1. Globus pharyngeus/pharyngis
Globus pharyngeus is a feeling of something stuck or a sensation of a lump or tightness in the throat.
Latin Globus means ball.Hippocrates first regarded it as a disease of women being inextricably
involved in the uterine axis from which all hysteria was believed to be derived.Patient have no
higher scores for hysteria than healthy subjects. So the term globus hystericus has been
abandoned. Globus is a well defined ,clinical symptom that is persistent , difficult to treat, & has a
tendency to recur.
It is often a nebulous clinical diagnosis to make because the symptom are variable within & between
subjects . Objective clinical findings are by definition absent. Globus is considered functional when
no organic explanation is detected.The most popular organic explanation for globus can be GERD or
caused by oesophageal dysmotility.
Epidemiology
Globus accounts for around 4% of otolaryngological referrals. The peak incidence of the symptom is
middle age , very uncommon under the age of 20. Older people can complain of global sensation but
it is often difficult to differentiate this from age –related mucosal inflammation. Since the time of
ancient Greece, globus was considered a disease of women.The everyday experience of globus is
more or less equally by the both sexes.
Aetiology
A wide variety of explanations ,physical & psychological ,have been proposed over the last four
decades.some popular theories of the past include strap muscle spasm, hypertrophy of the lingual
tonsils, sinusitis, anterior cervical osteophyte,overclosure of bite, granular pharyngitis,tonsillitis &
thyroid nodules.
The most popular organic aetiology theory of recent years is that globus is a atypical presentation of
gastro-oesophageal reflex or oesophageal dysmotility.
1)Possible mechanisms for symptom production include contact of reflux acid & pepsin with
oesophageal & tracheal mucosa that activates vagal refluxes leading to reflux or spasm.
2)In addition ,there may be direct inflammation of the upper oesophagus with or without frank
pharyngo-oesophageal reflux.
3)There may also be reflux cough & throat clearing in response to distal or proximal oesophageal
acid exposure.
4) No one really knows whether the issue is one of excess acid or excessive acid sensitivity ,direct or
reflex or appear of acid in unusual location ( oesophageal-pharyngeal junction).

2. Presentation
The patient complains of a lump in the throat not associated with eating. The sensation may be
relieved by eating or drinking.The symptom aggravated by stress. Globus is essentially a sensory
disturbance, like itching &tinnitus,
D/D
Cricopharyngeal web
Symptomatic diffuse oesophageal spasm
GERD
Laryngo-pharyngeal reflex disease
Skeletal muscle disorder(myasthenia gravis, polymyositis, myotonic dystrophy)
Neurological disease; stroke, cranial nerve palsy, parkinsonism.
Investigations
Elderly male smokers are not the typical globus patients ,high index of suspicion pyriform fossa
cancer. In a non-smoker female , iron deficiency anaemia to exclude post-cricoid carcinoma.
CXR to see the cricopharyngeal indentations.
Flexible laryngopharynoscopy orFlexible fibreoptic examinationof upper GIT.
Reassure the patient & reserve futher investigations. Over investigations may reinforce anxiety.
Therapeutic trail of antacids , flexible oesophagoscopy & PH metry.
Management options
Reassurance is important. Explain the uncertain pathophysiological mechanisms behind globus.
Avoid dry swallows.
A strong history of gastro-oesophageal reflux may respond to a powerful antacid. &PPI. PPI failed to
demonstrate superiority over placebo. Suggesting that laryngopharyngeal reflux perhaps be a self-limiting
disease.
Tricyclic antidepressant can be quite effective.
Neck & shoulder exercise to reduce the laryngeal muscle tension.
Adequate rehydration & voice exercise together with avoidance of cigarette smoking & alcohol.
Outcome: follow up & prognosis
The sensation may persist at two years in 85% of women & 95% of men. Last as long as 7years in
45% of patients.