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.

• Pain

  pain with palpitation, epigastric pain due to seven emotions, cough and dyspnea due to disorder of Gi, and six kinds of stagnations. [kpubs.org]

  […] her throat” that made it difficult and painful for her to swallow. [mdedge.com]

  Its frequent symptoms are: throat ache, globus pharyngeus, hawking, dysphonia, dry cough, laryngospasm fits, together or not with symptoms such as heartburn, upper gastric pain, retrosternal pain. [tr-ex.me]

  One may also feel mild chest pain or even severe pain with a clicking sensation when swallowing. [educalingo.com]

• Inflammation

  Reflux of gastric contents may lead to irritation and inflammation of the laryngopharynx, or increased tone in the upper oesophageal sphincter may be triggered by distention or acid in the distal oesophagus. [patient.info]

  The more modern terms, globus sensation or globus pharyngeus, reflect recognition of one or more possible contributing anatomico-physiological factors, such as gastro-oesophageal reflux disease (GORD) or pharyngeal inflammation. [ncbi.nlm.nih.gov]

  Inflammation is a frequent culprit in globus, and the most commonly cited cause for the sensation is reflux. [enttoday.org]

  The more modern terms, globus sensation or globus pharyngeus, reflect recognition of one or more possible contributing anatomico-physiological factors, such as gastro-oesophageal reflux disease (GORD) or pharyngeal inflammation.1-4 Each year on average [racgp.org.au]

  […] pharyngeus sensation as a hysterical condition rooted in anxiety/psychological causes; then, we briefly review the emerging evidence that roots globus pharyngeus sensation within a constellation of pathophysiologies that are related to pharyngoesophageal inflammation [jhu.pure.elsevier.com]

• Goiter

  Goiter can be distinguished by the changes in the appearance of neck. Even though the symptoms are similar, globus hystericus is caused by the stagnation of Gi, but the pectorial pain with stuffiness, by the insufficiency of the Heart blood. [kpubs.org]

  Goiter, Nontoxic (Overview) are associated with sometimes immense thyroid hypertrophy, hypothyroidism, and cretinism. [tripdatabase.com]

  Indications to surgery were multinodular goiter or cytologically suspected cancer and the final diagnoses were benign goiter in 72 patients and papillary cancer in 23 patiens. [bmcsurg.biomedcentral.com]

  I have no goiter or any symptoms of Grave's Disease or other thyroid symptoms. Does anyone out there have this Globus thing and if so any advice HELP! [medhelp.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]

  nodules/goiter: Thyroid Ultrasound If concern for thyroid nodules/goiter: Thyroid Ultrasound If concern for head/neck adenopathy/mass: Head/Neck CT/MRI If concern for head/neck adenopathy/mass: Head/Neck CT/MRI If persistent symptoms after PPI/psych [medicine.uiowa.edu]

  J Laryngol Otol 121:242–245 Article PubMed CAS Google Scholar Nam IC, Choi H, Kim ES, Mo EY, Park YH, Sun DI (2015) Characteristics of thyroid nodules causing globus symptoms. [link.springer.com]

  Characteristics of thyroid nodules causing globus symptoms. Eur Arch Otorhinolaryngol. 2015;272(5):1181-8. [Crossref] [PubMed] Finkenbine R, Miele VJ. Globus hystericus: a brief review. Gen Hosp Psychiatry. 2004;26(1):78-82. [dergi.kbb-bbc.org.tr]

• Chills

  Advise patients to resist the urge to dry swallow or clear the throat (one tip suggested is for the patient to sip chilled carbonated water when they feel an urge to clear their throat).4 An invitation to return if symptoms persist will provide a safety [bjgp.org]

  For me, it tells me I'm stressed and that I need to chill out. Uncomfortable but quite helpful really. CocktailQueen Mon 20-Oct-14 22:26:16 That is useful. Who knew it was so common? Thank you. This is page 1 of 1 (This thread has 16 messages.) [mumsnet.com]

• Cough

  Its frequent symptoms are: throat ache, globus pharyngeus, hawking, dysphonia, dry cough, laryngospasm fits, together or not with symptoms such as heartburn, upper gastric pain, retrosternal pain. [tr-ex.me]

