Globus Pharyngeus, or ‘feeling a lump in the throat’

Have you ever had the feeling of a lump in your throat, the feeling as if you have to swallow against something? It’s possible you have what is known as globus pharyngeus. This is a common reason for people to attend ENT clinics. I usually see about one person with this problem in every clinic that I do.

What are other symptoms of globus pharyngeus?

Patients often find it difficult to find the right words to describe the feeling in their throat. It is often described as the feeling of a lump, but can also be described as 'a strange feeling'; a tight feeling; a sensation of constriction around the neck. These are all classical symptoms of a condition that comes under various names but is commonly called globus, or globus pharyngeus or globus sensation.

What is important to remember, is that it is a feeling or sensation of a lump, rather than an actual lump.

The symptoms of globus vary from person to person, however, in most cases, the symptoms tend to fluctuate in severity. Although the symptoms can be present for months, or even years, the symptoms do not usually get progressively worse. A common feature is that the feeling of a lump improves whilst eating, which is due to the reflex relaxation of the sphincter at the top of the food pipe whilst swallowing. An unreliable voice is a common associated symptom. This is because the voice is also powered by muscles, which commonly tighten up under the influence of stress, this can give rise to a condition called a 'muscle tension dysphonia'. Another common feature is that if you focus on the feeling, it tends to return, that is to say, if you look for the symptom, you will find it.

Sometimes people will ‘test’ the lump, and notice it is present when swallowing saliva, but better when eating. In about 70% of cases the symptoms are intermittent.

Globus is caused by tightening of the muscles in the upper part of the gullet (oesophagus) and throat. One of the most relevant muscles is the cricopharyngeus muscle which forms part of the sphincter mechanism at the top of the gullet. This muscle is there to prevent the contents of your stomach coming into your throat and into your windpipe, and so to stop you choking.

There are some common reasons why the throat muscles can tighten up, and sometimes there is more than one cause. The first is stress or anxiety. This is an increasingly common problem in the 21st century. Stress and anxiety can give rise to a host of different physical symptoms all over the body. It's common for people to have stiff necks, which whilst unpleasant, doesn't usually give rise to further anxiety as it is well-recognised that a stiff neck can be caused by stress. It isn't so well known that it can also cause tightening of the muscles in the front part of the neck, around the throat and voice box.

An example of this in action is if you go to a funeral or watch a sad film. This will cause most people to get a lump in their throat - it is an example of stress or emotion causing a physical symptom (actual tightening of the muscles in the throat). Most people don't worry about it when this occurs, as they correctly make the connection between the emotion and the feeling in the throat. However, if people don't make the association, for example, if the tightening is caused by a passing stressful thought or experience, then it can make people wonder why they have a lump in their throat. The sequence of thoughts, particularly if you are prone to worry, often goes along the following lines: I've got a lump in my throat, I wonder why? Could it be caused by a lump or blockage? What causes lumps and blockages? Could I have a tumour or growth or cancer? Most people will rationalise with themselves and correctly say, well that's most unlikely, however, the subtext of that thought is that it could be. The concern regarding cancer, even if unlikely, will cause the tightening to persist and sometimes worsen, reinforcing the concern that something unpleasant is going on, leading to a self-reinforcing downward spiral.

Another common cause is laryngopharyngeal reflux, which is sometimes called silent reflux. This occurs when the secretions of the stomach come back up the gullet or food pipe and cause irritation at the back of the throat. It commonly gives rise to a globus type sensation, but can also cause persistent throat-clearing, a husky voice, sore throat, cough and several other symptoms. It can be difficult to diagnose, as people often have no other symptoms of classical reflux such as indigestion or heartburn, hence its name silent reflux. Most of the time the irritation is due to the acidic nature of the secretions, although sometimes it is thought to be caused by the enzymes that help break down food in your stomach.

Occasionally mucus dripping down the back of the nose (also called a postnasal drip) can cause these symptoms. Postnasal drip can be due to inflammation of the sinuses, although there are several other causes of this symptom.

Cervical spondylitis or arthritis in the neck is a common cause of generalised tension in the neck and throat and can also cause a globus sensation.

And finally, there are other less common causes such as an enlarged thyroid gland or side-effects of medicines.

How do you treat globus pharyngeus?

Globus pharyngeus is a natural phenomenon. Once people have an understanding of the condition, the symptoms will often gradually better of their own accord. When it does recur, people know what is going on, so don't go into a vicious cycle, so many, if not most, people don’t require any treatment at all.

If stress is the main cause, then treating this is important, as far as possible. It is easier said than done, but it is worth spending some time trying to identify causes of stress, and reducing or removing them if you can. Meditation and mindfulness exercises can also be very helpful.

Sometimes treatment for acid reflux can be helpful. This could be with lifestyle and dietary changes, and sometimes medicines can be helpful.

Postnasal drip can be a difficult symptom to treat, but it is often worth trying over the counter salt water sprays, and occasionally steroid or other sprays for the nose are prescribed. Stopping smoking can also be helpful, as this causes generalised inflammation of the throat and airways.

Some people find physiotherapy for the muscles of the throat and neck very helpful, and this can also help reduce stress. And if you also have problems with the voice, then speech therapy is sometimes helpful.

Other measures that can help reduce the symptoms are:

Trying to reduce the habit of throat-clearing. Persistent throat-clearing can cause mild inflammation in the throat, which then increases the desire to clear the throat, so breaking this cycle can really help.

A drink of cold water is also often helpful, so carrying a water bottle around, and taking sips of water rather than clearing the throat. Regular sipping will help relax the throat, and improve hydration, which can also help symptoms of globus.

It is also best to avoid caffeinated and fizzy drinks and to minimise alcohol intake. Alcohol and caffeine both can dry the throat and also have a diuretic effect, that is to say, they cause you to pass more water, which then causes dehydration.

If the symptoms of globus persist, you should see your GP, and quite possibly an ENT surgeon, such as myself, who will usually complete a full examination of the head and neck region, including an examination of the throat with a flexible telescope, and sometimes arrange further tests.