Globus Sensation: Symptoms, Causes and Treatment

Symptoms of Globus Sensation

Globus sensation, often described as the persistent feeling of a lump or foreign body in the throat, is a common and sometimes distressing experience. Although it is typically benign, its symptoms can disrupt daily life and cause significant worry, especially when people fear more serious underlying issues. Understanding the range and nature of symptoms is essential for proper diagnosis and reassurance.

Symptom	Description	Variability	Source(s)
Lump in throat	Persistent or intermittent non-painful lump	Intensity, location	1 4 5
Throat irritation	Sensation of swelling, hair, or nut	Quality, severity	5
Throat clearing	Frequent need to clear throat	Common	5
Dry swallowing	Repeated dry swallowing attempts	Perpetuates symptoms	5
Hoarseness	Mild voice change (dysphonia)	Occasionally	5 2
Sore throat	Non-specific sore sensation	Sometimes present	2 11

Table 1: Key Symptoms

The Core Symptom: Lump in the Throat

The hallmark of globus sensation is the subjective feeling of a lump, fullness, or foreign object in the throat. This feeling is usually persistent or intermittent, and, notably, it is not associated with pain. Some people describe it more as throat tightness, swelling, or even a persistent itch. The sensation most often occurs at the back of the throat, although it can sometimes shift or even be felt on one side more than the other. Despite its prominence, the lump is not visible or palpable on examination, which can be both reassuring and frustrating for patients 1 4 5.

Symptom Variability

Globus sensation displays significant variability between individuals and even within the same person over time. Some patients feel the sensation more strongly when swallowing saliva, while others note that eating food either relieves or worsens the feeling. Interestingly, up to 20% of patients continue to feel the lump even when swallowing food, and for some, eating actually draws more attention to the sensation. Conversely, others report relief during meals, which can occasionally lead to overeating and weight gain 5.

Associated Features

• Throat clearing and dry swallowing: The persistent sensation often leads individuals to repeatedly clear their throat or dry swallow in an attempt to alleviate discomfort, but this can perpetuate throat irritation and even cause mild hoarseness 5.
• Hoarseness and sore throat: These symptoms can occur, though they are less common. When present, they are typically mild 2 5 11.
• Absence of alarming symptoms: Globus is rarely associated with red flag symptoms like significant pain, weight loss, difficulty swallowing solid foods, or voice loss. The presence of such symptoms warrants immediate medical evaluation to rule out serious conditions 5.

Emotional Impact

Many people with globus sensation experience anxiety or distress about the possibility of a serious illness, especially cancer. However, globus sensation alone, without additional warning signs, is almost never caused by malignancy. Anxiety can also amplify the perception of throat discomfort, creating a cycle that sustains the sensation 5.

Causes of Globus Sensation

Understanding the causes of globus sensation is key to effective management and patient reassurance. Although globus was once considered mostly psychological (“globus hystericus”), research now reveals a complex interplay of physical and psychological factors. No single cause explains all cases.

Cause	Mechanism/Association	Key Details	Source(s)
Hypertensive UES	High upper esophageal sphincter pressure	Significant association	1 6 7
Cricopharyngeal dysfunction	Dysfunctional sphincter relaxation	Abnormal motility	6 7
Gastroesophageal reflux (GERD)	Acid reflux irritation	Some cases, not all	3 4 9 7
Gastric inlet patch	Heterotopic gastric mucosa in esophagus	May cause symptoms	2 10 11
Psychological factors	Anxiety, neuroticism, stress	Common association	5 8
Other factors	Laryngeal/pharyngeal tension, sensitivity	Non-specific triggers	12

Table 2: Common Causes

Upper Esophageal Sphincter (UES) Dysfunction

A leading hypothesis is that abnormal pressure in the upper esophageal sphincter, especially hypertonicity (excessive tightness), contributes to globus sensation. Studies have shown a significant association between hypertensive UES and the symptom, with many patients showing notably higher sphincter pressures than healthy controls 1 6. This dysfunction might make individuals more aware of normal throat sensations or promote a feeling of obstruction.

• Cricopharyngeal hypertonicity: The cricopharyngeal muscle (part of the UES) may fail to relax properly or become overly tense, further contributing to the sensation 6.
• Dysmotility: Some studies report abnormal muscle contractions or “after-contraction” in the throat during swallowing, although the role of this finding is still debated 7.

Gastroesophageal Reflux Disease (GERD)

Acid reflux is another well-recognized cause, particularly when stomach acid irritates the lower throat or larynx. Several studies show that treating GERD can relieve globus symptoms in many patients, especially when other reflux symptoms (heartburn, regurgitation) are present 3 4 9. However, not all people with globus have reflux, and in some, the sensation persists even when acid reflux is controlled 1 7 11.

