Overview

Globus pharyngeus, also known as globus sensation, is a very common and often unsettling feeling of having a lump or foreign body in your throat. It is important to understand that this sensation occurs even though there is no actual physical obstruction or lump present. It is a subjective feeling, meaning it's something you experience, rather than something that can be seen or felt by a doctor from the outside.

This condition is not serious and is not related to throat cancer. It affects a significant number of people, with up to 45% of the population experiencing it at some point. It accounts for about 4% of all referrals to ear, nose, and throat (ENT) specialists in the UK.

People with globus pharyngeus typically describe a persistent feeling of something being stuck, tightness, or constriction in their throat, despite being able to swallow normally. Unlike true difficulty swallowing (called dysphagia), the sensation of globus often improves when you eat or drink, and there is usually no pain associated with it.

Symptoms and Causes

Globus pharyngeus is a complex condition, and its symptoms and causes are often intertwined. Understanding these can help you manage the sensation more effectively.

Symptoms

The symptoms of globus pharyngeus can vary from person to person, but they commonly include:

• A feeling of a lump or foreign body in the throat.
• A sensation of tightness, pressure, or constriction in the throat.
• Feeling like there is un-clearable mucus or catarrh (a build-up of phlegm) in the throat.
• General discomfort in the throat, but typically not pain.
• A feeling of something being stuck, even after swallowing.
• The sensation is often felt in the front of the neck and can sometimes feel like it moves up and down.
• Symptoms are usually most noticeable when swallowing saliva.
• They tend to worsen with stress, worry, or tiredness, and can fluctuate daily, often coming and going.
• Sometimes, there might be a feeling of a dry, tight throat or even intermittent hoarseness (a change in your voice).

A key characteristic of globus pharyngeus, which helps distinguish it from more serious conditions, is that the sensation often improves or is even relieved by eating and drinking. You should not experience difficulty or pain when swallowing food or liquids. If you do, this is a 'red flag' symptom that needs urgent medical attention.

Causes

The exact cause of globus pharyngeus is not fully understood, but it is thought to be due to a combination of factors. It is often described as "multifactorial," meaning many things can contribute to it. The main suggested causes and associated factors include:

• Gastro-oesophageal Reflux Disease (GORD) and Laryngopharyngeal Reflux (LPR): These conditions involve stomach acid or other stomach contents flowing back up into the food pipe (oesophagus) and sometimes even reaching the throat (pharynx) and voice box (larynx). LPR is often called 'silent reflux' because it may not cause typical heartburn symptoms, but it can still irritate and inflame the delicate tissues in the throat, making them more sensitive.
• Increased Muscle Tension: The muscles in your throat, particularly the upper oesophageal sphincter (a ring of muscle at the top of your food pipe) and the cricopharyngeus and constrictor muscles (other muscles in your throat that help with swallowing), can become tense. This tension can create the feeling of a lump. General tension in the jaw, neck, and shoulders can also contribute.
• Stress, Anxiety, and Psychological Factors: Emotional states like stress, anxiety, worry, and even bereavement can significantly worsen globus symptoms. Suppressing emotions, such as holding back tears, can also make the sensation more pronounced. Tiredness is another common trigger.
• Excess Mucus and Throat Irritation: An increase in mucus production, perhaps due to post-nasal drip (mucus dripping down the back of your throat from your nose), or general irritation of the throat tissues can contribute to the sensation.
• Habitual Throat Clearing: While it might feel like it helps, constantly clearing your throat can actually irritate the throat lining and worsen the globus sensation.
• Lifestyle Factors:
• • Smoking: Irritates the throat and can worsen reflux.
  • Alcohol and Caffeine: Can contribute to reflux and dehydrate the throat.
  • Certain Foods: Spicy, fried, fatty, or acidic foods can trigger reflux.
  • Voice Strain: Overusing or straining your voice can affect throat muscles.
• Other Associations: Less common factors that have been linked include spinal changes (such as cervical osteophytosis, which are bony growths on the bones of your neck or spine), cricopharyngeal spasm (a sudden tightening of the muscle at the top of the food pipe), an enlarged lingual tonsil (tonsil at the back of the tongue), hiatus hernia (where part of the stomach pushes up into the chest), sinusitis, and goitre (an enlarged thyroid gland in the neck).
• Altered Perception of Throat Sensations: Sometimes, the brain might become overly sensitive to normal sensations in the throat, interpreting them as a lump or obstruction.

Diagnosis and Investigations

Diagnosing globus pharyngeus involves a careful process to ensure that the sensation is not due to a more serious underlying condition. Your doctor will focus on understanding your symptoms and ruling out any 'red flag' signs.

