etc, after drinking or eating the mixture. X-ray pictures are taken and your swallowing can be examined.
- pH monitoring - during this test, a thin tube is passed through your nose and mouth and into your gullet. A monitor that is attached to the tube can measure the acid level (pH) in your gullet.
What is the treatment for globus sensation?
For many people with globus sensation, having their symptoms explained may be all that is needed. Just knowing that they do not have a serious underlying problem like cancer can be very reassuring.
For others, various treatments may be suggested. For example:
- Physiotherapy for the muscles around the throat. You may be referred to a speech and language therapist for this type of physiotherapy.
- Treatment for postnasal drip - for example, treatment with a nasal spray.
- Treatment for acid reflux, including antacid medicines and acid-suppressing medicines.
- Stopping smoking.
- Treatment for stress, if this is a problem. This can be antidepressant tablets or a talking treatment called cognitive behavioural therapy (CBT).
Dr Michelle Wright
Dr Mary Harding
Dr Helen Huins