Globus Sensation

 

This guideline applies to adults aged 16 years and over.

 

Introduction

Globus sensation (or globus pharyngeus) is a subjective feeling of a lump or foreign body in the throat. It was previously thought to be a type of somatisation disorder, presenting with pseudo-neurological symptoms, but it is now recognised that there can be an underlying physiological or anatomical cause.

 

Red Flag Features

• Un-investigated, unexplained palpable lump in the neck (including thyroid, parotid and submandibular glands)
• Unexplained persistent (more than 4 weeks) sore or painful throat (especially with otalgia)   
• Persistent (more than 3 weeks) unexplained hoarseness and age 45yrs or over
• Dysphagia

Not an exhaustive list.

 

Investigations

In the absence of red flag features, no investigations are routinely required or recommended prior to referral. Globus sensation is not due to a true palpable lump and therefore ultrasound scan or other imaging is not indicated.

 

Management Optimisation

In context of no red flag features:

1. Discuss self-care measures, including stress reduction, smoking cessation and avoiding damaging behaviours such as throat clearing, dry cough and voice strain.
    
2. Treat associated laryngopharyngeal “silent” reflux, which is occasionally implicated.
    
3. Consider ENT referral if endoscopy required for purpose of simple reassurance:

• Be mindful that for many patients, throat symptoms are persistent, so if structural pathology has already been excluded by ENT, consider carefully whether re-referral in the absence of any change is required.

 

Advice and Guidance

In the absence of red flags, consider seeking ENT Advice and Guidance if:

• Diagnostic uncertainty
• Patient falls outside the referral criteria

 

Referral

Globus in the absence of red flag features does not warrant a suspected cancer referral.

 

Fast Track Suspected Cancer: ENT

Refer via Fast Track ENT Suspected Cancer pathway:

• Un-investigated, unexplained palpable lump in the neck (including thyroid, parotid and submandibular glands)
• Unexplained persistent (more than 4 weeks) sore or painful throat (especially with otalgia)   
• Persistent (more than 3 weeks) unexplained hoarseness and age 45yrs or over

 

Fast Track Suspected Cancer: Gastroenterology

Refer via Fast Track Suspected Upper GI Cancer pathway (barium swallow):

• Dysphagia above suprasternal notch

 

Refer via Fast Track Suspected Cancer Direct Access Gastroscopy (OGD):

• Dysphagia below suprasternal notch

 

Adult ENT Referral

Inclusion criteria:

• Sensation of something in throat (globus sensation)
• Intermittent sore/painful throat
• Throat discomfort
• Odd sensations that are not painful e.g. dry throat, scratchy/gritty feeling, tightness, constriction etc.

Referral pathways:

If there is severe cancer phobia and reassurance cannot be achieved in primary care, refer to either (urgency of referral at discretion of referring HCP):

• Routine Adult ENT (Neck and Throat) Referral, via e-RS
• Urgent Throat Symptoms Clinic, via Fast Track ENT Suspected Cancer Referral Form

These services are only for adults, aged 16 years and over.

 

Supporting Information

For professionals:

Patient UK: Globus Sensation

For patients:

RCHT Throat Symptoms Patient Information Leaflet

 

Page Review Information

Review date	18 October 2024
Next review date	18 October 2026
GP speciality lead	Dr Laura Vines
Contributors	Mr Venkat Reddy, Consultant ENT Surgeon