Globus pharyngeus is the term applied to the sensation of a lump or discomfort in the throat. This is a fairly common condition and represents about 5% of new referrals to an Ear, Nose and Throat specialist.
Some feels as a vitamin capsule being stuck, or a part of food like curry leaf, or some food bolus stuck. The sensation is more after eating solids than liquid. Swallowing can be performed normally, so it is not a true case of dysphagia, but it can become quite irritating.
The discomfort or irritation in the throat can be made worse by repeatedly clearing the throat or the constant action of swallowing. Stress and anxiety seem to make the problem worse. Many patients are cancer phobic- fear of cancer.
Causes of Globus sensation
1. Commmonest cause is Cricopharyngeal Spasm-
Behind and anchored to the cricoid cartilage, there is a muscle called the Cricopharyngeal muscle that makes a sling around the esophagus (or swallowing tube that leads to the stomach from the mouth). This muscle acts like a sphincter to prevent food from coming back into the mouth after swallowing. This sphincter muscle is what causes the lump sensation in the throat when it becomes too tight for one reason or another.
In some cases the cause is unknown and symptoms may be attributed to a psychogenic –stress and anxiety disorder. Increased stress may cause this muscle to constrict more strongly.
2-Thyroid swelling- Enlargement of thyroid even if it is a minor, can lead to a sensation of lump in the throat. An Ultrasound and hormone assay of the Thyroid will rule out any thyroid pathology.
3- Enlarged, lingual tonsils behind the base of tongue is another common cause. It can be inflamation or hypertrophy.
4-Chronic granular pharyngitis is another cause, which can be due to allergy or chronic irritation.
5-Rarely pathological webs, rings and strictures are encountered. This is more common in anemic patients.
6- A mucosal lesion may cause this sensation. Such lesions may be due to trauma (swallowing a small piece of fish or chicken bone) or ulcer (apthous ulcer of the throat).
7-Cervical osteophytes pressing on the hypopharynx in patients with cervical spondylosis, mainly in older patients.This is not uncommon.
8- Very rarely, a mass (tumor) of some kind can cause this sensation. Such masses may include cancer, cysts, granulomas etc.
9-LPR-Laryngopharyngeal reflux or GERD -Gastro esophageal reflux Disorder- occurs when acid from the stomach backs up into the esophagus and larynx or hypo pharynx.
When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction-mucositis . This is why GERD is often characterized by the burning sensation known as heartburn.
Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some may have difficulty breathing and voice change, if the voice box is affected.
In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup and asthma.
Most people with GERD/LPR respond favorably to a combination of lifestyle changes and medication. Rarely surgery is recommended. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, and pro-motility drugs.
Investigations done in these patients include-
• Detailed ENT examination after taking a proper history
• Fibre optic naso pharyngo laryngoscopy-either using Rigid or Flexible endoscopes.
• X-ray, CT Scan and MRI studies
• Upper esophageal manometry
• 24 hour pH probe and multichannel intraluminal impedance testing
• Barium or Gastrograffin swallow study
• If needed examination under a general anesthesia and biopsy if indicated.
Upper Esophagoscopy being performed under GA
Treatment of Globus pharyngeus
Treatment tries to address the underlying cause of Globus pharyngeus. With reflux, proton pump inhibitors often tried for at least 3-4 weeks though in some people, it may take up to 3-6 months for adequate resolution.
With stress, reassurance alone is often sufficient. Should symptoms persist, antidepressants or tranquilizers with muscle relaxants can be tried for a short period.
Procedures to relieve Cricopharyngeal muscle hypertrophy, spasticity, or scarring include esophageal dilatation or Cricopharyngeal myotomy, rarely needed.
When dealing with any tumor, treatment is usually excision or biopsy for diagnostic purposes.