Globus pharyngis

Globus pharyngis (also known as globus sensation, globus or, somewhat outdatedly, globus hystericus, commonly referred to as having a "lump in one's throat"), is the persistent sensation of having phlegm, a pill or some other sort of obstruction in the throat when there is none. Swallowing can be performed normally, so it is not a true case of dysphagia, but it can become quite irritating. One may also feel mild chest pain or even severe pain with a clicking sensation when swallowing.

Causes

The "lump in the throat" sensation that characterizes globus pharyngis is often caused by inflammation of one or more parts of the throat, such as the larynx or hypopharynx, due to cricopharyngeal spasm, gastroesophageal reflux (GERD), laryngopharyngeal reflux or esophageal versatility.^[1]

In some cases the cause is unknown and symptoms may be attributed to a psychogenic cause i.e. a somatoform or anxiety disorder. It has been recognised as a symptom of depression, which responds to anti-depressive treatment.^[2][3] Differential diagnosis must be made from Eagle syndrome which 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.

The results of recent studies have strongly suggested that GERD is a major cause of globus, though this remains under considerable debate.^[4]

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 anatomy e.g. the superior cornu abrading against the thyroid lamina,^[5][6] surgically trimming the offending thyroid-cartilage provides immediate relief in all cases.^[1] 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.^[1] High resolution computed tomographic (CT) or MRI scan of the larynx is usually required to fully understand the anomalous laryngeal anatomy. Anterior displacement the thyroid ala on the affected side while swallowing can help resolve symptoms.

Cultural references

A notable fictional sufferer was Danny Weems in the 1944 film Up in Arms, a hypochondriac who constantly complained about a "clicking" in his throat, especially when he turned his neck.^[1] Another was Cheryl Glickman who, in the novel "The First Bad Man" by Miranda July, kept referring to her globus.

References