What are the typical physical exam findings for globus sensation?

Physical Examination Findings in Globus Sensation

Globus sensation typically presents with normal physical examination findings, as it is characterized by a subjective feeling of a lump in the throat that improves during eating rather than worsening with swallowing food. 1

Key Physical Examination Characteristics

• Patients with globus sensation typically have a normal oropharyngeal and laryngeal examination when assessed with nasolaryngoscopy 2
• The sensation is usually felt medially deep in the throat during empty swallowing, but not while drinking or eating 3
• Physical examination often reveals associated functional voice disorders that can be detected during voice assessment 1
• Patients frequently demonstrate throat clearing behavior and repeated swallowing attempts during examination 1
• Unlike true dysphagia, patients with globus can swallow normally without any objective impediment to food passage 3

Differential Diagnosis Considerations

• A thorough head and neck examination is essential to rule out structural abnormalities that may mimic globus sensation 2
• Nasolaryngoscopy is a crucial first-line examination tool to exclude pathologies that could cause similar symptoms 2
• Physical examination should assess for signs of:
  • Reflux laryngitis (posterior laryngeal erythema, edema) 1, 2
  • Cervical tendinopathy around the hyoid bone 3
  • Thyroid enlargement or nodules 4
  • Upper esophageal sphincter dysfunction 5

Diagnostic Pitfalls

• Relying solely on physical examination findings may lead to missed diagnoses, as globus sensation is primarily a diagnosis of exclusion 4
• Imaging studies (CT neck, barium esophagram) have very low yield (3.4-3.9%) in patients with isolated globus sensation and rarely change management (0.8% of cases) 6
• Mistaking globus for true dysphagia can lead to inappropriate treatment approaches 1
• Psychological factors often contribute to globus sensation but may not be evident on physical examination 4

Clinical Pearls

• The hallmark physical finding is the absence of objective abnormalities despite significant subjective complaints 2
• Improvement of symptoms during eating is a key distinguishing feature from other pathologies 1
• The absence of pain during swallowing helps differentiate globus from other oropharyngeal conditions 3
• Physical examination should include assessment for signs of anxiety or stress, which frequently exacerbate symptoms 1, 4