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Globus Hystericus

Patients with globus hystericus (GH) feel as if there is a mass in the throat even though it does not exist.


Presentation

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]
Thyroid Nodule
  • I already knew I had a large (4.7mm) thyroid nodule that had been long standing and always biopsied benign.(over 15 years) EVERY jumped on that as the cause but I wasn't satisfied so I had them check also with an endoscopy.[medhelp.org]
Weight Gain
Deglutition Disorder
  • Keywords Thyroid cartilage Odynophagia Foreign body sensation Deglutition Deglutition disorders This is a preview of subscription content, log in to check access. References 1.[doi.org]
  • EBM Guidelines May 11, 2018 • Latest change Mar 1, 2017 Table of contents Search terms Deglutition Disorders, Diverticulum, Diverticulum, Esophageal, Dysphagia, Esophageal Motility Disorders, Esophageal Neoplasms, Esophageal Perforation, Esophageal Stenosis[ebm-guidelines.com]
Constipation
  • الصفحة 143 - Whitehead WE, Engel BT, Schuster MM: Irritable bowel syndrome: physiological and psychological differences between diarrhea-predominant and constipation-predominant patients. ‏ الصفحة 26 - Clinical characteristics of fibrositis. I.[books.google.com]
Arthritis
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]
Neck Mass
  • 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.[symptoma.com]
Globus Symptom
  • CONCLUSIONS: The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns.[ncbi.nlm.nih.gov]
  • While 27 (50%) of Helicobacter pylori-eradicated patients had regressing globus symptoms, 12 (17.3%) of them did not have any regression in globus symptoms.[ncbi.nlm.nih.gov]
  • The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns.[journals.lww.com]
  • Recently, it has been suggested that the globus symptom may be related to Helicobacter pylori infection of the CHGM[ 57 ].[doi.org]
Tingling
  • Everyone agrees it is anxiety, severe depression driven-sometimes my tongue even goes numb or tingles which can be caused by dry mouth, medications, but usually anxiety as well.[medhelp.org]

Workup

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] .

Treatment

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.

Prognosis

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

Etiology

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].

Epidemiology

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].

Sex distribution
Age distribution

Pathophysiology

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.

Prevention

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

Summary

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.

Patient Information

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.

References

Article

  1. Chen CL, Tsai CC, Chou AS, Chiou JH. Utility of ambulatory pH monitoring and videofluoroscopy for the evaluation of patients with globus pharyngeus. Dysphagia. 2007; 22(11):16–19.
  2. Agada FO, Coatesworth AP, Grace AR. Retroverted epiglottis presenting as a variant of globus pharyngeus. Journal of Laryngology and Otology. 2007; 121(4): 390–92.
  3. Anandasabapathy S. and Jaffin BW, Multichannel intraluminal impedance in the evaluation of patients with persistent globus on proton pump inhibitor therapy. Annals of Otology, Rhinology and Laryngology. 2006; 115(8): 563–70.
  4. Gale CR, Wilson JA, Deary IJ., Globus sensation and psychopathology in men: the Vietnam experience study. Psychosomatic Medicine. 2009; 71 (9):1026–31.
  5. Harris MB, Deary IJ, Wilson JA. Life events and difficulties in relation to the onset of globus pharyngis. Journal of Psychosomatic Research. 1996; 40(6):603–15.
  6. Pollack A, Charles J, Harrison C, Britt H. Globus hystericus. Australian Family Physician. 2013; 42(10):683.
  7. Thompson WG, Heaton KW. Heartburn and globus in apparently healthy people. Canadian Medical Association Journal. 1982;126(1):46-48.
  8. Moloy PJ. and Charter R. The globus symptom. Incidence, therapeutic response, and age and sex relationships. Archives of Otolaryngology. 1982;108(11):740-44.
  9. Back GW, Leong P, Kumar R, Corbridge R. Value of barium swallow in investigation of globus pharyngeus. Journal of Laryngology and Otology. 2000; 114(12):951–54.
  10. Tsikoudas A, Ghuman N, Riad MA. Globus sensation as early presentation of hypopharyngeal cancer. Clinical Otolaryngology 2007; 32(6):452–6.
  11. Ali KH and Wilson JA. What is the severity of globus sensation in individuals who have never sought health care for it? Journal of Laryngology and Otology. 2007; 121(9): 865–8.

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Last updated: 2018-06-22 07:06