Globus pharyngis
| Globus pharyngeus | |
|---|---|
| Other names | Globus pharyngeus, globus sensation, globus, globus hystericus, lump in one's throat |
 | |
| Specialty | ENT surgery |
Globus pharyngis,globus hystericusorglobus sensationis the persistent but painless sensation of having a pill, foodbolus,or some other sort of obstruction in thethroatwhen there is none. Swallowing is typically performed normally, so it is not a true case ofdysphagia,but it can become quite irritating. It is common, with 22–45% of people experiencing it at least once in their lifetime.[1][2]
Causes
[edit]The "lump in the throat" sensation that characterizes globus pharyngis is often caused byinflammationof one or more parts of the throat, such as thelarynxorhypopharynx,due tocricopharyngeal spasm,gastroesophageal reflux(GERD), orlaryngopharyngeal reflux. In some cases the cause is unknown and symptoms may be attributed to apsychogeniccausei.e.asomatoformoranxiety disorder.It has been recognised as a symptom of depression, which responds to anti-depressive treatment.[3][4]
The results of recent studies have strongly suggested that GERD is a major cause of globus, though this remains under considerable debate.[5]
A less common cause, distinguished by a "lump in the throat" accompanied with clicking sensation and considerable pain when swallowing, may be due to thyroid-cartilage rubbing against anomalous asymmetrical laryngeal anatomye.g.the superior cornu abrading against thethyroid lamina,[6][7]surgically trimming the offending thyroid-cartilage provides immediate relief in all cases.[8]However this cause is frequently misdiagnosed, despite requiring a simple clinical examination involving careful palpation of the neck side to side which elicits the same click sensation (laryngeal crepitus) and pain as when swallowing, most cases are due to prior trauma to the neck.[8]High resolutioncomputed tomographic(CT) orMRIscan of the larynx is usually required to fully understand the anomalous laryngeal anatomy. Anterior displacement of the thyroid ala on the affected side while swallowing can help resolve symptoms.[citation needed]Other anomalous laryngeal anatomy with the potential to cause the globus sensation include thyroid nodules or parathyroid adenomas.[9]
Diagnosis
[edit]Asglobus sensationis a symptom, a diagnosis ofglobus pharyngisis typically adiagnosis of exclusion.If globus sensation is presenting with other symptoms such as pain, swallowing disorders such as aspiration or regurgitation (dysphagia), weight loss, or voice change,[10]an organic cause needs to be investigated, typically withendoscopy.Barium swallowsare not recommended as a diagnostic tool as although they are less invasive than endoscopy and may be reassuring to the patient, they commonly miss sinister causes. It is very rare that globus sensation presenting with no other symptoms has a sinister cause and therefore endoscopy is not recommended in this case.[10][11]
Differential diagnosis
[edit]Differential diagnosis must be made fromEagle syndromewhich uses the patient's description of "something caught in my throat" as a diagnostic tool. Eagle syndrome is an elongation of the styloid process causing irritation to nerves and muscles in the region resulting in a number of unusual symptoms.[citation needed]
Management
[edit]Reassurance of the patient is recommendable when no cause can be found. If a cause is identified, treat the cause symptomatically or, if possible, systemically.[citation needed]
References
[edit]- ^Robson KM, Lembo AJ."Globus Sensation".UpToDate.Retrieved2019-08-31.
- ^Jones D, Prowse S (October 2015)."Globus pharyngeus: an update for general practice".The British Journal of General Practice.65(639): 554–55.doi:10.3399/bjgp15X687193.PMC4582871.PMID26412835.
- ^Cybulska EM (1997). "Globus hystericus – a somatic symptom of depression? The role of electroconvulsive therapy and antidepressants".Psychosomatic Medicine.59(1): 67–69.doi:10.1097/00006842-199701000-00009.PMID9021868.S2CID24181148.
- ^Cybulska EM (August 1998). "Globus hystericus or depressivus?".Hospital Medicine.59(8): 640–41.PMID9829059.
- ^Lee BE, Kim GH (May 2012)."Globus pharyngeus: a review of its etiology, diagnosis and treatment".World Journal of Gastroenterology.18(20): 2462–71.doi:10.3748/wjg.v18.i20.2462.PMC3360444.PMID22654443.
- ^Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace AR (July 2006). "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.PMID16681864.S2CID20575227.
- ^Lin D, Fischbein N, Eisele DW (2005). "Odynophagia secondary to variant thyroid cartilage anatomy".Dysphagia.20(3): 232–34.doi:10.1007/s00455-005-0012-2.PMID16362512.S2CID8595093.
- ^abSmith ME, Berke GS, Gray SD, Dove H, Harnsberger R (September 2001). "Clicking in the throat: cinematic fiction or surgical fact?".Archives of Otolaryngology–Head & Neck Surgery.127(9): 1129–31.doi:10.1001/archotol.127.9.1129.PMID11556866.
- ^Srikantha, Luxman; Amjad, Esmael H.; Beydoun, Rafic (2020-12-29)."Sudden Odynophagia and Globus—A Unique Presentation of a Nonsecreting Parathyroid Adenoma: A Case Report and Literature Review".Case Reports in Otolaryngology.2020:6805805.doi:10.1155/2020/6805805.ISSN2090-6765.PMC7785386.PMID33457030.
- ^abKortequee S, Karkos PD, Atkinson H, Sethi N, Sylvester DC, Harar RS, et al. (2013)."Management of globus pharyngeus".International Journal of Otolaryngology.2013:946780.doi:10.1155/2013/946780.PMC3725834.PMID23935629.
- ^Manabe N, Tsutsui H, Kusunoki H, Hata J, Haruma K (2014)."Pathophysiology and treatment of patients with globus sensation – from the viewpoint of esophageal motility dysfunction".Journal of Smooth Muscle Research = Nihon Heikatsukin Gakkai Kikanshi.50:66–77.doi:10.1540/jsmr.50.66.PMC5137314.PMID26081369.
External links
[edit]- "Globus Sensation. Myasthenia gravis and globus information".patient.info.Retrieved29 April2018.