Diagnosis

The diagnosis of globus pharyngeus is primarily made through a detailed discussion about your symptoms (history taking) and a physical examination. Your doctor will ask you many questions, such as:

• When did the sensation start?
• How often do you feel it?
• Does it come and go, or is it constant?
• Does it improve or worsen with eating and drinking?
• Do you have any pain?
• Have you lost any weight without trying?
• Do you have any difficulty swallowing food or liquids?
• Do you have any other symptoms like heartburn, hoarseness, or earache?
• Are you feeling particularly stressed or anxious?

They will also perform a physical examination of your neck to check for any lumps or tenderness. The main goal at this stage is to reassure you that globus pharyngeus is a common and non-serious condition, while also carefully checking for any signs that might suggest something else is going on.

Investigations

In many cases, if your symptoms are typical of globus pharyngeus and you have no 'red flag' signs, extensive investigations may not be needed. However, your GP or ENT specialist may recommend certain tests, especially if there are any concerns or if your symptoms are persistent.

The most common investigation is a:

• Nasolaryngoscopy (or Fibreoptic Laryngoscopy): This is a procedure where a thin, flexible tube with a camera on the end is gently passed through your nose to look at your throat (pharynx) and voice box (larynx). This allows the ENT specialist to get a clear view of these areas and confirm that there is no physical lump, growth, or other obstruction. This examination is often sufficient to confidently diagnose classic globus pharyngeus and rule out other issues.

'Red Flag' Symptoms Requiring Urgent Assessment:

It is crucial to seek urgent medical advice from your GP if you experience any of the following symptoms, as they could indicate a more serious condition and would warrant further, more urgent investigations and referral to an ENT specialist:

• Difficulty swallowing food (dysphagia) or pain when swallowing (odynophagia).
• Unexplained weight loss (losing weight without trying).
• Persistent hoarseness or voice changes that last for 3 weeks or longer.
• Pain, especially if it's only on one side of your throat or if you have an earache (otalgia) on one side.
• Symptoms that are persistent and getting worse over time.
• Regurgitation or vomiting (bringing food back up).
• A palpable lump in your neck that you can feel.
• Coughing up blood (haemoptysis).
• Symptoms that are only on one side of your throat.
• If you have a history of smoking or excessive alcohol use, which are risk factors for certain throat conditions.

If any of these 'red flag' symptoms are present, or if your globus symptoms persist despite initial self-care measures, your doctor may consider further investigations such as:

• Barium Swallow: This involves drinking a liquid containing barium, which shows up on X-rays, allowing doctors to see the shape and function of your oesophagus. While it has limited value for globus itself, it can sometimes identify other benign (non-cancerous) lesions.
• Endoscopy: A procedure where a thin, flexible tube with a camera is passed down your throat into your oesophagus and stomach to look for any abnormalities.
• Transnasal Oesophagoscopy (TNO): This is a newer technique that allows for a thorough examination of the upper food pipe and throat through the nose, often in an outpatient clinic setting, potentially avoiding the need for other investigations that might require sedation.

Management and Treatment

Managing globus pharyngeus often involves a combination of strategies aimed at addressing the underlying causes and relieving your symptoms. There isn't a single standard treatment, but rather a personalised approach based on your specific situation.

Key management strategies include:

