A new predictive scoring model for globus pharyngeus in patients with gastroesophageal reflux disease.

BACKGROUND: Globus pharyngeus is a clinical condition, wherein, a patient senses a lump or a foreign body in the throat with a tightening or choking feeling. A strong association between globus pharyngeus and gastroesophageal reflux disease (GERD) was reported. Therefore, we sought to investigate the predictive factors of globus pharyngeus in patients with established GERD and fit a predictive scoring model for globus pharyngeus. METHODS: In this case-control study, 143 patients having globus pharyngeus along with GERD ( case ) and 109 patients having globus pharyngeus without GERD ( control ) were enrolled. Data comprising demographics, comorbidities, and psychosocial stress levels were recorded. The predictive factors of globus pharyngeus in patients with GERD were unraveled, and a predictive scoring model was fit for globus pharyngeus. RESULTS: Proton pump inhibitor usage in the case group was significantly higher compared to controls (63.63% vs 24.78%, P < 0.001), and differences in Hiatus Hernia and Stress levels were highly significant between the two groups ( P < 0.001). Multivariate logistic regression revealed that variates, Hiatus Hernia, psychosocial stress, and age were highly significant ( P < 0.001) independent predictors of globus pharyngeus. Using the regression coefficients of all the independent predictor variables, a predictive scoring model was fitted, which yielded an area under receiver operating characteristic (AUROC) curve of 78.9. CONCLUSION: Hiatus hernia, psychosocial stress, and age are significant independent predictors of globus pharyngeus in GERD, and our predictive scoring model may help in identifying patients at higher odds of experiencing globus pharyngeus and modulate treatment accordingly.

The Development of Head and Neck Cancer in Patients with the Isolated Complaint of Globus Pharyngeus.

OBJECTIVES: Globus pharyngeus (GP) is a perplexing problem that accounts for 4% of referrals to otolaryngologists. Workup can be extensive and may not be definitive in terms of etiology. The concern that lingers is that of a subtle cancer, which can prolong anxiety and increase testing cost. The aim of this study was to identify the incidence of head and neck cancer (HNC) in patients diagnosed with GP. METHODS: Longitudinal data were captured from two academic institutions, identifying patients with a new diagnosis of globus pharyngeus in 2015. The patient cohort was tracked for at least 4 years to assure follow-up and ability to determine if a HNC developed. Additional demographic data was also collected to determine most common consults, treatments, and testing employed. RESULTS: Excluding patients with previous diagnosis of HNC, 377 patients were identified who presented with GP in 2015 that had at least 4 years of follow-up. Demographics were predominantly women (64.65%), with a mean age of 56.48 years at diagnosis, and the most common provider specialty on the first visit was otolaryngology (39.52%). Four patients ultimately developed HN cancer, for an overall incidence of 1% for the 4-year period of 2015-2019. CONCLUSIONS: Given the long-term follow-up of this population, the overall incidence of developing a head and neck cancer, with a presenting symptom of globus, is low. This is the largest study to date to report the percentage of patients endorsing GP to then subsequently develop HNC. This helps otolaryngologists to reassure patients who have a normal comprehensive exam, flexible endoscopy, and targeted studies. LEVEL OF EVIDENCE: 4 Laryngoscope, 134:1147-1154, 2024.

Determination of the Relationship between Globus-Type Complaints and COVID-19 Anxiety in Adult Cases with COVID-19.

INTRODUCTION: Besides generalized symptoms, patients with COVID-19 also show otolaryngological (ENT) symptoms. Globus is one of these symptoms. Anxiety problems may accompany the disease, as well. This study investigated the relationship between globus symptoms and COVID-19 anxiety in patients diagnosed with COVID-19. METHODS: The Turkish version of Glasgow-Edinburgh Throat Scale (GETS-T) and Coronavirus Anxiety Scale (CAS) was used to investigation of the relationship between globus symptoms and COVID-19 anxiety in patients diagnosed with COVID-19. They responded to the GETS-T for the evaluation of throat symptoms and determination of their severity. Additionally, it examined the level of dysfunctional anxiety associated with the coronavirus in COVID-19 patients by using the CAS. Data were collected through telephone interviews. There were 220 participants in a prospective cross-sectional study (110 COVID-19 patients and 110 non-COVID-19). RESULTS: Results show the GETS-T total score to be significantly higher in the COVID-19 group than in the non-COVID-19 group (p < 0.001). As the GETS-T total score increased, CAS total score also increased significantly in the COVID-19 group. Total scores of GETS-T and CAS were found to be lower in the post-acute period than in the acute period in the COVID-19 group (p < 0.001). CONCLUSION: This study confirms that globus-type symptoms may be present in the clinical appearance of COVID-19 infection. In addition, the results support the opinion held in the academic literature that there are positive correlations between globus sensation and psychosomatic etiology. Furthermore, the study concludes that the symptoms generalized as globus-type symptoms, which include sore throat, the feeling that something is stuck in the throat, and the inability to clear the throat, decrease and almost disappear after the first month of the disease.

