ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

Abstract

Globus is a non‐painful sensation of a tightness or a lump/foreign body in the throat that is not associated with dysphagia and may actually improve during meals. While several otorhinolaryngologic, thyroid, and esophageal disorders have been linked to globus, cause‐and‐effect relationships are difficult to establish. Consequently, though part of the evaluation, objective otorhinolaryngologic and esophageal testing is often negative. The presence of alarm symptoms, particularly pain, weight loss, dysphagia, or odynophagia is indications for objective testing. A diagnosis of idiopathic globus requires exclusion of pharyngeal, laryngeal, and esophageal disorders with laryngoscopy, endoscopy, high‐resolution manometry, barium radiography, and/or ambulatory reflux monitoring. A trial of acid‐suppressive therapy may be reasonable in the absence of alarm symptoms, especially if concurrent reflux symptoms are identified. Ablation of heterotopic gastric mucosa in the proximal esophagus has been reported to improve globus symptoms. Beyond these specific approaches, further management of idiopathic globus consists of reassurance, neuromodulators, and complementary approaches. Globus has a benign course with no long‐term consequences, and the overall prognosis is good as the magnitude of symptoms may decline over time.

Itchy Ears

“…22 In this subset of patients, in the absence of alarm symptoms, a trial of acid-suppressive therapy may be reasonable and successful. 26 Similarly, in this study, patients with globus pharyngeus (N=5) were successfully treated with reassurance, and H2-blockers (± antacid suspension).…”

Assessment and management of disorders of gut–brain interaction in patients with eating disorders

“…Globus is the non-painful sensation of a lump or a foreign body in the throat [ 30 ]. Patients may describe tightness, itching, tickling, mucus accumulation, or choking.…”

“…Patients may describe tightness, itching, tickling, mucus accumulation, or choking. However, globus does not impede passage of food, and in most patients, the sensation generally improves with swallowing [ 30 ].…”

“…After excluding structural, mucosal, and motor disorders, the treatment of globus and functional dysphagia in patients with EDs involves reassurance, use of neuromodulators to treat visceral hypersensitivity, and complementary therapies (Fig. 1 ) [ 30 , 37 ]. Explanation and reassurance are a mainstay of treatment, as both globus and dysphagia may improve over time without intervention.…”

“…neuromuscular electrical stimulation) [ 42 ]. Neck and shoulder exercises and pharyngolaryngeal relaxation techniques administered by speech language pathologists have been shown to be helpful in globus sensation relief in some uncontrolled studies [ 30 , 43 ]. Xerostomia or dry mouth, which is seen in increased frequency in patients with EDs, can mimic or worsen symptoms and should be treated with appropriate oral hygiene care [ 44 ].…”