Skip to main content

Advertisement

Log in

Globus pharyngeus: a review of etiology, diagnostics, and treatment

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

A Letter to the Editor to this article was published on 19 August 2018

Abstract

Globus is a non-painful sensation of a lump or a foreign body in the throat, and it frequently improves with eating. Although globus is a common symptom, only little is known about the etiology, and the causes have remained controversial. Previously, globus was labelled as a hysterical symptom. However, nowadays, the research has been mainly focused on somatic causes and it is suspected that the etiology is complex. Because of the unclear etiology, the diagnostics and treatment are varying, predisposing patients to possible unnecessary investigations. This review presents the current literature of globus: its etiology, diagnostics, and treatment. In addition, a special aim is to discuss the rational investigation methods in globus diagnostics and present a diagnostic algorithm based on recent researches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Thompson WG, Heaton KW (1982) Heartburn and globus in apparently healthy people. Can Med Assoc J 126:46–48

    PubMed  PubMed Central  CAS  Google Scholar 

  2. Tang B, Cai HD, Xie HL, Chen DY, Jiang SM, Jia L (2016) Epidemiology of globus symptoms and associated psychological factors in China. J Dig Dis 17:319–324

    Article  PubMed  Google Scholar 

  3. Merskey H, Merskey SJ (1993) Hysteria, or “suffocation of the mother”. CMAJ 148:399–405

    PubMed  PubMed Central  CAS  Google Scholar 

  4. Koufman JA (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope 101:1–78

    Article  PubMed  CAS  Google Scholar 

  5. Corso MJ, Pursnani KG, Mohiuddin MA, Gideon RM, Castell JA, Katzka DA, Katz PO, Castell DO (1998) Globus sensation is associated with hypertensive upper esophageal sphincter but not with gastroesophageal reflux. Dig Dis Sci 43:1513–1517

    Article  PubMed  CAS  Google Scholar 

  6. Gooi Z, Ishman SL, Bock JM, Blumin JH, Akst LM (2014) Laryngopharyngeal reflux: paradigms for evaluation, diagnosis, and treatment. Ann Otol Rhinol Laryngol 123:677–685

    Article  PubMed  Google Scholar 

  7. Peng L, Patel A, Kushnir V, Gyawali CP (2015) Assessment of upper esophageal sphincter function on high-resolution manometry: identification of predictors of globus symptoms. J Clin Gastroenterol 49:95–100

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zerbib F, Roman S, Ropert A, des Varannes SB, Pouderoux P, Chaput U, Mion F, Verin E, Galmiche JP, Sifrim D (2006) Esophageal pH-impedance monitoring and symptom analysis in GERD: a study in patients off and on therapy. Am J Gastroenterol 101:1956–1963

    Article  PubMed  Google Scholar 

  9. Postma GN (2006) Transnasal esophagoscopy. Curr Opin Otolaryngol Head Neck Surg 14:156–158

    Article  PubMed  Google Scholar 

  10. Galmiche JP, Clouse RE, Balint A, Cook IJ, Kahrilas PJ, Paterson WG, Smout AJ (2006) Functional esophageal disorders. Gastroenterology 130:1459–1465

    Article  PubMed  Google Scholar 

  11. Harar RP, Kumar S, Saeed MA, Gatland DJ (2004) Management of globus pharyngeus: review of 699 cases. J Laryngol Otol 118:522–527

    Article  PubMed  CAS  Google Scholar 

  12. Khalil HS, Bridger MW, Hilton-Pierce M, Vincent J (2003) The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial. Rev Laryngol Otol Rhinol (Bord) 124:187–190

    CAS  Google Scholar 

  13. Millichap F, Lee M, Pring T (2005) A lump in the throat: should speech and language therapists treat globus pharyngeus? Disabil Rehabil 27:124–130

    Article  PubMed  CAS  Google Scholar 

  14. Malcomson KG (1968) Globus hystericus vel pharyngis (a recommaissance of proximal vagal modalities). J Laryngol Otol 82:219–230

    Article  PubMed  CAS  Google Scholar 

  15. Batch AJ (1988) Globus pharyngeus (Part I). J Laryngol Otol 102:152–158

    Article  PubMed  CAS  Google Scholar 

  16. Moloy PJ, Charter R (1982) The globus symptom. Incidence, therapeutic response, and age and sex relationships. Arch Otolaryngol 108:740–744

    Article  PubMed  CAS  Google Scholar 

  17. Rasmussen ER, Schnack DT, Ravn AT (2018) A prospective cohort study of 122 adult patients presenting to an otolaryngologist’s office with globus pharyngeus. Clin Otolaryngol. https://doi.org/10.1111/coa.13065

