The Faculty of Medicine, through the department of Ear Nose and Throat (ENT), held a grand round on June 13, 2023 on the topic “Globus pharyngeus” The presentation and discussion were centered on key features, symptoms, diagnosis clinical assessment, management and medical treatment.
Globus pharyngeus is an intermittent or constant non-painful sensation of fullness or lump in the throat. This sensation usually lasts longer than 3 weeks. First related to Hysteria by John Purcell but later found to be completely unrelated. It is a diagnosis of exclusion of other possible conditions with similar presentation.
in primary health care (PHC) is managed in 6.7 per 100,000 encounters according to Pollack et al (2014).
Women may be affected more according to statistics. Some of the known causes are pharyngeal and esophageal dysfunctions like infections and esophageal sphincter malfunction, some of the causes are psychological for example a woman who felt the sensation after having a husband die from esophageal carcinoma. The other possible cause is Gastroesophageal reflux disorder (GERD).
The risk factors include smoking, alcohol intake and these two specifically lead to relaxation of esophageal sphincter causing reflux. Drugs like Calcium Channel blockers (CCB) e.g. Diltiazem, Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) e.g. ibuprofen are known to be a risk factor for globus pharyngeus. Defects in anatomy like tonsillar hypertrophy and masses within the pharynx and larynx can lead to globus. Lastly stress as a major factor in the psychological aspect of the disorder is a leading risk factor for globus pharyngeus in this current era.
Some of the symptoms seen include a feeling of fullness and discomfort around the throat, having the feeling of food being stuck in throat and this feeling is absent in between eating and drinking.
The diagnosis and clinical assessment include a full Ear Nose and Throat (ENT) clinical examination with attention to the oropharyngeal area. Investigations are mainly of the imagining kind and these include esophagogastroscopy, laryngotracheoscopy and Barium Swallow Fluoroscopy. These aid and provide the specialists with better images of the pharynx and exclude other possible diagnoses.
Management for Globus pharyngeus is centered on diet and lifestyle modifications which include reduction in alcohol consumption, increase in hydration, exercise and cessation of citrus fruit eating. These modifications are to remove the precipitating factors for globus pharyngeus.
Medical treatment in the line with discovered cause is advised, it includes anti-reflux treatment with proton pump inhibitors like Omeprazole and this dosage is to go for at least 3 months, twice daily or if no response then for 6 months. This ensures maximum efficacy of the drug regime. Anti-acids like sodium bicarbonate can be provided to reduce the acidity in case of GERD.
Speech and language therapy is paramount for the Rehabilitation of the vocal chords and the throat at large.
In cases of non-responders, further investigations and procedures are done to remedy this, lifestyle modifications are then recommended for life.
Some of the red flags in globus pharyngeus are;
- Weightless
- Dysphagia
- Unilateral symptoms and
- Systemic symptoms
These are red flags because they signal a more deliberating condition that needs more immediate attention compared to globus pharyngeus.
In conclusion, globus pharyngeus is a symptom of a greater diagnosis and should be considered and approached with care.
