Unfortunately, as in many difficult-to-diagnose disorders, a feeling of having a persistent lump in your throat used to be considered a psychiatric disorder and referred to as globus hystericus (which is a term that was discontinued and should not be used to refer to this disorder).
As is usually also the case with these types of difficult-to-diagnose disorders, there is growing evidence this feeling is not just “in your head” and there are physiological reasons why you are having this sensation.
Now that having a lump in throat sensation is better understood, this feeling is commonly also referred to as globus pharyngeus, globus sensation, or simply globus.
Prevalence of Globus Sensation
Many people have experienced this sensation at one point in their lifetime. It is estimated that at least 46 out of 100 people have experienced globus sensation, and this actually accounts for 4% of all new appointments scheduled with an otolaryngologist, also known as an ear, nose, and throat specialist.
Globus sensation also appears to be equally prevalent among men and women regardless of their state of health. You are not alone, and there are tests available to help identify any problems that you should be concerned about.
Diagnosis
Your ENT’s primary objective during your visit will be to determine whether you are experiencing dysphagia (difficulty swallowing). Dysphagia and globus are different in that dysphagia is accompanied by a structural or functional problem with your pharynx (throat) or esophagus. Treatment will vary between the two different diagnoses.
History and Physical Examination
Your healthcare provider will take a thorough history to help identify potential causes of your symptoms. Common questions that you can expect include those which cover these symptoms:
Sudden, unexpected weight lossPain with swallowingNeck painVomitingMuscle weaknessOnset of symptomsProgressive worsening or things that make symptoms worse
While you may feel that the health history is not as important as what you are currently feeling, it is actually very important in differentiating whether you have any of the following disorders that can be associated with globus:
Dysphagia Gastroesophageal reflux disease (GERD) Esophageal motility disorders Thyroid disease Upper esophageal sphincter dysfunction Inflammatory diseases such as chronic sinusitis, pharyngitis, or tonsillitis Tumors (both cancerous or noncancerous)
Diagnostic Tests
There currently is not an identified best method for testing for the sensation of a lump in your throat. However, once your healthcare provider has taken a thorough history, they will likely target one of two different first approaches:
Treat with medication for GERDCancer screenings and work-up if cancer is suspected
Because GERD can be associated with 23% to 68% of cases of globus, your ENT may simply start you on a short trial of a proton pump inhibitor (PPI) medication to see if this resolves your sensation of a lump in your throat.
If your symptoms resolve, you may simply be referred back to your healthcare provider or a gastroenterologist. If you have a partial resolution of symptoms, your PPI dose may be increased.
However, if you do not have any changes in symptoms, your ENT may continue to evaluate reflux disease or other esophageal disorders by performing the following procedures:
Multichannel intraluminal impedance Acid (pH) monitoring Endoscopy Manometry Barium swallow study Videofluoroscopy
If Tests Are Negative
If all the tests are negative, you are likely feeling very frustrated. Try to relax and think positive. If you have made it this far, your condition is at least benign (not immediately harmful).
However, you will not have a resolution of symptoms that you are looking for. In these cases, there are several treatments that may be worth trying:
Speech therapyLearn relaxation techniquesAntidepressant trial (takes six weeks before effectiveness can be evaluated)
Speech therapy can teach you techniques to strengthen your swallow and vocal use. This may have varied success rates.
Antidepressant use and relaxation techniques have a similar line of rationale. Mood can be associated with feelings of having a lump in your throat and could be useful in trying to treat causes of your symptoms without any other known causes.
