Edit concept Question Editor Create issue ticket

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.

Italian
  • Hystericus Japanese ヒステリー球, ヒステリーキュウ French Globus hystericus, BOULE HYSTERIQUE, Boule hystérique, Globe hystérique German Globus hystericus, GLOBUS HYSTERICUS Czech Globus hystericus, globus hystericus Hungarian Globus hystericus Norwegian Globus hystericus Italian[fpnotebook.com]
  • 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]
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]
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
Snoring
  • The following signs and symptoms may be present : Difficulty swallowing Regurgitation Pain when swallowing Hoarse voice Coughing Snoring When the symptoms get progressively worse, then it should be taken very seriously and investigated further.[healthhype.com]
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]
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]
  • Read full article of Dysphagia and globus sensation (globus pharyngeus) Search terms C15, Deglutition Disorders, Diverticulum, Diverticulum, Esophageal, Dysphagia, Esophageal Motility Disorders, Esophageal Neoplasms, Esophageal Perforation, Esophageal[ebm-guidelines.com]
Flushing
  • 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]
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]
Globus Symptom
  • The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns.[ncbi.nlm.nih.gov]
  • Recently, it has been suggested that the globus symptom may be related to Helicobacter pylori infection of the CHGM[ 57 ].[doi.org]
Depersonalization
  • […] psychological factors F45.41 Pain disorder exclusively related to psychological factors F45.42 Pain disorder with related psychological factors F45.8 Other somatoform disorders F45.9 Somatoform disorder, unspecified F48 Other nonpsychotic mental disorders F48.1 Depersonalization-derealization[icd10data.com]
Stroke
  • Reptilia The Strokes • Room On Fire 3:39 0:30 16. Someday The Strokes • Is This It 3:03 0:30 17. Little House Of Savages The Walkmen • Bows Arrows 3:12 0:30 18. I'll Be Gone Oblivians • Desperation 2:03 0:30 19.[open.spotify.com]
  • Other causes for the feeling of a lump in the throat that may be attributed to actual conditions include : GERD – reflux laryngitis and/or pharyngitis Cricopharyngeal webs Diffuse esophageal spasm Neurological – Parkinson’s disease, stroke, nerve palsy[healthhype.com]
  • […] differential diagnosis of Globus Hystericus involves distinguishing its symptoms from those of other similar disorders like: Gastro-oesophageal reflux disease (GERD) Laryngo-pharyngeal reflux disease Cricopharyngeal web Parkinson’s disease Neurological disease Stroke[primehealthchannel.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]
Metrorrhagia
  • Code Female Dx psychogenic F45.8 painful N94.6 - see also Dysmenorrhea ICD-10-CM Diagnosis Code N94.6 Dysmenorrhea, unspecified 2016 2017 2018 2019 Billable/Specific Code Female Dx Type 1 Excludes psychogenic dysmenorrhea ( F45.8 ) psychogenic F45.8 Metrorrhagia[icd10data.com]

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.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:31