Treatment-associated network dynamics in patients with globus sensations: a proof-of-concept study.

In this proof-of-concept study, we used a systems perspective to conceptualize and investigate treatment-related dynamics (temporal and cross-sectional associations) of symptoms and elements related to the manifestation of a common functional somatic syndrome (FSS), Globus Sensations (GS). We analyzed data from 100 patients (M = 47.1 years, SD = 14.4 years; 64% female) with GS who received eight sessions of group psychotherapy in the context of a randomized controlled trial (RCT). Symptoms and elements were assessed after each treatment session. We applied a multilevel graphical vector-autoregression (ml GVAR) model approach resulting in three separate, complementary networks (temporal, contemporaneous, and between-subject) for an affective, cognitive, and behavioral dimension, respectively. GS were not temporally associated with any affective, cognitive, and behavioral elements. Temporally, catastrophizing cognitions predicted bodily weakness (r = 0.14, p < 0.01, 95% confidence interval (CI) [0.04-0.23]) and GS predicted somatic distress (r = 0.18, p < 0.05, 95% CI [0.04-0.33]). Potential causal pathways between catastrophizing cognitions and bodily weakness as well as GS and somatic distress may reflect treatment-related temporal change processes in patients with GS. Our study illustrates how dynamic NA can be used in the context of outcome research.

Globus pharyngeus due to a lymphangiomatous polyp arising from the tonsil.

INTRODUCTION: Lymphangiomatous polyp of the tonsil is generally accepted as a hamartomatous lesion. Its differential diagnosis includes fibroepithelial polyp, squamous papilloma, angiofibroma, haemangioma, arteriovenous malformation, hamartoma and lymphangioma. CASE REPORT: A 33-year-old man presented with 2 months history of feeling of foreign body sensation in the throat. Examination revealed a nodular red coloured polyp on the left tonsil. Histologically, the polyp was covered by squamous epithelium and is composed of numerous vascular channels containing lymphocytes and eosinophilic material, in a fibrous stroma. Immunohistochemically, the endothelial cells were positive toward CD31 and D2-40. DISCUSSION: The characteristic histological features of a lymphangiomatous polyp are benign vascular proliferation with variable fibrous, adipose and lymphoid stromal components. Nested intraepithelial epidermotropism of lymphocytes can be observed. The vascular channels are typically thin-walled and contain eosinophilic proteinaceous material and lymphocytes. There is no reported incidence of recurrent or malignant transformation.

[Globus pharyngeus : etiologies, diagnosis and management. A narrative review]. / Globus pharyngé : étiologies, diagnostic et prise en charge. Revue narrative de la littérature.

Globus pharyngeus is a very common symptom in the general population. It is defined as a sensation of lump or foreign body in the throat, generally not accompanied by pain and relieved by eating. This last notion makes the differential diagnosis with dysphagia, which requires a different management. Its possible etiologies are complex and multiple, both organic and psychological, and many of them are still debated. Therefore, there is no consensus on the management and the treatment of globus pharyngeus. The purpose of this narrative review of the literature is to synthesize the current evidence regarding the causes, diagnostic strategy, and therapeutic management of globus pharyngeus.

Le globus pharyngé est un symptôme très fréquent dans la population générale. Il est défini comme une sensation de boule ou de corps étranger dans la gorge généralement, non accompagnée de douleurs et soulagée par l'alimentation. Cette dernière notion fait le diagnostic différentiel avec la dysphagie qui relève d'une mise au point et de traitements différents. Ses étiologies possibles sont complexes et multiples, aussi bien organiques que psychologiques et nombre d'entre elles restent débattues. Par conséquent, il n'existe aucun consensus sur la mise au point du globus pharyngé ni sur son traitement. Cette revue narrative de la littérature a pour objectif de synthétiser les données actuelles concernant les causes, la mise au point et la prise en charge thérapeutique du globus pharyngé.

History of Otolaryngology: Globus Pharyngeus as "Globus Hystericus".

Globus pharyngeus is the uncomfortable sensation of a "lump in the throat," and at present it has many recognized pathophysiologic causes. However, until relatively recently, this condition was often labeled "globus hystericus" and was thought to be a manifestation of hysteria or anxiety. In this commentary, we briefly review the history surrounding the initial treatment of globus pharyngeus sensation as a hysterical condition rooted in anxiety/psychological causes; then, we briefly review the emerging evidence that roots globus pharyngeus sensation within a constellation of pathophysiologies that are related to pharyngoesophageal inflammation and irritation rather than psychological disorders.

