Globus sensation

What is globus sensation?

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 abnormality present when the throat is examined. Globus sensation is sometimes called globus pharyngeus (pharynx refers to the throat in medical terms). It used to be called globus hystericus which is a term no longer used.

What causes globus sensation?

The exact cause of globus sensation is basically not known. 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 or anxiety can trigger globus sensation or make the symptoms worse; tiredness can also make the feeling more noticeable. 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.

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 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 four in one hundred 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.

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 people eat, food passes from their 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 food, particularly solid foods, feel as though they get stuck as they swallow.

There are a number of problems that can lead to the symptom of dysphagia. The problem can stem from something going wrong at any point in the swallowing process, from the mouth to lower down in the gullet. See the separate leaflet called Difficulty Swallowing (Dysphagia) for the many conditions which can be possible causes.

It can be difficult to tell the difference between globus sensation and dysphagia but usually, unlike someone with dysphagia, someone with globus sensation does not have any problems eating or drinking. Also, dysphagia tends to be constant and may become worse over time whereas globus sensation symptoms tend to come and go.

What investigations might be needed?

There is no specific test which confirms globus pharyngeus. Instead the diagnosis is made on the basis of history and examination. Sometimes tests will be arranged to be sure there is not a more serious underlying condition which would be via referral to an ENT (ear, nose and throat) specialist. The specialist will usually examine the mouth, nose and throat in the outpatient clinic, using a flexible telescope passed via the nose,called nasolaryngoscopy.

Sometimes, if the diagnosis of globus sensation is not clear, various other investigations may also be suggested. These could be any of those discussed in the leaflet about difficulty swallowing (dysphagia). This is because sometimes it is necessary to exclude some of the other causes of problems with swallowing. In most cases however, further investigations are not required.

What is the treatment for globus sensation?

For many people with globus sensation, having their symptoms explained may be all that is needed. Knowing that there is no serious underlying problem can be very reassuring. In many people, the problem settles on its own with time.

For others, various treatments may be suggested. For example:

• Physiotherapy for the muscles around the throat. A speech and language therapist may be referred to 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).