    Article  PubMed  Google Scholar 

  18. Deary IJ, Wilson JA, Kelly SW (1995) Globus pharyngis, personality, and psychological distress in the general population. Psychosomatics 36:570–577

    Article  PubMed  CAS  Google Scholar 

  19. Ali KH, Wilson JA (2007) What is the severity of globus sensation in individuals who have never sought health care for it? J Laryngol Otol 121:865–868

    PubMed  CAS  Google Scholar 

  20. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R, Global Consensus Group (2006) The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus, Am J Gastroenterol 101:1900–1920 (quiz 1943)

    Google Scholar 

  21. Cherry J, Siegel CI, Margulies SI, Donner M (1970) Pharyngeal localization of symptoms of gastroesophageal reflux. Ann Otol Rhinol Laryngol 79:912–914

    Article  PubMed  CAS  Google Scholar 

  22. Nevalainen P, Walamies M, Kruuna O, Arkkila P, Aaltonen L (2016) Supragastric belch may be related to globus symptom—a prospective clinical study. Neurogastroenterol Motil 28:680–686

    Article  PubMed  CAS  Google Scholar 

  23. Ford CN (2005) Evaluation and management of laryngopharyngeal reflux. JAMA 294:1534–1540

    Article  PubMed  CAS  Google Scholar 

  24. Koufman J, Sataloff RT, Toohill R (1996) Laryngopharyngeal reflux: consensus conference report. J Voice 10:215–216

    Article  Google Scholar 

  25. Phua SY, McGarvey LP, Ngu MC, Ing AJ (2005) Patients with gastro-oesophageal reflux disease and cough have impaired laryngopharyngeal mechanosensitivity. Thorax 60:488–491

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Tokashiki R, Funato N, Suzuki M (2010) Globus sensation and increased upper esophageal sphincter pressure with distal esophageal acid perfusion. Eur Arch Otorhinolaryngol 267:737–741

    Article  PubMed  Google Scholar 

  27. Tauber S, Gross M, Issing WJ (2002) Association of laryngopharyngeal symptoms with gastroesophageal reflux disease. Laryngoscope 112:879–886

    Article  PubMed  Google Scholar 

  28. Kelchner LN, Horne J, Lee L, Klaben B, Stemple JC, Adam S, Kereiakes T, Levin L (2007) Reliability of speech-language pathologist and otolaryngologist ratings of laryngeal signs of reflux in an asymptomatic population using the reflux finding score. J Voice 21:92–100

    Article  PubMed  Google Scholar 

  29. Musser J, Kelchner L, Neils-Strunjas J, Montrose M (2011) A comparison of rating scales used in the diagnosis of extraesophageal reflux. J Voice 25:293–300

    Article  PubMed  Google Scholar 

  30. Hicks DM, Ours TM, Abelson TI, Vaezi MF, Richter JE (2002) The prevalence of hypopharynx findings associated with gastroesophageal reflux in normal volunteers. J Voice 16:564–579

    Article  PubMed  Google Scholar 

  31. Watson WC, Sullivan SN (1974) Hypertonicity of the cricopharyngeal sphincter: a cause of globus sensation. Lancet 2:1417–1419

    Article  PubMed  CAS  Google Scholar 

  32. Cook IJ, Dent J, Collins SM (1989) Upper esophageal sphincter tone and reactivity to stress in patients with a history of globus sensation. Dig Dis Sci 34:672–676

    Article  PubMed  CAS  Google Scholar 

  33. Sun J, Xu B, Yuan YZ, Xu JY (2002) Study on the function of pharynx upper esophageal sphincter in globus hystericus. World J Gastroenterol 8:952–955

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kwiatek MA, Mirza F, Kahrilas PJ, Pandolfino JE (2009) Hyperdynamic upper esophageal sphincter pressure: a manometric observation in patients reporting globus sensation. Am J Gastroenterol 104:289–298

    Article  PubMed  PubMed Central  Google Scholar 

  35. Choi WS, Kim TW, Kim JH, Lee SH, Hur WJ, Choe YG, Lee SH, Park JH, Sohn CI (2013) High-resolution manometry and globus: comparison of globus, gastroesophageal reflux disease and normal controls using high-resolution manometry. J Neurogastroenterol Motil 19:473–478

    Article  PubMed  PubMed Central  Google Scholar 

  36. Wilson JA, Pryde A, Piris J, Allan PL, Macintyre CC, Maran AG, Heading RC (1989) Pharyngoesophageal dysmotility in globus sensation. Arch Otolaryngol Head Neck Surg 115:1086–1090

