Globus Sensation

 

Background

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 considered that there can be an underlying physiological or anatomical cause.

 

 

Indication for referral

Globus in the absence of red flag symptoms DOES NOT warrant a 2WW referral or any imaging.

If there is severe cancer phobia where the patient cannot be reassured in primary care, refer to either:

• Routine ENT OPD, OR
   
• Urgent Throat Symptoms Assessment Clinic
  • Available as an alternative referral pathway on the ENT 2WW form 
  • ENT will aim to see these patients within 4 weeks

 

Primary care assessment prior to referral

A careful history and examination is paramount to differentiate between true dysphagia and globus sensation, where in the latter:

• Symptoms tend to come and go
• Usually felt in front of neck; can move up and down
• More notable when swallowing saliva
• Can be alleviated by eating and drinking
• Not painful

 

Examination of the neck, oropharynx, nose and ear is required to look for underlying or alternative pathology.

No investigations are required or recommended prior to referral.

 

Management options prior to referral

1. Provide patients with the Throat Symptoms Patient Information Leaflet 
   
    
2. Consider treatment for possible underlying laryngopharyngeal reflux. Typically, we would prescribe:

• Omeprazole 20mg twice a day for 2 months AND
• Gaviscon Advance 10mls four times a day to be taken after meals and before bedtime for 3 months

 

If symptoms worsen when coming off medication they may need to be taken for longer.

 

Red flags

Refer via 2WW if: 

• Previously un-investigated, unexplained PALPABLE lump in the neck (including thyroid, parotid and submandibular glands)
   
• Unexplained persistent (>4 weeks) sore or painful throat (especially with otalgia)                                                                                           
  (NOT for globus or throat discomfort)
   
• Persistent (>3weeks) unexplained hoarseness and age ≥ 45yrs

 

Note: Globus is a SENSATION of a lump in the throat, NOT a palpable neck lump.

 

 

References

https://patient.info/doctor/globus-sensation-pro

 

 

Review Date                December 2021

Next Review Date        December 2022

GP Sifter                      Dr Laura Vines

Contributor                   Mr Venkat Reddy

Version                        2.0