Globus is a Latin word for globe or sphere, which is what people often describe when they come in to see me complaining of a lump-like sensation in their throat. It is one of the most common complaints I see on a daily basis and is a very uncomfortable and troubling symptom for patients because they often feel like something is always present in their throat, or something is stuck in their throat, especially when they are swallowing. While there is a known entity in the psychiatric scientific literature of something called “globus hystericus” (the implication being that the lump-like sensation is because of psychological issues), I believe that almost all “globus” complaints are not in someone’s head, but truly in someone’s throat.
The important thing to do when a complaint of globus presents itself is to figure out what’s causing the lump-like sensation which will then allow proper treatment to take place. The first step is the patient’s history. How long has the sensation been going on? A globus sensation that has been going on for several days often suggests either an infection or some type of allergic response. A globus sensation taking place for months suggests a more chronic process such as acid reflux disease, a nerve injury in the throat, or even a tumor. For example, if the lump-like sensation been getting worse and worse then a situation of worsening symptoms is always worrisome and underscores the importance of taking this symptom seriously. What circumstances, if any, were associated with the onset of the globus sensation? A globus sensation associated with eating certain foods or after a bad cold or flu, can further direct the attention of your health care professional to the source of the problem. What makes it better? What makes it worse?
Diet and lifestyle history are also critical items to know. As far as diet, I always ask about 10 types of foods, 4 common acidic foods such as soda, citrus (lemon, lime, pineapple, orange, grapefruit), tomato and vinegar. Then about 6 common foods while not in and of themselves generally very acidic, but have effects on digestion that can cause problems for those who might have acid reflux disease, such as caffeine, chocolate, alcohol, mint, onion and garlic. Those 6 commonly consumed foods share the following trait, they all are powerful relaxers of the muscle that separates the stomach from the esophagus, called the lower esophageal sphincter (LES). Caffeine, which is often in chocolate as well, has the additional property of increasing acid production by the stomach. So caffeine and chocolate can not only loosen the protective muscular barrier between the acidic stomach and its adjacent structure, the esophagus, it can also increase acid production by the stomach, a physiologic “one-two punch” that can create misery for people, as acid from the stomach can then freely travel up the esophagus towards the throat.
Lifestyle history is also key. Eating late at night then lying down to sleep, or lying down right after eating are very common risk factors for the development of globus type symptoms. Smoking any substance is important to know as well, as smoking directly irritates the throat and, depending on what you are smoking, nicotine for example, can also have physiologic effects that loosen the stomach–esophagus barrier. Further, and this is always my greatest concern when I see patients who smoke or have a past history of smoking, there is always the risk of cancer in the head and neck and esophagus when smoking is part of the mix.
So once a thorough history is established, it is then important to examine the patient to see what is going on in their throat that might be causing their globus complaint. Examining the neck to make sure there are no lumps or bumps is essential. Then examining the nose, mouth, back of the throat, tongue, gums and teeth takes place. Abnormalities in those areas may give a hint as to the cause of the lump-like sensation. For example, in someone who has a few days of a lump-like sensation and a red throat on exam, that points more to an infection as the cause. On the other hand, if a mass is seen in the tonsil or tongue area, then that points to a tumor as a possible cause.
Generally, the most effective way to see what’s taking place in the throat itself is to use a tiny camera that is passed via the patients nose into their throat to actually visualize the throat structures in real time. This office-based procedure is called Transnasal Flexible Laryngoscopy (TFL) and allows the physician to see exactly what is going on in a patients throat, tongue, vocal fold area, top of the esophagus and top part of the windpipe. With TFL one can see if indeed there is swelling in the throat that’s causing the lump-like sensation. Nerve injury, tumor, consequences of allergies can all be determined with this type of exam. By far the most common cause of a globus sensation is acid reflux from the stomach, called Throatburn reflux. Also known as LPR (LaryngoPharyngeal (Lah-ringo faren gee uhl) Reflux), sometimes called “silent” reflux or “airway” reflux. I am not fond of the term “silent” (meaning no heartburn) reflux because the symptoms of a lump-like sensation in the throat is rarely silent as my patients are often constantly clearing their throat and coughing to clear their throats of that lump-like sensation.