Giant Fibrovascular Polyp as an Unusual Cause of Globus Pharyngeus.

Differential diagnosis of globus sensation in an otherwise asymptomatic patient should include hypopharyngeal fibrovascular polyp to avoid potentially fatal complications like airway compromise following regurgitation. We present a case of a 74-year-old man with a 13-cm long hypopharyngeal fibrovascular polyp with 9 months history of globus sensation. A narrow stalk of the giant polyp allowed endoscopic removal and complete resection with the CO2 laser. Histopathological examination was conclusive for the fibrovascular polyp.

[Dysphagia with no obvious cause: globus pharyngeus]. / Une dysphagie sans cause évidente : le globus pharyngé.

Globus pharyngeus or globus sensation is an ordinary ENT referral. It comprises a persistent or intermittent painless feeling of a lump or foreign body in the throat and may be outlined as a tightening or choking sensation. It is usually long-lasting and has a tendency to recur. There are no established guidelines concerning diagnosis or treatment. History and clinical examination represent essential elements as they enable the practitioner to narrow the differential diagnosis and consider red flags. Therapeutic trial using PPI is recommended as initial first line treatment in the absence of red flags and paraclinical assessment can be proposed in nonresponsive patients. Management of this clinical condition consists of reassurance and offering speech therapy for refractory cases.

Le globus pharyngé est une plainte fréquente en consultation ORL. Il est défini comme une sensation, généralement chronique, de masse, blocage ou corps étranger persistant ou intermittent dans la gorge. Il n'existe pas de standards clairs concernant son diagnostic ou son traitement. L'anamnèse et l'examen clinique sont des éléments essentiels puisqu'ils permettent d'affiner les diagnostics différentiels et d'envisager une origine oncologique en présence de drapeaux rouges (tabagisme, consommation alcoolique). En l'absence de facteurs de risque, un traitement d'épreuve par IPP (inhibiteurs de la pompe à protons) est la première ligne de traitement. En l'absence d'amélioration, on peut proposer un bilan paraclinique. La prise en charge thérapeutique consiste à rassurer le patient et lui proposer des séances de logopédie pour les cas sévères.

Neuropatía laríngea y movimiento paradojal de cuerdas vocales en la edad pediátrica: reporte de un caso / Laryngeal neuropathy and paradoxical vocal fold motion in the pediatric age: case report

Resumen La neuropatía laríngea es una condición de hipersensibilidad, hiperreactividad e hiper-función laríngea secundaria a un desequilibrio entre las aferencias y eferencias laríngeas. La respuesta individual y exagerada frente a diversos gatillantes específicos puede generar síntomas como tos crónica, parestesia laríngea, carraspera, disfonía, estridor, sensación de globus faríngeo, movimiento paradojal de las cuerdas vocales (también conocido como disfunción cordal) y/o laringoespasmo. Existe abundante literatura sobre neuropatía laríngea en adultos, sin embargo, en niños es limitada. El objetivo de este artículo es dar a conocer un caso de neuropatía laríngea en la edad pediátrica y la importancia de su consideración en el enfrentamiento de estos pacientes. Se presenta caso clínico de un paciente de 13 años, con antecedente de cirugía cardiaca reciente, evoluciona con disfonía severa evidenciándose aparente inmovilidad cordal bilateral con resultados discordantes entre nasofibrolaringoscopía y electromiografía laríngea. Posteriormente presenta mejorías en su voz, sin embargo, se agregan otros síntomas laringológicos como carraspera, globus faríngeo y estridor no explicados por causas anatómicas. Se expone la evaluación y abordaje otorrinolaringológico-fonoaudiológico para el caso. Se concluye que el diagnóstico de neuropatía laríngea requiere un alto índice de sospecha clínica ante signos laringológicos sugerentes, debiendo descartarse causas orgánicas y estructurales. El abordaje otorrinolaringológico-fonoaudiológico constituye el pilar terapéutico asociado al uso de neuromoduladores en casos seleccionados.

Abstract Laryngeal neuropathy is a condition of hypersensitivity, hyperresponsiveness and laryngeal hyperfunction secondary to an imbalance between laryngeal afferent and efferent information. The individual and exaggerated response to diverse specific triggers can lead to symptoms such as chronic cough, laryngeal paresthesia, throat clearing, dysphonia, stridor, globus pharyngeus, vocal cord dysfunction, and/or laryngospasm. There is plentiful literature on laryngeal neuropathy in adults, however, in children, it is limited. Here, we present a case report of laryngeal neuropathy in the pediatric age and discuss the importance of its consideration in the approach of these patients. A case of a 13-year-old patient, recently intervened with cardiac surgery that evolves with severe dysphonia is presented. Nasofibrolaryngoscopy shows apparent bilateral vocal fold immobility with discordant results in laryngeal electromyography. Later, his voice improves but other laryngological symptoms appeared, such as throat clearing, globus pharyngeus and stridor, not explained by anatomical causes. The otolaryngological-speech therapy evaluation and approach for the case is exposed. We conclude that for the diagnosis of laryngeal neuropathy, a high index of clinical suspicion is required in the presence of suggestive laryngological symptoms, and organic and structural causes must be previously ruled out. The otorhinolaryngological-logopedic approach constitutes the mainstay of treatment associated with the use of neuromodulators in selected cases.

