Causes of Throat Lump Sensation (Globus)


There are patients who suffer from a persistent
lump in throat sensation for months or longer that seems to defy all explanation and resist
all the usual standard medications. Known as globus, some of these patients have
suffered from this symptom for years resulting in frustration not only in terms of treatment,
but diagnosis. Globus is difficult to treat mainly due to
the many different possible triggers. As such, in order to properly diagnose and
treat this symptom, a comprehensive evaluation is mandatory. Numerous tests will be required with the attitude
of leaving no stone unturned. Just trying medications is no longer sufficient. Let’s go thru all the possible causes and
potential testing required. The esophagus is the swallowing tube that
connects the mouth and throat to the stomach. Reflux, eosinophilic esophagitis, and other
forms of esophageal dysmotility can cause persistent globus sensation due to irritation
of the cricopharyngeus muscle which is located just below the voicebox. When this muscle becomes tight, a patient
experiences the globus sensation. It is important to keep in mind that a patient
with globus may not have any symptoms beyond the lump sensation itself. All these symptoms may be absent: heartburn,
throat burning, choking, phlegmy throat, or trouble swallowing. However, if such symptoms ARE present, it
does reinforce the possibility of some type of esophageal disorder. Workup for esophageal causes of globus include
upper endoscopy with biopsies, barium swallow, 24 hour multichannel impedance testing, manometry,
and even spit tests. There may be a mass present causing the lump
sensation in the throat. This mass may not be something you can feel
from the outside, but is more internal requiring testing to evaluate further. Such tests may include upper endoscopy, neck
ultrasound, CT neck scans, and directed biopsies. A few examples of neck masses that might cause
globus include cervical spine bone spurs, throat cancer, benign cysts, throat mucosal
lesions, among others. Sino-nasal conditions such as allergies, chronic
sinusitis, and vasomotor rhinitis can trigger globus due to post-nasal drainage irritation. Workup for sino-nasal causes for globus include
trans-nasal endoscopy, allergy testing, and CT sinus scan. Workup also includes a trial of two different
nasal sprays, an anti-histamine nasal spray as well as ipratropium nasal spray in order
to address vasomotor rhinitis for which no good test exists. Some patients with globus ultimately find
that certain foods trigger this symptom. Some common foods that have been found to
cause globus are wheat, dairy, and egg. Uncommonly, it may even cause a condition
called eosinophilic esophagitis. Keep in mind that food sensitivities should
not be confused with traditional food allergies nor should it be confused with foods that
may cause reflux. Have you ever gone to a very sad movie and
you start to develop a lump in the throat sensation while trying to suppress crying
in public? Known specifically as globus hystericus, any
heightened emotional state that is suppressed, whether from stress, depression, or anxiety
can cause a persistent throat lump sensation. Finally, globus may actually be an illusion. Patients suffering from globus may actually
be suffering from nerve damage of the throat responsible for throat sensation. This condition is known as laryngeal sensory
neuropathy. To use an analogy, a temporary sensory neuropathy
occurs when a person gets a numbing shot at a dental office. When the jaw becomes numb, it is not unusual
for the individual to feel as if the area has become swollen, but when looking in the
mirror, no swelling is present. Similarly, globus due to neuropathy can cause
an illusory throat lump sensation. Once the cause of a person’s globus has
been determined, treatment can then be initiated with successful resolution. Keep in mind that it is not unusual in patients
with globus for years that more than one cause may ultimately be found to be present and
as such, multiple different treatments may be required. A full workup may require seeing multiple
different specialists including an ENT, gastroenterologist, allergist, psychologist, and neurologist.

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