Globus sensation or the sensation of lump in throat is a very common complaints that patients presenting to ENT clinics have. It is a very bothersome problem but most of the times we find no object or lump inside while examining.
Presenting Complaints
At least 15-20% of patients presenting to our out-patient clinics any day complain of lump sensation. They say they feel a constant sensation of something blocking. However, some say that such a feeling occurs only when they swallow. Yet others say they feel there is mucus inside the throat and they feel the urge to repeatedly clear it out. In some the complaints take the form of cough and change in voice. A few even complain of pain.
The condition is seen in middle aged people mostly and is slightly more common in women than men.
Causes
In the strict sense, the doctors diagnose the condition as Globus Pharyngeus when they have ruled out all possible causes for the problem. The globus is a diagnosis of exclusion. The most common causes are –
- Actual foreign body in throat
- Acid reflux
- Tension or Non co-ordination of muscles
- Problem with upper esophageal sphincter
- Emotional issues, stress, worries
- Tumors
- Thyroid diseases
- Allergy, Sinusitis and Post nasal drip
- Lack of saliva and dry mouth
What the ENT does
When you present yourself to an ENT in his office, he examines you to find the cause of the problem. It will include a laryngoscopic examination. Some prefer to hold your tongue and then pass a rigid angled telescope into the mouth till the back of tongue to visualise the larynx. The examination shows the back of tongue, epiglottis, vocal cords, pyriform sinus (which continues as the food pipe) and the upper part of wind pipe. Some prefer passing a flexible thinner fiberoptic device through the nose into the back of throat to see the same areas. In addition to the larynx this will show the nasal cavities in detail. The ENT will also rule out any allergy or post nasal drip which may be triggering the reflux and the lump sensation in throat.
Acid Reflux
Acid reflux is the commonest cause for globus sensation. When excessive acid is produced it escapes the stomach, rises up silently over the food pipe and causes inflamamtion in the throat. It produces thickening of the lining in the area where voice production occurs.
Causes for Acid Reflux / Increased Acidity
- Smoking
- Drinking
- Erratic food habits
- Excess spice and oil in diet
- Drinking a lot of water immediately after a meal
- Late night meals
- Lying down after meals
- Worries and tension
- Inadequate sleep
- Peptic ulcer disease
- Problem with lower esophageal sphincter
Treatment
Like I said, globus sensation is a diagnosis of exclusion and it does not have any treatment. But before we arrive at that diagnosis we try and rule out all the conditions enlisted above and provide appropriate treatment for those. No single treatment has been found successful in removing globus in all patients. Different people may find relief with different methods. The following are some of the treatment methods practiced-
- Anti-Reflux : Proton pump inhibitors are the mainstay. Esomeprazole is a very good drug which has about 16-18 hours of action and a once daily dosage of 40 mg. It suppresses acid production in the stomach effectively. Some also use Ranitidine and antacid.
- Control of Allergies : Allergen avoidance will keep allergy at bay. In the case of an acute condition, anti-histaminics (Loratidine, Cetrizine, Fexofenadine) with nasal sprays (mometasone and fluticasone) will help suppress allergies and reduce the post nasal drip. In some patients, immunotherapy achieves long term control.
- Control of Anxiety : Patients may need medicines to control their worries and anxieties if they are unable to control the same with just counseling and therapy. Some patients are always worried about their health, some always suspect they have cancer. Such patients will need a lot of counseling. It is advisable for doctors to spend adequate time with their patients and allay all their fears.
- Healthy lifestyle : A healthy lifestyle complete with exercises, nutritious foods, timely meals, peaceful mind and yoga will help a long way to remove the sensation of globus feeling. Exercise well and drink plenty of water.
- Behavioral Therapy : Cognitive Behavioral Therapy may be tried to relieve one of anxiety.
We shall discuss in a separate post about how to maintain a healthy dietary lifestyle. We shall tell you how to prevent reflux and acidity.
Warning Symptoms
Most of the times globus and lump sensation in throat is not serious. When your globus is accompanied by
Conclusion
We recommend that whenever any of you feel the globus symptoms, do visit us so that we can examine and rule out the causes. If there is any doubt or worry regarding your symptoms do not hesitate to write to us or call us. We are there to help you get over it.