Globus Pharyngeus

MUSC ENT will take the time to explore all possible causes and find the solution right for you

If you have ever felt like you had a “lump” or a “frog” in your throat, it may have been Globus Pharyngeus. Almost half of all people will experience this sensation at some point in their lifetime, but luckily over half the time the sensation goes away on its own.

When to Seek Medical Care

If you are constantly clearing your throat, coughing, feel you have persistent phlegm in your throat, or have trouble swallowing, you may be experiencing globus. If globus persists for an extended amount of time, a consultation with an Ear, Nose, and Throat (ENT) doctor can help in pinpointing the cause and developing a treatment plan.

“The symptoms associated with globus can be so frustrating, because it feels like there’s something physically present in the throat but no matter how much you try to clear it, the feeling doesn’t go away,” explains Ashli K. O’Rourke, M.D., of the MUSC Health Ear, Nose and Throat Department. “While globus may eventually subside for most people, getting a consultation for globus that persists can save you a lot of stress and guessing.”

What Causes Globus?

There are many possible causes of globus, and sometimes there can be multiple causes present at the same time. These include:

• Inflammation of the throat caused by acid reflux, allergies, infection or smoking
• Tonsillar hypertrophy (chronically enlarged tonsils)
• Spasm of the upper esophageal sphincter
• Esophageal motility problems
• Lesion or mass in the throat
• Hypersensitivity of the vagal nerve due to respiratory illness
• Abnormal laryngeal (voice box) anatomy
• Stress

“Due to the vast variety of causes, a thorough medical examination is the best way to figure out what may be causing the sensation so you can start the most effective course of treatment,” shares Dr. O’Rourke. “It’s important to share your full medical history with your doctor, from past surgeries to allergies to your stress levels, so we can order the right tests for you.”

How Globus is Evaluated

Evaluations usually start with a thorough head and neck examination followed by a laryngoscopy, which uses a small flexible camera inserted through the nose to view your throat and voice box. The procedure only takes a minute or two and nasal anesthesia is used to make the exam more comfortable.

If the laryngoscopy is inconclusive, an evaluation of the esophagus (food pipe) is helpful. Esophageal testing includes:

• Esophagoscopy – The esophagus will be examined with a flexible camera inserted through the mouth
• Esophagram – The patient will swallow a barium for a clear x-ray image
• pH testing – This will measure for acid reflux
• Manometry – Pressure testing of the throat and esophagus

Other possible tests that your doctor might discuss with you include allergy testing, a modified barium swallow (an x-ray examination similar to the esophagram but focusing on the throat), laryngeal electromyography (a test of muscle function of the voice box), CT scan or MRI.

Treatment Options

If the symptom has been present for a short time, is mild and initial testing is not concerning, then you and your doctor may decide to wait and see if the symptom will go away on its own or pursue simple speech therapy.

If you are experiencing acid reflux, diet changes and antacids can be an effective solution, and occasionally, surgery is needed to address the root cause of the reflux. Antibiotics can be prescribed if there are signs of an infection and allergy medication or allergy shots may be prescribed if allergy testing is positive.

In the case of nerve-related globus, certain medications can be tried to reduce nerve stimulation in the throat. There are also newer procedures that place steroid around the sensory nerves to the voice box that help reduce inflammation and sensitivity.