Patients with GH report a sensation of a lump or a foreign body in the throat. These symptoms are not associated with pain, dysphagia, or food sticking in the throat.

Worrisome features that are indicative of serious disorders include onset after the age of 50 years, concomitant weight loss, pain, palpable neck mass, dysphagia, regurgitation, muscle weakness, and worsening of symptoms.

Physical exam

There are no notable findings in GH.

• Family History of Depression

  Patients with recurrent globus symptom and family history of depressive illness should be screened for a possibility of depressive disorder. ECT and antidepressants may be successfully used in treatment of globus in a setting of depressive illness. [ncbi.nlm.nih.gov]

• Rigor

  Filled with simple humor and rigorous mime technique, the Road to Tadam has performed at numerous festivals in Slovenia (Ana Desetnica, Lent, Kamfest, SWISST), in Croatia (Festival Street Talks), in Montenegro (Festival International Alternative Theatre [globus-hystericus.org]

• Turkish

  Look up "globus hystericus" at Merriam-Webster Look up "globus hystericus" at dictionary.com In other languages: Spanish French Italian Portuguese Romanian German Dutch Swedish Russian Polish Czech Greek Turkish Chinese Japanese Korean Arabic Advertisements [wordreference.com]

• Weight Gain

  Weight gain was maintained at 1, 6, and 10 months posttreatment. [ncbi.nlm.nih.gov]

• Pallor

  […] factors for aerodigestive malignancy: smoking, alcohol use, HPV status, GERD, age, family history Physical Exam Complete exam of neck and oropharynx Inspection for neck/oral masses, adenopathy, tonsillar/pharyngeal inflammation, mucosal dryness and pallor [medicine.uiowa.edu]

• Sputum

  […] symptoms can be characterized and suggests another disorder present in concern such as; Dysphagia (Difficulty in swallowing and sometimes choked when eating) Feeling of a movable mass in the throat Hemoptysis (expectoration of blood or of blood stained sputum [healthsurgical.com]

• Dysphagia

  (C1955519) Concepts Disease or Syndrome ( T047 ) ICD10 R13.19 English cervical dysphagia, cervical dysphagia (diagnosis), Cervical dysphagia [fpnotebook.com]

  These symptoms are not associated with pain, dysphagia, or food sticking in the throat. [symptoma.com]

  ‘High dysphagia must be differentiated from globus hystericus (the feeling of having a lump in the throat without any true dysphagia).’ [en.oxforddictionaries.com]

• Pruritus Ani

  ani 2016 2017 2018 2019 Billable/Specific Code psychogenic F45.8 anogenital L29.3 ICD-10-CM Diagnosis Code L29.3 Anogenital pruritus, unspecified 2016 2017 2018 2019 Billable/Specific Code psychogenic F45.8 scroti, scrotum L29.1 ICD-10-CM Diagnosis Code [icd10data.com]

• Blurred Vision

  Globus hystericus is a symptom of some physical disorders such as reflux laryngitis as well as a classic sign of hysterical neurosis, a psychosomatic disorder characterized by a change or loss of physical function (such as blurred vision or paralysis [medicinenet.com]

• Ptosis

  Additional symptoms may include ptosis, chorea, ataxia, globus hystericus (difficulty swallowing), and astasia-abasia (the inability to stand or sit upright but an ability to move the legs when lying down or sitting). [tripdatabase.com]

• Short Neck

  neck, and signs of stagnation between the eyebrows. [kpubs.org]

• Globus Symptom

  The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns. [ncbi.nlm.nih.gov]

  Wareing et al. 2009 showed improvement in globus symptoms in 92% (23/25) of patients undergoing speech therapy. [medicine.uiowa.edu]

  Using DSM-III diagnostic categories, the patient was diagnosed as suffering from major depressive disorder with globus symptom. [insights.ovid.com]

• Insomnia

  If throat lumps are accompanied by other symptoms like insomnia, headaches, changes in libido or hot flushes, the underlying problem can be menopause. The problems usually go away in the post-menopausal stage. [primehealthchannel.com]

