“Doctor, I have a lump in my throat. I can’t swallow it down and I can’t cough it up.”
This is a question I often receive as an otolaryngologist and it’s one that has an answer: globus.
Globus — what is it?
The globus sensation is the persistent feeling that you have a foreign body (such as a pill) caught in your throat — when in fact you don’t. The globus sensation occurs right about the level of your Adam’s apple (your larynx). It generally affects adults ages 35 and older.
Symptoms of globus include:
- Mild hoarseness
- Slightly altered speech
- Nagging cough that won’t go away
- Perception that your swallowing is impaired
- Feeling that you need to drink more fluids than usual
Globus is a very common complaint we see in the ENT clinic. We see hundreds of patients a year with this concern. People report there is a sensation of a flap of skin in their throats. They insist that there’s something there, even when it’s been looked at directly with an endoscope. They can’t swallow it down and they can’t clear their throats to make it come up.
I learned about globus first in medical school as something called globus hystericus, which linked it with anxiety. People were anxious that there was something stuck in their throats.
Oftentimes there’s a cancer phobia that goes with it. They have a friend or relative who died with throat cancer. They think that perhaps because they smoked a little bit years ago they might have throat cancer now. If nobody looks at their throats, the fear gets exaggerated, which is why it’s called globus hystericus.
What causes the globus sensation?
Most cases of globus are caused by acid reflux. Your stomach acid comes up into your throat and irritates the mucosa, the lining of your throat, which causes a little bit of swelling. The way your throat lining defends itself against injury like acid is by producing mucus. Mucus is a protective barrier. So if acid is coming up frequently in an abnormal way as high as your throat, it’s going to cause injury and incite inflammation in your throat lining. In reaction to that, your throat is going to weep mucus and phlegm. That’s probably what you’re feeling that gives you this globus sensation.
Another cause of globus might be post-nasal drainage and excessive mucus from allergies. In this case, the sensation is coming from sticky phlegm and mucus hanging in your throat. You might not be able to clear it as well as you want. If you can’t get it to go down your throat, it can annoy you.
How to treat globus
If you experience the globus sensation (and are younger than 50 and don’t drink and smoke heavily), follow this plan of action:
- Take 14 days of Prilosec (a stomach-acid reducer)
- Carefully monitor globus symptoms
- If the globus sensation eases off or goes away, you likely have acid-reflux disease
- If the symptoms do not improve, see your primary care physician. He or she may refer you to an otolaryngologist or a gastroenterologist.
What’s the role of an otolaryngologist regarding globus?
Patients are often referred to otolaryngologists (ear, nose and throat doctors) because primary care physicians often do not have the tools necessary to perform a thorough examination of the throat.
In our clinic, we use a soft fiber-optic laryngoscope that’s passed down through the nose. We use a topical anesthetic in your nose to numb it first. A lot of patients come in and are afraid that it’s going to hurt, but it doesn’t.
The laryngoscope takes a 90-degree turn at the back of your nose and goes down into your throat. That gives us a panoramic view of all the anatomy of your vocal chords and the entrance to your esophagus.
We can survey all those mucus membranes and that part of the throat and either identify an abnormality, or in the phenomenon of globus hystericus, most of the time we don’t find anything like cancer or anything serious that you’ve been worried about.
With a thorough examination of your throat, you’ll have peace of mind knowing there’s no phlegm, there’s no foreign body, no pill that’s stuck, no fish bone and no cancer.
This blog was contributed by David Randall Pinkston, MD, an otolaryngologist on the medical staff at Baylor Scott & White Clinic – Temple.