Globus

Definition/diagnostic criteria Globus is characterised as a persistent or intermittent sensation of a lump or foreign body in the throat, without dysphagia (difficulty swallowing) or odynophagia (painful swallowing). This sensation typically does not interfere with eating or drinking and is not associated with any structural abnormalities or diseases.

Epidemiology Globus is a common ENT complaint, although its exact prevalence is difficult to ascertain due to its subjective nature and variability in reporting. It affects both genders and all age groups but is most commonly reported in middle-aged individuals. There is no clear consensus on the prevalence rate, but it’s acknowledged as a frequent reason for ENT referrals.

Diagnosis
Clinical features: Diagnosing globus primarily involves excluding other causes of similar symptoms such as Gastroesophageal Reflux Disease (GORD) and Eosinophilic Esophagitis (EoE).

• Patients typically describe a sensation of a lump or tightness in the throat, which is usually not associated with swallowing food or liquid.
• The sensation may be constant or intermittent and is often exacerbated by stress or anxiety.

Investigations: Often, no investigations are required. When necessary, their aim is to rule out other conditions rather than to confirm globus. These may include:

• Endoscopy: To exclude structural abnormalities or other conditions like GORD or EoE.
• Barium swallow: Can be considered if dysphagia is present or if endoscopy is inconclusive.
• Thyroid function tests: To exclude thyroid enlargement or dysfunction.
• Neck ultrasound: If a thyroid or other mass is suspected.

Treatment The treatment of globus primarily involves reassurance, as the condition is benign and self-limiting. If symptoms are persistent or troubling, the following approaches may be considered:

• Dietary modifications: Avoiding foods that exacerbate symptoms, especially if there is an overlap with GORD symptoms.
• Speech and language therapy (SLT): Techniques to relax the throat muscles can be helpful.
• Proton pump inhibitors (PPIs): Considered if GORD is suspected or confirmed.
• CBT or anxiolytics/antidepressants: In cases where anxiety or depression is contributing to or exacerbating symptoms.

Prognosis The prognosis for globus is generally good. Most patients experience improvement with reassurance and simple measures. However, some individuals may experience persistent or recurrent symptoms, especially if associated with anxiety or stress. In such cases, addressing the underlying psychological factors is crucial for symptom resolution.