There are patients who suffer from a persistent lump in throat sensation for months or longer
that seems to defy all explanation and resist all the usual standard medications.
Known as globus, some of these patients have suffered from this symptom for years resulting
in frustration not only in terms of treatment, but diagnosis.
Globus is difficult to treat mainly due to the many different possible triggers.
As such, in order to properly diagnose and treat this symptom, a comprehensive evaluation
is mandatory.
Numerous tests will be required with the attitude of leaving no stone unturned.
Just trying medications is no longer sufficient.
Let’s go thru all the possible causes and potential testing required.
The esophagus is the swallowing tube that connects the mouth and throat to the stomach.
Reflux, eosinophilic esophagitis, and other forms of esophageal dysmotility can cause
persistent globus sensation due to irritation of the cricopharyngeus muscle which is located
just below the voicebox.
When this muscle becomes tight, a patient experiences the globus sensation.
It is important to keep in mind that a patient with globus may not have any symptoms beyond
the lump sensation itself.
All these symptoms may be absent: heartburn, throat burning, choking, phlegmy throat, or
trouble swallowing.
However, if such symptoms ARE present, it does reinforce the possibility of some type
of esophageal disorder.
Workup for esophageal causes of globus include upper endoscopy with biopsies, barium swallow,
24 hour multichannel impedance testing, manometry, and even spit tests.
There may be a mass present causing the lump sensation in the throat.
This mass may not be something you can feel from the outside, but is more internal requiring
testing to evaluate further.
Such tests may include upper endoscopy, neck ultrasound, CT neck scans, and directed biopsies.
A few examples of neck masses that might cause globus include cervical spine bone spurs,
throat cancer, benign cysts, throat mucosal lesions, among others.
Sino-nasal conditions such as allergies, chronic sinusitis, and vasomotor rhinitis can trigger
globus due to post-nasal drainage irritation.
Workup for sino-nasal causes for globus include trans-nasal endoscopy, allergy testing, and
CT sinus scan.
Workup also includes a trial of two different nasal sprays, an anti-histamine nasal spray
as well as ipratropium nasal spray in order to address vasomotor rhinitis for which no
good test exists.
Some patients with globus ultimately find that certain foods trigger this symptom.
Some common foods that have been found to cause globus are wheat, dairy, and egg.
Uncommonly, it may even cause a condition called eosinophilic esophagitis.
Keep in mind that food sensitivities should not be confused with traditional food allergies
nor should it be confused with foods that may cause reflux.
Have you ever gone to a very sad movie and you start to develop a lump in the throat
sensation while trying to suppress crying in public?
Known specifically as globus hystericus, any heightened emotional state that is suppressed,
whether from stress, depression, or anxiety can cause a persistent throat lump sensation.
Finally, globus may actually be an illusion.
Patients suffering from globus may actually be suffering from nerve damage of the throat
responsible for throat sensation.
This condition is known as laryngeal sensory neuropathy.
To use an analogy, a temporary sensory neuropathy occurs when a person gets a numbing shot at
a dental office.
When the jaw becomes numb, it is not unusual for the individual to feel as if the area
has become swollen, but when looking in the mirror, no swelling is present.
Similarly, globus due to neuropathy can cause an illusory throat lump sensation.
Once the cause of a person’s globus has been determined, treatment can then be initiated
with successful resolution.
Keep in mind that it is not unusual in patients with globus for years that more than one cause
may ultimately be found to be present and as such, multiple different treatments may
be required.
A full workup may require seeing multiple different specialists including an ENT, gastroenterologist,
allergist, psychologist, and neurologist.