Symptoms of Globus

Globus is the medical term for the sensation of having a lump in the throat, or a feeling of having something stuck in the throat, or a tightness in the throat. It is a symptom that people experience, not a diagnosis.

Globus is a common symptom. Globus is not associated with pain, usually improves (or is not present) whenswallowing, and is not associated with difficulty swallowing (dysphagia).   It may be constant or intermittent, and its intensity may be vary. 

What causes globus is not understood fully, however there are several disorders that may play a role in the development of globus: reflux (both gastroesophageal and laryngopharyngeal), oesophageal dysmotility (incoordination of the muscles of the oesophagus), ectopic gastric mucosa (stomach lining) in the upper oesophagus, increased muscle activity of the upper oesophageal sphincter, cervical osteophytes (bony swellings of the cervical spine caused by arthritis), thyroid disorders, contact between the back of the tongue and the epiglottis, postnasal discharge (postnasal drip) and muscle tension (which may be related to stress and/or anxiety). In many cases several of these problems may contribute to the sensation of globus. If globus is the only symptom experienced by a person, it is important to remember that cancer of the throat is a rare cause of globus.

How do we evaluate globus?

People with globus are evaluated by taking a thorough medical history and by performing an examination of the neck and aerodigestive tract, including endoscopy. There are two types of endoscopy: standard endoscopy of the throat (including the larynx or voicebox) or transnasaloesophagoscopy (TNO). Both procedures involve the passage of an endoscope (a slim tube with a camera on the end) through the noseusing local anaesthetic. Both are performed in the office. In most cases additional investigations for globus are not required routinely. Investigations sometimes used to evaluate globus include: a barium swallow, a 24 houroesophageal impedance-pH study, oesophageal manometry and /or scanning (Ultrasound or CT or MRI).

A barium swallow is an x-ray recorded on video while you are swallowing barium, a thick white liquid. This x-ray evaluates the general structure of the throat and oesophagus, and the function of the muscles of swallowing, and is undertaken by a Radiologist in a Radiology facility.

A 24 houroesophageal pH-impedance study is an investigation to diagnose reflux. A thin tube called a catheter is passed through the nose into the throat and is then swallowed. The catheter comes out of the nose and is taped onto the cheek. It is connected to a small device worn on a belt (or carried on a sling) that records information from the catheter about the amount of reflux occurring during a 24 hour period. The person having this test are encouraged to go about their normal daily activities while the catheter is in place. The next day the catheter is removed and the information from the recording device is downloaded to analyze the results. This is undertaken by a Gastroenterologist and is inserted in the Gastroenterology office.

Oesophageal manometry is an investigation in which a thin tube called a catheter is passed through the nose into the throat and is then swallowed. The catheter comes out of the nose and is connected to a machine that measures pressures in the oesophagus while swallowing. This is undertaken by a Gastroenterologist in a Gastroenterology office.