Globus

Please note that the following is a general guideline only. For a full assessment, exclusion of any other underlying cause for your symptoms and an individualised treatment approach, you will need to be seen by a qualified specialist.

Definition

persistent or intermittent sensation of a lump or foreign body in the throat for at least 12 weeks

Epidemiology

Up to 40 % of the population been affected at some stage

M=F, F seek help more

Mostly middle age

Aetiology

A Sinister (Minority)

Mass/tumour-Pharynx/ neck / thyroid

B Non Sinister (majority)

LPR (laryngo pharyngeal reflux)-direct irritation

GERD-leading to reflex CP spasm

Psychogenic

Osteophytes-cervical

CP spasm

Tonsil hypertrophy

 Oesophagus- oesophagitis, motility disorders

Taking a Hx

Take a clear hx to identify the likely underlying cause (first exclude a sinister cause)

A Symptoms of sinister pathology include

dysphagia/ food sticking in the throat

odynophagia

otalgia-referred pain

B Usual non sinister globus sensation is..

Midline

Improves when eating (ie patients can gain weight)

Non progressive, been there for months

No associated dysphagia or above symptoms

DD symptoms of non sinister causes

LPR/ GORD

Vomit taste in the throat

Dry Cough especially at night

May have heart burn (LPR can occur without  heartburn)

CP Spasm

Caffeine , alcohol intake, smoking, 

GORD- relate CP spasm

Psychogenic- Stress, anxiety

Osteophyte

May become evident on examination/ barium swallow

 
        Tonsils large

Examination

complete H&N exam- Oral cavity, oropharynx, neck, fiberoptic scope

Diagnosis & Rx

Hx and examination will help you identify and diagnose most sinister pathology. Most globus due to LPR is difficult to diagnose and below is a simple guideline

If sinister pathology on Hx or Exam-URGENT panedsocopy and biopsy

if no obvious sinister pathology/ benign globus symptoms

First step

omeprazole 40 mg BD (1/2 hr pre prandial) for 3 months

If stressed help with relaxation therapy

Stop Caffeine, ETOH, and likely other ppt

(if better its most likely reflux/ stress / CP spasm)

2nd Step-If not better

Barium swallow

(show osteophytes, motility disorders)

3rd step-Still non diagnostic

Gastroenterology RV

Oesophagoscopy / biopsies/ PH probes for PH nonitoring

Treatment

-If Sinister: Rx the sinister pathology

-Non Sinister/ Stress/ Caffeine / CP spasm : general RX as above

-If Osteophyte may need surgery-spinal surgeon

-If significant reflux despite rx fundoplication