Globus sensation
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Globus Sensation: Definition and Prevalence
Globus sensation, also known as globus pharyngeus, is the feeling of a lump, tightness, or foreign body in the throat without any actual obstruction or mass found on examination. It is a common complaint, accounting for about 4% of ear, nose, and throat (ENT) referrals, and up to 45% of people may experience it at some point in their lives 15. The sensation is typically painless and may be accompanied by throat clearing, chronic cough, hoarseness, or catarrh 15.
Causes and Associated Factors in Globus Sensation
Gastroesophageal Reflux and Laryngopharyngeal Irritation
Gastroesophageal reflux disease (GERD) is frequently associated with globus sensation. Studies have found that 23–68% of patients with globus have evidence of reflux, although similar rates can be seen in people without symptoms 15. Acid and digestive enzyme regurgitation can cause chronic inflammation in the laryngopharynx, leading to globus symptoms 15910. Importantly, reflux does not always need to reach the throat to cause symptoms; even reflux limited to the lower esophagus can be associated with globus . Treatment with acid-suppressive therapy, such as proton pump inhibitors, can improve symptoms in many patients with reflux-related globus 910.
Esophageal Motility Disorders
Abnormalities in esophageal motility, especially involving the upper esophageal sphincter and cricopharyngeal muscle, are commonly found in patients with globus sensation. Studies using esophageal manometry have shown that a significant proportion of globus patients have increased sphincter pressure or nonspecific motility disorders 168. These findings suggest that esophageal motility testing can be useful in evaluating patients with persistent symptoms .
Psychological Factors: Anxiety and Depression
Psychological factors, particularly anxiety and depression, are frequently associated with globus sensation. Studies have found higher rates of anxiety and depression among globus patients, especially among women, housewives, and married individuals . However, the overall rate of psychiatric disorders in globus patients may not be higher than in the general population, indicating that psychological distress is a contributing factor but not the sole cause .
Other Contributing Factors
Other possible causes and associations include cricopharyngeal spasm, lingual tonsil enlargement, cervical osteophytes, hiatus hernia, sinusitis, post-nasal drip, goiter, and, rarely, hypopharyngeal cancer 15. In some cases, globus sensation has also been reported after COVID-19 infection, and alternative treatments such as herbal medicine have shown some benefit in case reports .
Diagnosis and Evaluation of Globus Sensation
The diagnosis of globus sensation is primarily clinical, but it is important to rule out serious underlying conditions. Evaluation may include laryngoscopy, endoscopy, barium swallow, high-resolution manometry, and ambulatory reflux monitoring, especially if there are alarm symptoms like pain, weight loss, or difficulty swallowing 458. Most patients do not have an identifiable organic cause, and local lesions are rare .
Management and Prognosis
For most patients, reassurance is a key part of management, as globus sensation is generally benign and has a good long-term prognosis . In cases where reflux or motility disorders are identified, targeted treatment can be effective 4910. Psychological support or neuromodulators may be considered for those with significant anxiety or depression 24. Complementary approaches, such as herbal medicine, may also be helpful in select cases .
Conclusion
Globus sensation is a common and often benign condition with a multifactorial origin. Gastroesophageal reflux, esophageal motility disorders, and psychological factors are the most frequently identified contributors, but many cases remain idiopathic. Careful evaluation to exclude serious pathology, reassurance, and targeted therapy for underlying causes form the cornerstone of management. Most patients experience improvement or resolution of symptoms over time 145.
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Globus pharyngeus: an update for general practice.
Globus pharyngeus is a common, painless sensation in the throat, often associated with persistent cough, hoarseness, and catarrh, and may be caused by various factors.
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