    Article  PubMed  CAS  Google Scholar 

  37. Farkkila MA, Ertama L, Katila H, Kuusi K, Paavolainen M, Varis K (1994) Globus pharyngis, commonly associated with esophageal motility disorders. Am J Gastroenterol 89:503–508

    PubMed  CAS  Google Scholar 

  38. Knight RE, Wells JR, Parrish RS (2000) Esophageal dysmotility as an important co-factor in extraesophageal manifestations of gastroesophageal reflux. Laryngoscope 110:1462–1466

    Article  PubMed  CAS  Google Scholar 

  39. Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJ, International High Resolution Manometry Working Group (2012) Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography. Neurogastroenterol Motil 24(Suppl 1):57–65

    Article  PubMed  PubMed Central  Google Scholar 

  40. Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE, International High Resolution Manometry Working Group (2015) The Chicago classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil 27:160–174

    Article  PubMed  CAS  Google Scholar 

  41. Aziz Q, Fass R, Gyawali CP, Miwa H, Pandolfino JE, Zerbib F (2016) Functional esophageal disorders. Gastroenterology 150:1368–1379

    Article  Google Scholar 

  42. Deary IJ, Smart A, Wilson JA (1992) Depression and ‘hassles’ in globus pharyngis. Br J Psychiatry 161:115–117

    Article  PubMed  CAS  Google Scholar 

  43. Harris MB, Deary IJ, Wilson JA (1996) Life events and difficulties in relation to the onset of globus pharyngis. J Psychosom Res 40:603–615

    Article  PubMed  CAS  Google Scholar 

  44. Moser G, Vacariu-Granser GV, Schneider C, Abatzi TA, Pokieser P, Stacher-Janotta G, Gaupmann G, Weber U, Wenzel T, Roden M (1991) High incidence of esophageal motor disorders in consecutive patients with globus sensation. Gastroenterology 101:1512–1521

    Article  PubMed  CAS  Google Scholar 

  45. Word Health Organization (2016) International classification of diseases and related health problems, 10th revision. http://www.who.int/classifications/icd/en/. Accessed 25 Oct 2017

  46. Batch AJ (1988) Globus pharyngeus: (part II), discussion. J Laryngol Otol 102:227–230

    Article  PubMed  CAS  Google Scholar 

  47. Haft S, Carey RM, Farquhar D, Mirza N (2016) Anticholinergic medication use is associated with globus pharyngeus. J Laryngol Otol 130:1125–1129

    Article  PubMed  CAS  Google Scholar 

  48. Mamede RC, De Mello-Filho FV, Dantas RO (2004) Severe hypertrophy of the base of the tongue in adults. Otolaryngol Head Neck Surg 131:378–382

    Article  PubMed  Google Scholar 

  49. Agada FO, Coatesworth AP, Grace AR (2007) Retroverted epiglottis presenting as a variant of globus pharyngeus. J Laryngol Otol 121:390–392

    Article  PubMed  CAS  Google Scholar 

  50. Burns P, Timon C (2007) Thyroid pathology and the globus symptom: are they related? A two year prospective trial. J Laryngol Otol 121:242–245

    Article  PubMed  CAS  Google Scholar 

  51. Nam IC, Choi H, Kim ES, Mo EY, Park YH, Sun DI (2015) Characteristics of thyroid nodules causing globus symptoms. Eur Arch Otorhinolaryngol 272:1181–1188

    Article  PubMed  Google Scholar 

  52. Hemmink GJ, Bredenoord AJ, Weusten BL, Timmer R, Smout AJ (2009) Supragastric belching in patients with reflux symptoms. Am J Gastroenterol 104:1992–1997

    Article  PubMed  Google Scholar 

  53. Bredenoord AJ (2010) Excessive belching and aerophagia: two different disorders. Dis Esophagus 23:347–352

    Article  PubMed  Google Scholar 

  54. Hemmink GJ, Ten Cate L, Bredenoord AJ, Timmer R, Weusten BL, Smout AJ (2010) Speech therapy in patients with excessive supragastric belching—a pilot study, Neurogastroenterol Motil 22:24–28 (e2–3)

    Google Scholar 

  55. Luyten A, Bruneel L, Meerschman I, D’haeseleer E, Behlau M, Coffe C, Van Lierde K (2016) Prevalence of vocal tract discomfort in the flemish population without self-perceived voice disorders. J Voice 30:308–314

    Article  PubMed  Google Scholar 

  56. Jarvenpaa P, Laatikainen A, Roine RP, Sintonen H, Arkkila P, Aaltonen LM (2017) Symptom relief and health-related quality of life in globus patients: a prospective study. Logoped Phoniatr Vocol. https://doi.org/10.1080/14015439.2017.1397741