Normative Value for the Laryngopharyngeal Measure of Perceived Sensation.

OBJECTIVES/HYPOTHESIS: The Laryngopharyngeal Measure of Perceived Sensation (LUMP) is a recently validated patient-reported outcome measure (PROM) aimed at evaluating the symptom severity of patients with globus pharyngeus (GP). The objective of this study was to define the normative values for the LUMP questionnaire. STUDY DESIGN: Prospectively collected, descriptive research/scale development. METHODS: The LUMP questionnaire was completed by 88 subjects. Individuals without throat-related symptoms such as dysphagia, dysphonia, or cough were provided LUMP. The results of the eight-item questionnaire were analyzed for standard error of the mean (SEM), mean, and standard deviation (SD). RESULTS: Review of the 88 LUMP questionnaires elucidated a mean of 0.42 (SEM = 0.10, SD = 0.96) in the normative population. By gender, the female (n = 50) mean was 0.24, SD = 0.66, SEM = 0.09; for males (n = 38), the mean was 0.66, SD = 1.21, SEM = 0.20. CONCLUSIONS: This study provides normative data for the LUMP, a recently established PROM useful in patients with GP. A LUMP score greater than or equal to 3 should be considered abnormal and warrants additional attention. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:398-400, 2022.

An unusual cause for globus sensation: infected tracheal diverticulum with abscess formation.

CASE REPORT: A 43-year-old woman presented with a 3-week history of globus sensation and malaise. A computed tomography scan of her neck showed a large right paratracheal abscess secondary to an infected tracheal diverticulum. The patient was admitted under the ENT surgical team, and underwent incision and drainage of the abscess. There were no post-operative complications and she was discharged home after 2 days, on oral antibiotics. CONCLUSION: This case demonstrates that a tracheal diverticulum may become infected and present as a cervical abscess. To our knowledge, this is the fourth reported case in the international literature of abscess formation related to an infected tracheal diverticulum.

Major Depressive Disorder in the Older Adult Associated With Globus Pharyngeus and Weight Loss - An Indication for Electroconvulsive Therapy.

Aspiration pneumonia and extreme weight loss are risks whenever globus pharyngeus (GP) complicates major depressive disorder (MDD) in the older adult. The timely administration of electroconvulsive therapy (ECT) may reverse GP in this context. We review cases of GP in depressed older adults and describe both successful outcomes, as well as a fatal outcome associated with delays in offering ECT. MDD in the older adult complicated by GP and marked weight loss, or repeated aspiration, should be considered an urgent indication for ECT.

Medical and psychiatric differential diagnoses of pediatric globus sensation: A case study with review discussion.

Globus hystericus, also known as globus pharyngeus or globus sensation, is characterized by the physical sensation of a mass in one's throat. Globus sensation is more common in adults and reported more rarely in children. Adult patients with globus sensation score higher on neuroticism, introversion, anxiety, and depression. However, not all patients with globus sensation have psychiatric abnormalities. Thus, it is important to share an atypical presentation in children and highlight the necessity of ruling out other organic causes. The present case study elucidates the process of ruling out medical etiologies of globus sensation in a young girl with anxiety and food aversion. We provide a review discussion of the differential diagnoses, both medical and psychiatric, of globus sensation in the pediatric population reported in past literature. The case study and review of pediatric globus sensation shows that the symptom can be associated with a wide array of psychological and medical diagnoses. The medical differential diagnoses of globus sensation include the gastroenteric system, laryngeal system, cardiovascular system, and nervous system. We encourage critical analysis of other potential diagnoses, given each patient's unique history and physical presentation.

The assessment and management of globus pharyngeus.

Globus is the sensation of a foreign body in the throat. Investigation and management of patients with globus is widely variable. Most investigations yield negative results yet incur varying patient morbidity and healthcare costs, while malignancy is vanishingly rare in the absence of red flag symptoms and ear, nose and throat examination findings. History taking is key and can help to identify possible causative pathology, directing further investigations and management if necessary. Treatment of globus mainly centres on patient reassurance and counselling, and may include reflux management, neuromodulation, or speech therapy in selected cases, and treatment of any identified cause.