Globus Sensation

What is Globus Sensation?

Globus sensation (also known as globus pharyngeus, globus pharyngis or a “lump in the throat”) is the feeling of having something stuck in the throat, even though there is no physical obstruction in the esophagus. This sensation can come and go, or can be constant.

While it can be uncomfortable, the globus sensation usually doesn’t cause pain or difficulty swallowing, and isn’t dangerous to a person’s health by itself. Most people have experienced a “lump in the throat” feeling momentarily due to pride, excitement, sadness or grief. But in those with globus pharyngeus, globus symptoms can be constant or come and go, even without being connected to these emotions.

In the past, having a recurring globus sensation was sometimes referred to as “globus hystericus,” as it was believed that the condition was “all in the patient’s head” and due to psychological factors. With the evolution of medical knowledge, testing and imaging, however, physicians now recognize that for many patients, experiencing a chronic globus sensation often does have a physical cause.

How Common is Globus Sensation?

Globus pharyngeus is a relatively common condition, accounting for around 4% of all referrals to ear, nose and throat (ENT) specialists. About 45% of the overall population is thought to have experienced globus symptoms at some point in their lives.

For most, experiencing a globus sensation is a short-term condition. For some people, however, globus symptoms persist longer, with the “lump in throat” feeling coming and going, sometimes in response to stressful events or triggers. For example, up to 96% of those who experience globus sensation report their symptoms get worse during emotionally-intense moments.

Why Is It Called ‘Globus Sensation’?

Many people who experience a chronic globus sensation describe it as feeling like there’s something hard and smooth stuck in their throat. “Globus” is the Latin word for “ball.” “Globus sensation” is a simple way of describing what the condition feels like for some people: like having a small ball stuck in your throat.

What Are The Symptoms of Globus Sensation?

The primary symptom of globus sensation is feeling like there’s a foreign body creating a lump in the throat. Other common ways of describing the throat symptoms associated with globus pharyngeus include:

• Feeling like there’s mucus in the throat that you’re unable to clear

• Feeling generalized pressure or tightness in the throat

• Having a strangling or choking feeling without known cause

• Having an area of discomfort in the front of the throat

In those with globus pharyngeus, the sensation of having something stuck in the throat usually isn’t changed or relieved by swallowing. The issue is most often felt at the front of the neck, with the sensation usually occurring in a range from a few inches below the chin and the top of the sternum/breastbone.

The globus sensation often comes and goes. Unlike many other conditions that include throat symptoms, globus pharyngeus is not typically painful, only odd-feeling or uncomfortable, and doesn’t usually cause problems swallowing.

Other symptoms associated with globus pharyngeus include:

• Chronic cough

• Repeated throat clearing

• Catarrh, which is a build-up of mucus in the throat

• Having a hoarse speaking voice

What Causes Globus Sensation?

The underlying cause of globus sensation is unknown. However, there are a number of conditions that are thought to be related to chronic globus sensation, including:

• Gastroesophageal reflux disease (GERD), which involves chronic regurgitation of stomach acid and contents into the esophagus. A condition called hypertensive upper esophageal sphincter, which is thought to be associated with globus sensation, is often linked with gastroesophageal reflux disease and GERD symptoms

• Cervical osteophytosis, which are bone spurs that can develop in the vertebrae of the neck

• Hiatal hernia, which is when part of the stomach intrudes into the space between the lungs that’s usually occupied by the esophagus

• Cricopharyngeal spasm (AKA upper esophageal sphincter dysfunction) which is a disorder characterized by an overly-tight cricopharyngeal muscle. Also called the upper esophageal sphincter (UES), this muscle allows food and liquid to pass from the mouth into the esophagus

• Postnasal drip

• Having a goiter, which is an abnormal enlargement of the thyroid gland

• Chronic sinusitis, which is an inflammation and swelling of the sinuses

• Tonsillitis

• Pharyngitis, which is an inflammation of the throat

• Abnormal upper esophageal sphincter (UES) function, which can allow stomach acid that has backwashed into the esophagus to also intrude into the throat

• Reflux esophagitis, a condition related to GERD which results in inflammation that can damage the lining of the esophagus

• Anxiety

• Esophageal motility disorders that impact the coordination and speed of esophageal muscle contractions, including:

  • Achalasia

  • Diffuse esophageal spasm

  • Eosinophilic esophagitis

  • Systemic sclerosis

When Should I Worry About a Lump In My Throat?

While it can be uncomfortable and can lead to issues like repeated throat clearing and chronic cough, globus sensation alone is not a serious danger to a person’s health.

However, globus patients who experience that “lump in the throat” feeling along with certain other issues may be a sign you are experiencing a more serious condition. Symptoms that might suggest a more serious condition when experienced in conjunction with globus sensation include:

• Difficulty swallowing (AKA dysphagia)

• Vomiting

• Choking or gagging when swallowing

• Throat pain, including pain while swallowing

• Unexplained weight loss

• A lump in the neck that can be felt through the skin

• Unexplained muscle weakness or fatigue

What Triggers Globus Sensation?

There are several factors that can trigger globus sensation or make symptoms worse in some people. These factors may include:

• Being tired

• Muscle tension in the throat and neck

• Stress, anxiety and/or psychological distress

• Over-stressing your voice through talking, shouting, public speaking, etc.

• Smoking

• Acid reflux symptoms

• Having an enlarged thyroid gland

How Is Globus Sensation Diagnosed?

Diagnosing globus sensation can be difficult, with more dangerous conditions that can create issues with the throat and esophagus often ruled out first. As part of your treatment, you will likely be referred to an ear, nose and throat specialist.

For patients reporting globus sensation that is recurring, the doctor will usually begin by asking questions, including:

• What the globus sensation feels like to you

• Whether you experience any pain or a sore throat along with the globus sensation

• Whether you have a history of gastric reflux or reflux symptoms

• When the symptoms first started (AKA symptom onset)

• Your personal and family medical history

• Whether any factors trigger the globus sensation in your throat or make it worse

These questions will usually be followed by a thorough physical examination of the neck and throat, including feeling the neck for any swellings or masses, and looking into your throat for an obstruction that could be causing your globus symptoms.

Depending on the results of this examination, you may be asked to submit to more specialized tests that can rule out other conditions of the throat, esophagus and upper GI tract. These tests may include:

• Chest X-rays

• Endoscopy

• Barium Swallow Testing, which utilizes a special liquid containing barium that allows the tissues of the esophagus to be more easily visualized

Can Chronic Globus Sensation be Cured?

Currently, there’s no known cure for recurring globus sensation. As the underlying cause of globus sensation is also not known, treatment and management options will usually be aimed at treating any conditions that might be contributing to your symptoms.

What Are The Treatment Options For Globus Sensation?

If gastroesophageal reflux disease (GERD) is suspected, you may be prescribed special medications called proton pump inhibitors that can reduce the amount of stomach acid produced by your body. Proton pump inhibitor therapy can be useful in alleviating ongoing irritation and inflammation of the throat and esophagus that may be contributing to chronic globus sensation.

Other steps that may be involved in treating globus sensation or managing symptoms include:

• Learning relaxation techniques that can help you reduce stress while moving your focus away from the sensation in your throat

• Quitting smoking

• Taking medications to reduce postnasal drip

• Speech therapy for globus-related hoarseness of voice

• Taking antidepressants, undergoing cognitive-behavioral therapy and other treatments if severe stress or other psychiatric disorders are thought to be contributing to your symptoms