What is globus hystericus?
Globus hystericus (globus sensation or globus pharyngis) is the medical term for the sensation of a lump in the throat. This feeling is differentiated from other masses in the throat in that globus hystericus :
- is unrelated to swallowing
- is unaccompanied by difficulty (dysphagia) or pain upon swallowing (odynophagia)
- no mass is present in the pharynx (throat) which can be concluded upon relevant diagnostic investigations
- usually does not cause weight loss or impair food intake
The sensation of a lump in the throat is often seen with anxiety and hysteria, hence the phrase ‘I had a lump in my throat’ to describe a stressful event. However, in some cases, the feeling of a lump in the throat may persist for weeks or months despite the absence of stress.
Causes of a Lump in the Throat Feeling
The exact cause is unknown and it is often attributed to psychiatric disorders. More recently, a greater understanding of gastroesophageal reflux disease (GERD / acid reflux) and associated conditions like reflux laryngitis has provided a more definitive etiology for many cases of globus hystericus.
The following seem to be the more likely causes of globus hystericus :
- Emotion – anxiety, fear
- Psychosomatic disorders – hysterical neurosis
The presence of other related signs and symptoms may provide a clearer indication of possible causative factors. Difficulty swallowing (dysphagia) and pain upon swallowing (odynophagia) are frequent symptoms that are present in these cases. Other causes for the feeling of a lump in the throat that may be attributed to actual conditions include :
- GERD – reflux laryngitis and/or pharyngitis
- Cricopharyngeal webs
- Diffuse esophageal spasm
- Neurological – Parkinson’s disease, stroke, nerve palsy
- Muscular – myasthenia gravis, myotonic dystrophy, polymyositis
- Benign or malignant tumor in the neck or mediastinum
- Upper respiratory tract infections
- Xerostomia – dry mouth
Signs and Symptoms
A lump in the throat feeling is a symptom and not a disease on its own. It may be accompanied by other symptoms. The presence of these concomitant symptoms can help provide a possible clue as to the cause when assessed collectively. The following signs and symptoms may be present :
- Difficulty swallowing
- Pain when swallowing
- Hoarse voice
When the symptoms get progressively worse, then it should be taken very seriously and investigated further. Swallowing problems that affects total nutrition, loss of voice and coughing up of blood are very serious symptoms that should be attended to immediately.
Treatment for Lump in Throat Sensation
There is no specific treatment for a lump in the throat feeling. The cause should first be diagnosed where possible with various tests and investigations. Treatment should be directed at the cause. For example, gastroesophageal reflux disease (GERD) is treated with antacids and acid-suppressing drugs. Another group of drugs known as prokinetics will speed up emptying of the stomach thereby reducing the chances of reflux.
The concern though, particularly in the smokers, is malignacies (cancers). Cancer of the mouth, throat and voice box is common in smokers and therefore thorough diagnostic investigations should be undertaken. Drugs like nitrates that relax muscles in organs or even botulinum injections can be used to ease spasms of the throat muscles. When globus hystericus is present, usually associated with anxiety, then anti-anxiety medication may be needed with long term use of tricyclic antidepressants.
- Globus Hystericus. Patient.co.uk