Globus Sensation

What is globus sensation?

Globus sensation is when there is a feeling of having a lump in the throat, but there is no actual lump. This condition is very common and may be accompanied with hoarseness of voice. This sensation comes and goes with eating and drinking and does not interfere with it. However, the cause is still uncertain. To exclude any other possibilities, an examination and tests can be done. In terms of treatment, one may need to be reassured that there is no serious underlying problem.

A person with globus sensation will feel as though they are unable to remove the lump from their throat or there is a pill stuck in their throat. Although there is no obstruction with globus pharyngeus. Doctors understand that there could be psychological and physical causes associated with this condition and there are real symptoms. Anxiety and gastroesophageal reflux disease is the main cause of globus sensation. In this condition, towards the food pipe the stomach contents tend to travel upwards and sometimes will travel into the throat. One may feel as though muscle spasms are the cause. A study has shown that commonly hypertensive upper esopahgeal sphincter is the leading cause of globus. There are other causes also associated with this condition such as:

• Swallowing disorders 
• Minor inflammation in the throat or the back of the mouth
• Changes in mood or psychological health issues

Causes of globus sensation

When the throat is examined, there is no lump present. Although in the back of the throat there is a feeling of a lump which is called globus sensation. Sometimes this condition is also known as globus pharyngeus. Previously, this condition was associated with a psychiatric condition hence it was known as globus hystericus. In men with a wide range of psychopathology, the condition globus sensation has been found to occur. The exact cause is still not known. It is believed that in the muscles involved in swallowing there is some problem with their coordination, and for swallowing to occur normally, they need to be tensed and relax in the correct sequence then it causes this condition. In an individual with globus sensation some swallowing muscles do not relax completely when they try to swallow saliva and thus in the throat there is sensation of a lump. However, during the swallowing of food, in a different way the muscles are stimulated and thus the muscles relax normally.

It is also believed that from the stomach into the gullet acid reflux occurs, then it may lead to globus sensation. It is because there is some problem in the relaxation of the throat muscles due to stomach acid. In some cases, globus sensation may get triggered or symptoms could become worse due to stress. The symptoms may even become worse when from the nose down the back of the throat the mucus runs down. In every individual suffering from the condition, the causes may vary. In the muscles of the throat when tension increases then it causes globus sensation. This is a very common cause. Along with this, the tissue lining of the throat may swell and get irritated. The following causes may be associated with globus sensation:

• Stress and anxiety - in times of stress and anxiety most of the individual’s experience globus sensation. This is particularly felt when feelings or emotions are held back strongly.
• Acid reflux - this condition is also known as laryngopharyngeal reflux or silent reflux. In this condition by the food pipe the stomach acid travels. Since the symptoms of heart burn or indigestion is not felt by the individual hence it is difficult to detect but mostly there are changes in voice, chronic throat clearing, and globus sensation.
• Cervical spondylitis - when in the neck and throat muscles, globus increases then the sufferers may experience this condition.
• Other causes - side effect of medication, enlarged thyroid gland, and other medical problems cause globus sensation.

Usually, the doctor will discuss the throat symptoms that you are experiencing. The ear, nose and throat specialist will examine you to rule out other causes of the condition. According to the symptoms being experienced, the treatment can be done. The following treatment can be done:

• First, one has to be reassured that no underlying disease exists.
• Advice on vocal hygiene.
• If there is evidence of acid reflux, then mediation may be advised.
• If there is a hoarseness of voice, then one can go to a speech and language therapist.

Symptoms of globus sensation

Having a lump like sensation in the throat is the main symptom. This sensation keeps coming and going. Usually, in the front of the neck it is felt and it can move up or down. Eating and drinking is not affected and some people have also reported that the symptoms get relieved while eating or drinking. There is no pain typically associated with this condition. When swallowing the saliva, the symptoms may be experienced.

This condition is thought to be quite common and it is difficult to give the specific number of people affected by this condition since there are no reliable studies done on this. It has been estimated that almost four hundred people with globus sensation are referred to an ENT specialist. Men and women are equally affected. In middle aged people, this condition is very common and almost any one can be affected by it.

Diagnosis

There is no specific test to confirm globus sensation. Based on the history and examination the doctor will make a diagnosis. Sometimes the doctor has to give reassurance that there is no serious underlying condition. If globus sensation is suspected, then for further examination the doctor will refer you to an ENT so that it can be assured that the underlying symptoms are not associated with any underlying condition. In the outpatient clinic the mouth, nose and throat will be examined. To look through the nose a flexible telescope will be used known as a nasolarynoscopy.

Various other tests can be done if the diagnosis of globus sensation is unclear. By doing this other problems associated such as difficulty in swallowing can be excluded. In most of the cases, there is no need of further testing. Regarding diagnosis and management of globus sensation there is no best consensus. In one study it was found that 14 percent patients with globus sensation were clinically indicated and simply prescribed medications were given and no test was performed. In remaining patients by various ways the symptoms were investigated. Sometimes for investigation two methods are combined:

• Nasal endoscopy - this is done in a clinic so that the throat, nose and voice box can be viewed. For this a nose flexible fibre optic camera is used.
• Barium swallow - this is done in the radiology department. First, a drink containing barium sulphate is prepared and you are asked to drink this. Barium sulphate shows up in the X-rays. Through the upper digestive system, the barium sulphate is tracked by doing X-ray. If there are abnormalities in the esophagus and stomach, they can be viewed by using this method.
• X-ray C spine - by doing this the neck and spine can be checked for arthritis. This is a simple neck X-ray. Sometimes the globus sensation can be caused by osteophytes.
• Rigid endoscopy - for this the throat, voice box and food pipe is examined by using general anesthesia.

