Globus pharyngeus (also termedglobus sensation) is the persistent but painless sensation of having a pill, foodbolus, or some other sort of obstruction in thethroat when there is none. Swallowing is typically performed normally, so it is not a true case ofdysphagia, but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.[1][2]
The results of recent studies have strongly suggested thatGERD is a major cause of globus, though this remains under considerable debate.[5]
A less common cause, distinguished by a "lump in the throat" accompanied with clicking sensation and no pain when swallowing, may be due to thyroid-cartilage rubbing against anomalous asymmetrical laryngeal anatomye.g. the superior cornu abrading against thethyroid lamina,[6][7] surgically trimming the offending thyroid-cartilage provides immediate relief in all cases.[8] However this cause is frequently misdiagnosed, despite requiring a simple clinical examination involving careful palpation of the neck side to side which elicits the same click sensation (laryngeal crepitus) and pain as when swallowing, most cases are due to prior trauma to the neck.[8] High resolutioncomputed tomographic (CT) orMRI scan of the larynx is usually required to fully understand the anomalous laryngeal anatomy. Anterior displacement of the thyroid ala on the affected side while swallowing can help resolve symptoms.[citation needed] Other anomalous laryngeal anatomy with the potential to cause the globus sensation include thyroid nodules or parathyroid adenomas.[9]
Asglobus sensation is a symptom, a diagnosis ofglobus pharyngis is typically adiagnosis of exclusion. If globus sensation is presenting with other symptoms such as pain, swallowing disorders such as aspiration or regurgitation (dysphagia),weight loss, or voice change,[10] an organic cause needs to be investigated, typically withendoscopy.Barium swallows are not recommended as a diagnostic tool, as although they are less invasive than endoscopy and may be reassuring to the patient, they commonly miss sinister causes. It is very rare that globus sensation presenting with no other symptoms has a sinister cause and therefore endoscopy is not recommended in this case.[10][11]
Differential diagnosis must be made fromEagle syndrome which uses the patient's description of "something caught in my throat" as a diagnostic tool. Eagle syndrome is an elongation of the styloid process causing irritation to nerves and muscles in the region resulting in a number of unusual symptoms.[citation needed]
Reassurance of the patient is recommendable when no cause can be found. If a cause is identified, the treatment is chosen according to what will resolve the underlying problem.
^Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace AR (July 2006). "Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review".The Journal of Laryngology and Otology.120 (7):608–09.doi:10.1017/S0022215106001125.PMID16681864.S2CID20575227.