  It felt like I couldn’t cough effectively- but I felt like if I coughed too hard, my throat would close up completely. And then it hit me- I am choking to death. [panicfreeme.com]

  […] sensation as of a ball in the throat or as if the throat were compressed; a symptom of conversion disorder. globus hystericus [glō′bus] Etymology: L, small ball; Gk, hystera, womb a transitory sensation of a lump in the throat that cannot be swallowed or coughed [medical-dictionary.thefreedictionary.com]

  The nights spent awake trying to cough up an imaginary hair then feeling a lump was blocking my throat. It didn't help that I used to cough all the time with it and irritated my throat so it felt even worse. [mumsnet.com]

• Dyspnea

  Symptoms Sensation of lump in throat (Cervical Dysphagia) Intermittent fear of Choking with Dyspnea III. Associated conditions IV. [fpnotebook.com]

  […] hystericus is usually followed by Seven Gi injuries, Pain and depressive syndrome due to disorder of Gi, palpitation due to fright, continuous violent palpitation, Gi phlegm, precordial pain with palpitation, epigastric pain due to seven emotions, cough and dyspnea [kpubs.org]

  In both groups we first did an interview, which aim was to assess gender, age, proton pump inhibitors PPI, smoking/smoking load and the presence of laryngeal symptoms in general, such as cough, dyspnea, hawking, globuspharyngeus, throat pain or irritation [tr-ex.me]

• Dysphagia

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

  Differential diagnosis The differential diagnoses are the causes of true dysphagia. See separate article Dysphagia for further details. [patient.info]

• Odynophagia

  In practice, it is essential to differentiate globus from dysphagia or odynophagia, because the later entities portend more worrisome pathological processes. [uclahealth.org]

  Case Report First Online: 13 December 2005 Abstract We present a case of a displaced superior cornu of the thyroid cartilage causing odynophagia and a foreign body sensation of the pharynx. [doi.org]

  Globus Hystericus ( C0017650 ) Definition (NCI) Persistent or intermittent non-painful sensation of a lump or foreign body in the throat occurring between meals in the absence of dysphagia, odynophagia, evidence of gastroesophageal acid reflux, or histopathogically [fpnotebook.com]

• Nausea

  It is a subjective sensation as if a plum pit is stick in the throat and is compressed, usually ac companied by stuffiness in chest, depression, nausea, and hiccup. But the throat is not marked with redness and swelling. [kpubs.org]

  Anxiety can make you feel tense, cause nausea, lead to sweating, and so on. These are the symptoms that most people associate with anxiety. [calmclinic.com]

  By NaomiX 2 replies 298 views NaomiX 4/30/2019 7:59 PM Daily severe GERD attacks while on Easter vacation By GIpain 3 replies 341 views SharonZ 4/29/2019 8:03 AM Nausea at 14 weeks post Op! [healingwell.com]

  […] esophagogastric junction outflow obstruction, diffuse esophageal spasm, jackhammer esophagus, absent peristalsis) *Rome IV criteria are sets of diagnostic criteria for determining functional gastrointestinal disorders (e.g., irritable bowel syndrome, nausea [medicine.uiowa.edu]

• Foreign Body Sensation

  We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. [doi.org]

  DOI: https://doi.org/10.3399/bjgp15X687193 INTRODUCTION Globus pharyngeus or globus sensation is the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling. [bjgp.org]

  "Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review". The Journal of Laryngology and Otology. 120 (7): 608–09. doi:10.1017/S0022215106001125. PMID 16681864. [en.wikipedia.org]

• 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]

• Torticollis

  Dystonic presentations include spasmodic dysphonia, torticollis, tremor, and gait disturbance. [tripdatabase.com]

  2016 2017 2018 2019 Billable/Specific Code Type 1 Excludes congenital torticollis ( Q68.0 ) hysterical torticollis ( F44.4 ) ocular torticollis ( R29.891 ) psychogenic torticollis ( F45.8 ) torticollis NOS ( M43.6 ) traumatic recurrent torticollis [icd10data.com]

  300.11 Spasm, spastic, spasticity (see also condition) 781.0 hysterical 300.11 Staggering gait 781.2 hysterical 300.11 Substitution disorder 300.11 Tachypnea 786.06 hysterical 300.11 Tetany, tetanic 781.7 functional (hysterical) 300.11 hysterical 300.11 Torticollis [icd9data.com]