It was found that the combined use of transnasal esophagoscopy and swallowing function test is a reliable tool to evaluate the symptoms of globus sensation.

Treatment of globus sensation

Explaining the symptoms is helpful for individuals with globus sensation. It can be very reassuring that there is no serious underlying problem. In most of the cases, globus sensation will resolve on its own. In some cases, the following treatment options may be suggested.

• For the muscles around the throat a physiotherapy may be needed for which you will be referred to a speech and language therapist.
• For post nasal drip treatment this will be done with a nasal spray.
• By using antacid medicines and acid suppressing medicines the doctor will treat acid reflux.
• Smoking should be stopped.
• If stress is a problem, then that should be treated. The doctor may suggest an antidepressant tablet or cognitive behavioral therapy.

What can be done to help?

In one study in patients undergoing thyroidectomy, the symptoms of globus was assessed using Glasgow Edinburgh throat scale and a significant decrease in its mean was found. Usually no further investigation is needed due to the benign nature of this condition. Rather one of the reliable treatments is taking anti-reflux medication which is of high dose.

• Acid reflux medications - the doctor may prescribe omeprazole, lansoprazole, gaviscon or ranitidine.
• Modifications in lifestyle - some changes in lifestyle will help to reduce acid reflux, changes such as minimizing fruit juice, caffeine, spicy foods, avoiding fizzy drinks, not to smoke and three hours before going to sleep having dinner are some changes that will be helpful.
• Relaxation techniques - this includes drinking adequate amount of fluid, throat clearing should be avoided since the globus symptoms may get exacerbated. Drink some lukewarm water if you feel like clearing your throat. Further it can be helpful to do relaxing exercises, sometimes this condition may be associated with stress. You should check whether the symptom is becoming worse and address it if required. Often for children with throat clearing habit consultation with speech and language therapist will be helpful.
• Patients who are heavy smokers or heavy drinkers have a lot of anxiety caused by globus sensation. A more extensive evaluation is needed in those patients who have throat pain, dysphagia, odynophagia, hoarseness of voice and weight loss.

Also, it has been reported that by eradicating the bacteria Helicobacteria pylori the symptoms of globus can decrease.

Could globus sensation be a serious condition?

Many people are worried that globus sensation could be due to some underlying cause or could be associated with some other condition such as cancer. First, it is important to distinguish between globus sensation and dysphagia. When food is eaten from our mouth the food goes into the esophagus to the stomach and then into the small and large intestine. The passage from where from the mouth, to the gullet and to the stomach the fluid or solid passes will be delayed in people with dysphagia. They feel that the food gets stuck when it is swallowed. Symptoms of dysphagia could occur due to many reasons. From the mouth to lower down in the gullet at any swallowing point there could be a problem.

Sometimes telling the difference between dysphagia and globus sensation can be very difficult. One clue is that people with dysphagia have issues with eating or drinking, but people with globus sensation do not have that. Also, dysphagia is a condition that remains constant and over time can become worse, whereas the symptoms of globus sensation tend to come and go.

Should I see a doctor for globus sensation?

Usually, over time this condition tends to disappear, but if the condition causes the following symptoms then one should see a doctor.

• In the throat or neck there is pain
• Weight loss
• Vomiting
• Swallowing becomes difficult
• During swallowing there is pain
• While swallowing the person may choke
• The throat or other body muscles may become weak
• In or around the neck or throat a mass can be felt or seen

For this condition there is no specific treatment, but this condition can be controlled. Medications that can lead to dry mouth should be changed and changes should be made in lifestyle so that anxiety can be reduced. When there is some other underlying condition associated with globus sensation, then the condition can be alleviated by treating that underlying cause first.

What else could it be?

• Strep throat - when on the tonsils streptococcus bacteria grows then it causes the bacterial infection known as strep. It causes throat pain while swallowing, tonsils could become red, swollen and have a white spotty appearance.
• Mononucleosis - this is caused by Epstein Barr virus. They cause a whitish appearance on the tonsils or it could be red or swollen.
• STD - most commonly gonorrhea could occur in the throat. It causes the tonsils to swell, become red and causes severe sore throat and mouth sores.
• Cancer - it could be cancer of the throat and mouth. If there is a mouth sore that does not heal, there is weight loss, night sweats, fever and sensation of something stuck in the throat, then seek medical attention.

Article resources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3360444/

https://patient.info/health/difficulty-swallowing-dysphagia/globus-sensation

https://www.hey.nhs.uk/patient-leaflet/globus-sensation/

https://exploringyourmind.com/globus-sensation-feeling-lump-throat/