    Article  PubMed  Google Scholar 

  57. Rowley H, O’Dwyer TP, Jones AS, Timon CI (1995) The natural history of globus pharyngeus. Laryngoscope 105:1118–1121

    Article  PubMed  CAS  Google Scholar 

  58. Jarvenpaa P, Ilmarinen T, Geneid A, Pietarinen P, Kinnari TJ, Rihkanen H, Ruohoalho J, Markkanen-Leppanen M, Back L, Arkkila P, Aaltonen LM (2017) Work-up of globus: assessing the benefits of neck ultrasound and videofluorography. Eur Arch Otorhinolaryngol 274:931–937

    Article  PubMed  Google Scholar 

  59. Ardran GM (1982) Feeling of a lump in the throat: thoughts of a radiologist. J R Soc Med 75:242–244

    PubMed  PubMed Central  CAS  Google Scholar 

  60. Webb CJ, Makura ZG, Fenton JE, Jackson SR, McCormick MS, Jones AS (2000) Globus pharyngeus: a postal questionnaire survey of UK ENT consultants. Clin Otolaryngol Allied Sci 25:566–569

    Article  PubMed  CAS  Google Scholar 

  61. Dworkin JP, Dowdall JR, Kubik M, Thottam PJ, Folbe A (2015) The role of the modified barium swallow study and esophagram in patients with globus sensation. Dysphagia 30:506–510

    Article  PubMed  Google Scholar 

  62. Luk WH, Lo AX, Au-Yeung AW, Lai MH, Woo YH, Wong LK, Chiang CC (2014) The role of barium swallow pharyngoesophagography in the management of the globus pharyngeus: our ten years local experience of asian population. Indian J Otolaryngol Head Neck Surg 66:153–155

    Article  PubMed  Google Scholar 

  63. Kubba H, Spinou E, Brown D (2003) Is same-day discharge suitable following rigid esophagoscopy? Findings in a series of 655 cases. Ear Nose Throat J 82:33–36

    PubMed  Google Scholar 

  64. Takwoingi YM, Kale US, Morgan DW (2006) Rigid endoscopy in globus pharyngeus: how valuable is it? J Laryngol Otol 120:42–46

    Article  PubMed  CAS  Google Scholar 

  65. Shaker R (1994) Unsedated trans-nasal pharyngoesophagogastroduodenoscopy (T-EGD): technique. Gastrointest Endosc 40:346–348

    Article  PubMed  CAS  Google Scholar 

  66. Aviv JE, Takoudes TG, Ma G, Close LG (2001) Office-based esophagoscopy: a preliminary report. Otolaryngol Head Neck Surg 125:170–175

    Article  PubMed  CAS  Google Scholar 

  67. Postma GN, Cohen JT, Belafsky PC, Halum SL, Gupta SK, Bach KK, Koufman JA (2005) Transnasal esophagoscopy: revisited (over 700 consecutive cases). Laryngoscope 115:321–323

    Article  PubMed  Google Scholar 

  68. Dean R, Dua K, Massey B, Berger W, Hogan WJ, Shaker R (1996) A comparative study of unsedated transnasal esophagogastroduodenoscopy and conventional EGD. Gastrointest Endosc 44:422–424

    Article  PubMed  CAS  Google Scholar 

  69. Thota PN, Zuccaro G Jr, Vargo JJ 2nd, Conwell DL, Dumot JA, Xu M (2005) A randomized prospective trial comparing unsedated esophagoscopy via transnasal and transoral routes using a 4-mm video endoscope with conventional endoscopy with sedation. Endoscopy 37:559–565

    Article  PubMed  CAS  Google Scholar 

  70. Streckfuss A, Bosch N, Plinkert PK, Baumann I (2014) Transnasal flexible esophagoscopy (TNE): an evaluation of the patient’s experience and time management. Eur Arch Otorhinolaryngol 271:323–328

    Article  PubMed  Google Scholar 

  71. Amin MR, Postma GN, Setzen M, Koufman JA (2008) Transnasal esophagoscopy: a position statement from the American Bronchoesophagological Association (ABEA). Otolaryngol Head Neck Surg 138:411–414

    Article  PubMed  Google Scholar 

  72. Lundell LR, Dent J, Bennett JR, Blum AL, Armstrong D, Galmiche JP, Johnson F, Hongo M, Richter JE, Spechler SJ, Tytgat GN, Wallin L (1999) Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 45:172–180