  One thing for me that makes it worse is that I also have Spasmodic Torticollis where I can't control the muscles in my throat. It's a bad combination having the two illnesses. [netmums.com]

• Muscle Spasm

  However, as the BJGP article outlines, there are many suspected causes, including: Stress or anxiety (during times of emotional stress, affected patients may report a 96% increase in symptoms) Post-nasal drip Gastro-oesophageal reflux Muscle spasm in [colgate.com]

  This can result in muscle spasms that trigger feelings of an object caught in the throat. [gohealthuc.com]

  GERD can also cause muscle spasms that trigger feelings of an object caught in the throat. Psychological health issues or mood changes : In some people, anxiety disorders and depression trigger the globus sensation. [medicalnewstoday.com]

• Globus Symptom

  A prompt response of globus symptom to ECT was observed with 5-year symptom-free follow-up period as long as the patient remained on a maintenance dose of antidepressant. [ncbi.nlm.nih.gov]

  Globus symptom causes a lot of anxiety among patients who are smokers or heavy drinkers. [parkside-hospital.co.uk]

  […] or symptoms consistent with globus syndrome from H&P. [medicine.uiowa.edu]

  […] was a significant predictor of the globus symptom[ 79 ]. [doi.org]

• Fear

  […] the brain switches off anxiety and returns itself to normal fear responses. [thelindencentre.org]

  Symptoms Sensation of lump in throat (Cervical Dysphagia) Intermittent fear of Choking with Dyspnea III. Associated conditions IV. [fpnotebook.com]

• Anxiety Disorder

  Birmingham Simple and fast anxiety disorder recovery with phone, email and mobile access to resources, apps and support NCFE Accredited learning centre - BPS & BACP support Generalized Anxiety - Panic Disorder - Agoraphobia - OCD - PureO - PTSD - Health [lindenmethod.com]

  What we do is called LAR Therapy and it is the only dedicated, accredited anxiety disorder recovery therapy. [thelindencentre.org]

  To see if anxiety might be playing a role in your symptoms, rate your level of anxiety using our free one-minute instant results Anxiety Test or Anxiety Disorder Test. [anxietycentre.com]

  People who suffer with high anxiety conditions such as generalized anxiety disorder, panic disorder, agoraphobia, OCD and Pure O, for example, often complain of a sensation of restriction or that they feel like they have a ‘lump in their throat’. [lindenmethodanxietyrecovery.com]

• Compulsive Behavior

  The term behavioral addiction correctly refers to a compulsion to engage in a natural reward – which is a behavior that is inherently rewarding – despite adverse consequences, reviews of preclinical studies indicate that long-term frequent and excessive [wikivisually.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]

• 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]

  ASCIA Clinical Update - Anaphylaxis tumours (e.g. carcinoid syndrome, VIPomas) • Alcohol related • Medullary carcinoma of thyroid • “Red Man Syndrome” (vancomycin related) Neurological syndromes • Epileptic seizures • Strokes Other causes of collapse [tripdatabase.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]

• Constant Throat Clearing

  Globus may be associated with throat irritation, soreness, dryness, catarrh, or constant throat clearing. It forms a large part of ENT practice and may account for about 4% of referrals to our outpatient clinics [3]. [hindawi.com]

  […] symptoms (e.g., dryness, constant throat clearing) Rowley et al. 1995- A prospective study of 67 patients diagnosed with globus pharyngeus (continuation of Timon et al. 1991 cohort): Average follow-up of 7.6 years (range 7.0-8.8 years) 55% symptom-free [medicine.uiowa.edu]

• Tremor

  Dystonic presentations include spasmodic dysphonia, torticollis, tremor, and gait disturbance. [tripdatabase.com]

  […] hysterical 300.11 Staggering gait 781.2 hysterical 300.11 Substitution disorder 300.11 Tachypnea 786.06 hysterical 300.11 Tetany, tetanic 781.7 functional (hysterical) 300.11 hysterical 300.11 Torticollis (intermittent) (spastic) 723.5 hysterical 300.11 Tremor [icd9data.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]

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] .

• Esophageal Motility Disorder

  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]

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.

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.