• Reflux Management:
• • If reflux (GORD or LPR) is suspected, your doctor might suggest a trial of medication such as a proton pump inhibitor (PPI). This is a type of medication that reduces the amount of acid your stomach makes.
  • Over-the-counter antacids, like Gaviscon®, can also be helpful for managing acid indigestion.
  • Lifestyle and dietary changes are crucial (see 'Prevention' section for more details). This includes leaving at least a 3-hour gap between your last meal and bedtime.
• Muscle Tension and Relaxation Techniques:
• • Gentle Neck and Shoulder Exercises: Regular, gentle exercises can help release tension in your jaw, neck, and shoulder muscles. This includes correcting your posture (thinking 'TALL' and keeping your head balanced over your shoulders), shoulder shrugs, and slow, gentle head rotations.
  • Relaxing Throat Muscles: Try swallowing small sips of water frequently, yawning often, and making exaggerated chewing movements to help relax the muscles in your throat.
  • Speech and Language Therapy (SLT): Referral to an SLT can be very beneficial. They can teach you specific neck, shoulder, and voice exercises, as well as relaxation techniques tailored to your needs.
  • Tummy Breathing: Practicing deep breathing from your tummy (diaphragm) rather than shallow chest breathing can help promote overall relaxation.
  • Emotional Release: If you are feeling tearful or emotional, allowing yourself to cry can sometimes help, as suppressing emotions can worsen the sensation.
• Stress and Anxiety Management:
• • Since stress and anxiety are major triggers, finding ways to manage them is vital. This could include active relaxation methods like swimming, walking, or gentle exercise.
  • Relaxation techniques such as yoga, meditation, or mindfulness can also be very effective.
  • For those with significant anxiety, depression, or other psychiatric disorders that contribute to globus, your doctor might suggest therapies like Cognitive Behavioural Therapy (CBT) or, in some cases, antidepressants.
• Hydration:
• • Keeping your throat well-hydrated is crucial. Aim to drink at least 1.5 litres (about 6-8 glasses, or up to 12 cups) of water daily, taking small sips frequently throughout the day. A dry throat can make symptoms worse.
  • Breathing in steam from hot water (e.g., from a bowl with a towel over your head, or in a steamy shower) can also help to soothe and moisten your throat.
• Avoiding Habitual Throat Clearing:
• • This is a very important step. While it might feel like you need to clear your throat, this action actually irritates the delicate lining of your throat and can make the globus sensation worse.
  • Instead of clearing your throat, try sipping water, swallowing, yawning, or making a quiet 'huff' sound.
• Lifestyle Adjustments:
• • Quitting smoking is highly recommended, as smoking severely irritates the throat.
  • Maintaining a healthy weight can help reduce reflux symptoms.

Prevention

Preventing globus pharyngeus, or at least reducing the frequency and severity of its symptoms, largely involves adopting certain lifestyle changes and being mindful of factors that can trigger or worsen the sensation. Many of the management strategies also serve as preventative measures.

• Vocal Hygiene and Throat Care:
• • Avoid cigarette smoke: Smoking is a major irritant to the throat and can worsen reflux. Quitting smoking is one of the most effective preventative steps.
  • Limit alcohol and caffeine: Excessive consumption of alcohol, coffee, tea, and fizzy/acidic drinks can irritate the throat and contribute to reflux. Try to reduce your intake.
  • Avoid fatty, spicy, and fried foods: These types of foods can trigger or worsen reflux, which is a common contributor to globus.
  • Stop habitual throat clearing: This is a critical step. Constantly clearing your throat irritates the throat lining. Instead, try sipping water, swallowing, yawning, or making a quiet 'huff' sound to manage any sensation of mucus.
• Maintain Good Hydration:
• • Drink plenty of water throughout the day. Aim for at least 1.5 litres (about 6-8 glasses, or up to 12 cups) of water daily, taking small sips regularly. A well-hydrated throat is less prone to irritation and dryness, which can exacerbate globus symptoms.
• Dietary Habits for Reflux Prevention:
• • Try to leave a gap of at least 3 hours between your last meal of the day and bedtime. Eating too close to bedtime can increase the likelihood of reflux.
  • If you suspect reflux, consider discussing anti-reflux medications (available from a pharmacist or your GP) to help manage symptoms.
• Stress and Anxiety Management:
• • Actively work on reducing stress and worry in your daily life. Techniques such as mindfulness, meditation, yoga, regular exercise, or spending time in nature can be very beneficial.
  • Identify and address sources of stress where possible, and seek support if you feel overwhelmed.
• Maintain a Healthy Weight:
• • Being overweight can put extra pressure on your stomach, increasing the risk of reflux. Maintaining a healthy weight can help reduce this risk.
• Posture and Muscle Relaxation:
• • Practice good posture, keeping your head balanced and shoulders relaxed.
  • Incorporate regular, gentle neck and shoulder exercises into your routine to help release muscle tension.

Outlook / Prognosis

The outlook for globus pharyngeus is generally very good. It is a benign (non-cancerous) condition, and for many people, the symptoms often resolve over time, especially with appropriate self-care and management strategies.

While globus pharyngeus can be a chronic condition, meaning it can persist for a long time, its symptoms are typically fluctuating. This means they may come and go, or vary in severity from day to day. It is common for symptoms to recur, particularly during periods of stress or when triggers are present.

By actively addressing the contributing factors, such as managing reflux, reducing stress and anxiety, and releasing muscle tension through exercises and relaxation techniques (including those taught by a Speech and Language Therapist), most people experience significant improvement in their symptoms. The self-help measures outlined in this leaflet are often very effective in bringing relief.

Living with globus pharyngeus can be frustrating and sometimes worrying, but understanding that it is not a serious threat to your health and learning how to manage your triggers can greatly improve your quality of life. With consistent effort and patience, many individuals find that their globus sensation either disappears completely or becomes much more manageable, allowing them to live comfortably.