From the Guidelines
To approach globus sensation, start with reassurance and lifestyle modifications while investigating potential causes, as this approach has been shown to be effective in managing the condition 1. When managing globus sensation, it is essential to reassure patients that this feeling of a lump or tightness in the throat is common and rarely indicates a serious condition.
Key Recommendations
- Recommend lifestyle changes including stress reduction techniques, avoiding throat clearing, adequate hydration, and dietary modifications (reducing caffeine, alcohol, spicy foods, and acidic foods) 1.
- If reflux is suspected, prescribe proton pump inhibitors such as omeprazole 20mg once daily for 4-8 weeks, as suggested by the consensus recommendations for speech and language therapy 1.
- For anxiety-related globus, consider cognitive behavioral therapy or short-term anxiolytics like lorazepam 0.5mg as needed, as cognitive behavioral therapy strategies may be useful in addressing psychological and life stresses contributing to symptoms 1.
- Speech therapy can help address muscle tension dysphonia, and education about the physiology of anxiety, the anxiety arousal curve, and the importance of avoiding avoidance can be beneficial 1.
Further Evaluation
If symptoms persist beyond 4-8 weeks or are accompanied by dysphagia, weight loss, or voice changes, refer for ENT evaluation with laryngoscopy to rule out structural causes, as globus sensation often results from heightened sensitivity of throat muscles, reflux-related inflammation, or psychological factors, and most cases improve with conservative management and time 1.
Treatment Strategies
Treatment strategies for functional articulation disorders, such as those outlined in Table 5 of the consensus recommendations for speech and language therapy, may also be effective in managing globus sensation, including education and explanatory approaches, symptomatic approaches, and psychological approaches 1. In summary, a comprehensive approach to managing globus sensation should include reassurance, lifestyle modifications, and investigation of potential causes, with referral for further evaluation and treatment as needed 1.
From the Research
Approach to Globus Sensation
The approach to globus sensation involves a combination of careful history taking, physical examination, and diagnostic tests to rule out underlying conditions.
- Careful history taking and nasolaryngoscopy are essential as a first step for managing globus 2
- Empirical therapy with a high dose of proton pump inhibitors is reasonable for patients with typical globus, given the benign nature of the condition and the possible link to gastroesophageal reflux disease 2, 3
- If patients are nonresponsive to proton pump inhibitor therapy, further assessments such as endoscopy, multichannel intraluminal impedance/pH monitoring, and manometry should be considered 2, 3
Diagnostic Tests
Diagnostic tests are necessary to rule out underlying conditions that may be causing the globus sensation.
- Upper GIT endoscopy can be used to exclude organic lesions in the throat, such as pharyngeal cancer, Zenker's diverticulum, or thyroid enlargement 3, 4
- Laryngoscopy, high-resolution manometry, barium radiography, and/or ambulatory reflux monitoring can be used to diagnose idiopathic globus 5
- Psychological state assessment is also important, as globus sensation has been linked to anxiety and depression 6, 4
Treatment Options
Treatment options for globus sensation depend on the underlying cause and may involve a combination of pharmacologic and non-pharmacologic approaches.
- Proton pump inhibitors can be effective in treating globus sensation, especially if gastroesophageal reflux disease is suspected 2, 3
- Prokinetics can be considered for patients with esophageal motility dysfunction 3
- Cognitive-behavioral therapy, anti-depressants, and gabapentin may be helpful for patients with persistent symptoms despite negative investigations 2, 3
- Reassurance and neuromodulators can also be used to manage idiopathic globus 5