• Hot Flushes

  If throat lumps are accompanied by other symptoms like insomnia, headaches, changes in libido or hot flushes, the underlying problem can be menopause. The problems usually go away in the post-menopausal stage. [primehealthchannel.com]

• Nocturia

  R35.1 ICD-10-CM Diagnosis Code R35.1 Nocturia 2016 2017 2018 2019 Billable/Specific Code psychogenic F45.8 Nycturia R35.1 ICD-10-CM Diagnosis Code R35.1 Nocturia 2016 2017 2018 2019 Billable/Specific Code psychogenic F45.8 Oculogyric crisis or disturbance [icd10data.com]

• Pruritus Vulvae

  vulvae 2016 2017 2018 2019 Billable/Specific Code Female Dx psychogenic F45.8 neurogenic F45.8 (any site) psychogenic F45.8 (any site) Pseudocyesis F45.8 Ptyalism (periodic) K11.7 ICD-10-CM Diagnosis Code K11.7 Disturbances of salivary secretion 2016 [icd10data.com]

The clinical assessment consists of a full history with details about the symptoms, possible emotional triggers, review of systems, and presence of underlying illnesses. The clinician should identify red flag signs in order to rule out serious differential diagnoses.

Another major component of the workup is the physical exam, which should include palpation of the neck, inspection of the oropharynx, and evaluation of swallowing during eating and drinking. Also, a neurological exam is warranted.

While patients with typical features of GH do not require testing, clinicians may obtain various studies to clarify the diagnosis and exclude other causes. Institutions in the United Kingdom perform barium contrast swallows since they are rapid, safe, and effective [9] [10]. Other modes of investigation such as rigid or flexible esophagoscopy and/or fiberoptic laryngoscopy may be performed to visualize the throat.

Some physicians use the validated Glasgow Edinburgh Throat Score (GETS) to monitor the progression of symptoms [11] .

This condition does not require treatment. However, some clinicians will empirically treat these patients with proton pump inhibitors (PPIs) although GH's relation to GERD is debatable. If symptoms still persist, then clinicians may consider further testing with manometry or pH monitoring.

Coexisting depression or anxiety should be addressed with psychotherapy and antidepressants if needed. Additionally, speech and language therapy may be beneficial.

This benign condition is not associated with negative outcomes or complications.

The etiology of GH has not been clarified although there are possible causes such as severe emotional states, diffuse esophageal spasm, anatomical abnormalities, masses in the neck, or skeletal muscle disorders.

There is a questionable association between gastroesophageal reflux disease (GERD) and GH but the data is conflicting [1] [2]. Also, nonacid reflux (NAR) may play a role [3].

One study noted a prevalence of psychological disorders such as depression and somatization disorder in men with GH [4]. Another investigation reported that significant life events can contribute to the onset or progression of GH [5].

One study evaluated patients who sought care in a general clinic and observed that the prevalence of GH was 6.7 per 100,000 encounters [6]. This is a common condition [7] and is implicated in approximately 4% of otolaryngology referrals [8].

Since the etiology is unknown, the pathophysiology has not been elucidated. Emotional stressors, GERD, mechanical abnormalities, and other conditions have been suspected to play a role.

Preventative strategies include diet modification by reducing consumption of foods that cause GERD. For example, patients should avoid spicy and fatty foods.

Globus hystericus (GH) refers to the sensation of a lump or foreign object in the throat. This is usually diagnosed clinically through a detailed history, throat and neck exam although various institutions will also perform imaging studies. There is no specific treatment.

What is globus hystericus?

This is a condition in which the patient feels as if there is a lump in the throat. The exact causes are not known although some believe it is caused by emotional states, depression or anxiety, gastroesophageal reflux disease (GERD), or mechanical problems in the throat. Patients do not have pain, swallowing, or food sticking.

How is it diagnosed?

The physician will ask important questions about the symptoms, perform a neck and throat exam, and possibly order imaging tests to visualize the throat and airway.

How is it treated?

There is no specific treatment although some doctors will prescribe proton pump inhibitors in case the patient has GERD. Also, patients with psychiatric disorders may require treatment and referral to a psychiatrist.

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