Globus Pharyngeus

The exact cause of Globus remains unclear. There are several theories as to why people develop this condition. It was once called Globus Hystericus, wrongly suggesting that this is a purely psychiatric condition. The factors currently believed to cause Globus are:

• Excess muscle tension in the muscles of the voice box (larynx)
• Irritation or swelling of the tissues lining the throat
• Altered perception of how the throat feels

These difficulties can be associated with:

• Acid reflux: Many people with globus have reflux of stomach acid into the oesophagus (gullet) or throat. This can be ‘silent’ and individuals do not always feel symptoms of heartburn or indigestion. The muscles of the throat do not like acid washing over them, and this is often a cause of increased tension in these muscles. Stress causes an increase in stomach acid production as well. Acid reflux is most often associated with chronic throat clearing, voice quality change and a globus sensation.
• Stress and anxiety: Nearly everyone with globus find that their symptoms are worse when they are stressed or anxious. This is partly because stress causes a general increase in muscle tension and that any stress makes us more aware of any problem which we feel may interfere with our performance or life in general. If you are worried that you may have cancer, not surprisingly you become even more stressed and anxious, and the globus gets worse still.
• Smoking: not everyone who has globus smokes, but smoking can make globus worse as it can cause irritation of the throat. Smoking can also make reflux worse.
• Voice strain: overuse of the voice, or not having the most efficient technique for projecting the voice can affect the small muscles in the throat which increases muscle tension leading to globus sensation.
• Post-nasal drip – Mucus produced from the back of the nose can drip back down into the throat creating the sensation of something in the throat and the need to clear the throat. Continually clearing the throat can also cause irritation of the throat making the globus worse.
• Tiredness – Often people will describe their symptoms being worse when they are more tired, usually at the end of the day or after a busy and stressful day especially if most of the day has been spent talking or on the phone.

Usually, a detailed history of your symptoms with an examination of your throat using a fibre-optic camera (nasendoscopy) in an Ear Nose and Throat clinic (to rule out any significant underlying physical causes) is all that is required to establish a diagnosis of Globus. Most patients with globus have nothing to worry about; globus is not associated with cancer of the throat which itself is uncommon.

It is unusual to require any further investigations beyond outpatient nasendoscopy, however, if your doctor has any concerns, they may organise additional investigations such as a barium swallow (X-ray of the throat and oesophagus) or an endoscopy (a look down the throat under anaesthetic).

Patients who have throat cancer may have similar symptoms, but the sensation tends to be one sided and associated with difficulty swallowing and sometimes pain radiating to the ear.

Difficulty swallowing, a hoarse voice persisting for 3 weeks or an unexplained sore throat persisting for 3 weeks should always be investigated urgently.

Many patients find that an explanation and reassurance following examination can alleviate the symptoms of globus. It may also be necessary to treat or manage the underlying triggers of the symptoms:

• Treatment of reflux – this can be with antacid medications and with changes to your diet or often both. Treatment for reflux of the throat will often take several weeks of months of continued treatment before you will notice an improvement.

• Treatment of any post-nasal drip – with nasal steroid spray and saline nasal washes. You will need to use the sprays for several weeks before seeing any effect.

• Treatment for allergies

• Speech and language therapy (SLT) – In some cases you may be referred to SLT for treatment and this can be effective for symptoms such as voice strain or overuse, throat clearing and tension.

There are many things you can consider doing to improve your symptoms:

• Ensure you keep well hydrated, avoiding too much coffee, alcohol and fizzy or acidic drinks.

• Stop throat clearing where possible. Try taking a sip of water instead of throat clearing.

• Try and address any stresses in your life or talk to your GP about ways to manage these.

• Stop smoking if you currently smoke.

• Consider weight loss if appropriate.

In most cases the symptoms of Globus Pharyngeus will get better without specialist help or treatment.

If your symptoms include any “red flags” such as difficulty swallowing food, regurgitation or vomiting, associated weight loss, one-sided throat pain, or a persistently hoarse voice you should seek an early medical assessment with your GP.

If your symptoms do not include any “red flag” elements but do not improve after trying the self-care measures described above, then you should seek further advice from your GP and may require further investigations.

Useful information about Globus:

• Throat symptoms: information for patients – Kernow Clinical Commissioning Group
• Globus Pharyngeus: patient information leaflet – Torbay & South Devon NHS Foundation Trust
• Globus Pharyngeus: patient information leaflet – University Hospital Plymouth NHS Trust

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

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