What causes a persistent sensation of a lump in the throat while swallowing?

Understanding the Sensation of a Lump in the Throat When Swallowing

The sensation of a lump in the throat when swallowing is most commonly caused by globus pharyngeus (or globus sensation), which is a functional disorder characterized by a recurrent, non-painful but uncomfortable feeling of something stuck in the throat without actual dysphagia or structural abnormalities. 1, 2

Key Characteristics of Globus Sensation

• Presents as a persistent or intermittent sensation of a foreign body, tightness, or lump in the throat 1
• Typically improves during eating rather than worsening, which is a key distinguishing feature from true dysphagia 2
• More noticeable between meals rather than during swallowing 1
• Often associated with throat clearing, sense of mucus buildup, dry throat, and repeated swallowing 1, 2
• Commonly co-occurs with functional voice disorders 1

Common Triggers and Associated Factors

• Psychological stress often exacerbates symptoms, with many patients reporting worsening during periods of high emotional intensity 1, 3
• Historically called "globus hystericus" due to its association with anxiety, though modern understanding recognizes multiple physiological causes 4
• May be linked to gastroesophageal reflux disease (GERD), which can cause referred sensations in the throat 5
• Can co-exist with functional dysphagia in approximately 20% of cases 1, 2

Differential Diagnosis

• Must be distinguished from true dysphagia (difficulty swallowing), which typically worsens with eating 1, 2
• Oropharyngeal dysphagia patients may complain of food sticking in the throat or globus sensation, but will have additional symptoms like coughing/choking during swallowing 1
• Abnormalities of the distal esophagus or gastric cardia can cause referred sensation of dysphagia to the upper chest or pharynx 1
• Other conditions to consider include:
  • Laryngeal hypersensitivity syndrome 1
  • Chronic cough with throat irritation 1
  • Post-nasal drip syndrome 6

Diagnostic Approach

• A thorough medical history is essential to distinguish globus from dysphagia and other conditions 1
• Key questions to ask:
  • Does the sensation improve or worsen with eating? (Globus typically improves) 2
  • Is there actual difficulty swallowing food or liquids? 1
  • Are there associated symptoms like throat clearing, coughing, or voice changes? 1
• Nasolaryngoscopy is recommended as an initial assessment to rule out structural abnormalities 5
• If symptoms persist or are concerning for dysphagia rather than globus:
  • Barium swallow studies may be indicated to evaluate the pharynx and esophagus 1
  • Endoscopy may be needed to rule out structural causes 5

Management Approaches

• Reassurance about the benign nature of the condition is an important first step 7, 5
• For patients with suspected GERD contribution, empirical therapy with proton pump inhibitors is reasonable 5
• Speech and language therapy exercises have shown benefit in some patients 7
• For persistent symptoms with psychological components, cognitive-behavioral therapy and/or antidepressants may be helpful 3, 5
• Addressing underlying anxiety or stress can improve symptoms 3

Prognosis and Follow-up

• Globus sensation tends to be persistent and may recur despite treatment 3, 5
• The condition is benign but can significantly impact quality of life 7
• Patients should be reassessed if symptoms change significantly, particularly if true dysphagia develops 1, 2

Common Pitfalls in Management

• Mistaking globus for true dysphagia can lead to unnecessary investigations 2
• Focusing solely on psychological factors without considering potential physiological causes 4
• Failing to recognize that abnormalities in the distal esophagus can cause referred sensations in the throat 1
• Not providing adequate reassurance about the benign nature of the condition 7, 5