An approach to globus pharyngeus.

BACKGROUND: Globus pharyngeus, or globus, is characterised by the sensation of a lump or tightness in the throat. Symptoms can be persistent, difficult to treat and often reoccur. Globus is a common issue in the community, with lifetime prevalence occurring in up to 45% of the population. OBJECTIVE: This article aims to provide a narrative review of potential causes of globus, as well as a suggested guideline for work-up and management in the primary care setting. DISCUSSION: Causes for globus remain uncertain; however, current opinion focuses on a mixture of muscle tension and mucosal irritation. It is estimated that globus makes up 4% of all primary care referrals to otolaryngologists. There are a handful of proposed causes, with treatments often able to be initiated in the primary care setting. Although most causes are benign, it is important for clinicians to maintain suspicion for malignancy, because this is often the patient's main concern.

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

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.