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  73. Ronkainen J, Aro P, Storskrubb T, Lind T, Bolling-Sternevald E, Junghard O, Talley NJ, Agreus L (2006) Gastro-oesophageal reflux symptoms and health-related quality of life in the adult general population—the Kalixanda study. Aliment Pharmacol Ther 23:1725–1733

    Article  PubMed  CAS  Google Scholar 

  74. Fox M, Hebbard G, Janiak P, Brasseur JG, Ghosh S, Thumshirn M, Fried M, Schwizer W (2004) High-resolution manometry predicts the success of oesophageal bolus transport and identifies clinically important abnormalities not detected by conventional manometry. Neurogastroenterol Motil 16:533–542

    Article  PubMed  CAS  Google Scholar 

  75. Kahrilas PJ, Clouse RE, Hogan WJ (1994) American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 107:1865–1884

    Article  PubMed  CAS  Google Scholar 

  76. Sifrim D, Silny J, Holloway RH, Janssens JJ (1999) Patterns of gas and liquid reflux during transient lower oesophageal sphincter relaxation: a study using intraluminal electrical impedance. Gut 44:47–54

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  77. Vela MF, Camacho-Lobato L, Srinivasan R, Tutuian R, Katz PO, Castell DO (2001) Simultaneous intraesophageal impedance and pH measurement of acid and nonacid gastroesophageal reflux: effect of omeprazole. Gastroenterology 120:1599–1606

    Article  PubMed  CAS  Google Scholar 

  78. Katz PO, Castell DO (2000) Medical therapy of supraesophageal gastroesophageal reflux disease. Am J Med 108(Suppl 4a):170S-177S

    PubMed  Google Scholar 

  79. Park W, Hicks DM, Khandwala F, Richter JE, Abelson TI, Milstein C, Vaezi MF (2005) Laryngopharyngeal reflux: prospective cohort study evaluating optimal dose of proton-pump inhibitor therapy and pretherapy predictors of response. Laryngoscope 115:1230–1238

    Article  PubMed  CAS  Google Scholar 

  80. Thibeault SL, Smith ME, Peterson K, Ylitalo-Moller R (2007) Gene expression changes of inflammatory mediators in posterior laryngitis due to laryngopharyngeal reflux and evolution with PPI treatment: a preliminary study. Laryngoscope 117:2050–2056

    Article  PubMed  Google Scholar 

  81. Gatta L, Vaira D, Sorrenti G, Zucchini S, Sama C, Vakil N (2007) Meta-analysis: the efficacy of proton pump inhibitors for laryngeal symptoms attributed to gastro-oesophageal reflux disease. Aliment Pharmacol Ther 25:385–392

    Article  PubMed  CAS  Google Scholar 

  82. Noordzij JP, Khidr A, Evans BA, Desper E, Mittal RK, Reibel JF, Levine PA (2001) Evaluation of omeprazole in the treatment of reflux laryngitis: a prospective, placebo-controlled, randomized, double-blind study. Laryngoscope 111:2147–2151

    Article  PubMed  CAS  Google Scholar 

  83. Vaezi MF, Richter JE, Stasney CR, Spiegel JR, Iannuzzi RA, Crawley JA, Hwang C, Sostek MB, Shaker R (2006) Treatment of chronic posterior laryngitis with esomeprazole. Laryngoscope 116:254–260

    Article  PubMed  CAS  Google Scholar 

  84. Brown SR, Schwartz JM, Summergrad P, Jenike MA (1986) Globus hystericus syndrome responsive to antidepressants. Am J Psychiatry 143:917–918

    Article  PubMed  CAS  Google Scholar 

  85. Cybulska EM (1997) Globus hystericus—a somatic symptom of depression? The role of electroconvulsive therapy and antidepressants. Psychosom Med 59:67–69

    Article  PubMed  CAS  Google Scholar 

  86. Wareing M, Elias A, Mitchell D (1997) Management of globus sensation by the speech therapist. Logoped Phoniatr Vocol 22:39–42

    Article  Google Scholar 

  87. Timon C, O’Dwyer T, Cagney D, Walsh M (1991) Globus pharyngeus: long-term follow-up and prognostic factors. Ann Otol Rhinol Laryngol 100:351–354

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Pia Järvenpää.

Ethics declarations

Conflict of interest

All authors have no conflict of interest.

Human and animal rights statement

This article is a review article within which there are no human participants or animals. Informed consent is not available in this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Järvenpää, P., Arkkila, P. & Aaltonen, LM. Globus pharyngeus: a review of etiology, diagnostics, and treatment. Eur Arch Otorhinolaryngol 275, 1945–1953 (2018). https://doi.org/10.1007/s00405-018-5041-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-5041-1

Keywords

Navigation