• Silent reflux: In some cases, acid may not reach the throat but still trigger the globus sensation via nerve reflexes 9.
• Treatment response: Successful treatment of reflux often improves globus, supporting a causal link in certain patients 3 4 9.

Gastric Inlet Patch

A gastric inlet patch is a segment of stomach-like tissue found in the upper esophagus. This patch can secrete acid locally, irritating the surrounding throat tissue and causing persistent globus sensation. In studies, patients with inlet patches, especially those colonized by Helicobacter pylori, frequently report classic globus symptoms. Eradication or ablation of these patches can provide significant relief 2 10 11.

Psychological Factors

Psychological distress, especially anxiety and neuroticism, is commonly associated with globus sensation. While the sensation is not “all in the mind,” emotional factors can heighten symptom perception and prolong its course. Some individuals with globus tend to be more anxious, introverted, or prone to other unexplained bodily symptoms. Acute stress does not seem to directly cause globus, but chronic psychological factors may play a role 5 8.

• Association, not cause: Psychological distress often coexists with globus but does not explain all cases 5 8.

Other Contributing Factors

• Laryngeal and pharyngeal tension: Excess muscle tension in the throat or voice box may perpetuate symptoms 12.
• Hypersensitivity: Some people may simply be more sensitive to normal throat sensations 1 5.

Treatment of Globus Sensation

Treating globus sensation requires a tailored, stepwise approach that addresses the underlying cause, manages symptoms, and reassures the patient. Although many cases resolve spontaneously or respond to simple measures, persistent symptoms may call for targeted therapies.

Treatment Type	Approach/Action	Indication/Outcome	Source(s)
Reassurance	Patient education, reassurance	Most cases, initial step	4 5 12
Empirical PPI therapy	High-dose proton pump inhibitors	Suspected or proven GERD	3 4 9 13
Speech therapy	Voice, swallowing, relaxation techniques	Pharyngeal tension	12
Ablation of inlet patch	Argon plasma coagulation (APC)	Gastric inlet patch	10 11
Psychotherapy	CBT, antidepressants	Refractory, psychological	4 5
Herbal medicine	Rikkunshito (Japanese herbal)	PPI-refractory cases	13

Table 3: Treatment Approaches

Initial Management: Reassurance and Education

The first and most important step in managing globus sensation is thorough evaluation to exclude serious disease, followed by reassurance of its benign nature. Most patients are physically well, and symptoms are non-progressive and not associated with cancer. Explaining this can significantly reduce anxiety and symptom severity 4 5.

Empirical Treatment for Reflux

Given the frequent association between globus and GERD, high-dose proton pump inhibitor (PPI) therapy is often started, even if classic reflux symptoms are absent. Several studies show that a substantial number of patients experience symptom improvement with this approach 3 4 9. If no benefit is seen after a trial (typically 8 weeks), further investigation is warranted.

• Rikkunshito: An herbal medicine used in Japan, has shown benefit in patients whose symptoms are resistant to PPI therapy, potentially by improving gastric emptying 13.

Speech and Language Therapy

For patients in whom muscle tension or dysfunctional swallowing is suspected, speech therapy can be highly effective. Techniques focus on relaxation of the laryngeal and pharyngeal muscles, improving voice use, and addressing maladaptive swallowing behaviors. Controlled trials have demonstrated significant improvement in globus symptoms with this intervention 12.

Ablation of Gastric Inlet Patch

In patients with a documented gastric inlet patch, removal or ablation of the patch using argon plasma coagulation (APC) can produce dramatic and lasting relief from globus sensation. Studies reveal high rates of symptom improvement after this procedure, particularly when medical therapy fails 10 11.

Psychological and Behavioral Interventions

When psychological distress is prominent or symptoms persist despite physical therapies, cognitive-behavioral therapy (CBT), antidepressants, or other psychological treatments may be helpful. These approaches target underlying anxiety, stress, or maladaptive behaviors that fuel the symptom cycle 4 5.

Other Measures

• Lifestyle modification: Reducing throat clearing, managing stress, and avoiding irritants (smoking, excess alcohol) may help.
• Further investigation: If symptoms persist despite treatment, or if red flag symptoms arise, further evaluation with endoscopy, manometry, or pH monitoring is indicated 4.

Conclusion

Globus sensation is a common, benign, but sometimes persistent feeling of a lump or foreign object in the throat. Although distressing, most cases can be effectively diagnosed and managed with a patient-centered approach. Key takeaways include:

• Symptoms are variable and usually non-progressive, with most patients describing a lump or fullness in the throat without pain or difficulty swallowing 1 4 5.
• Causes are multifactorial, with hypertensive UES, GERD, gastric inlet patches, and psychological factors all playing potential roles 1 3 4 5 6 7 8 9 10 11 12 13.
• Treatment is stepwise:
  • Begin with reassurance and education 4 5.
  • Empirical PPI therapy for suspected GERD 3 4 9.
  • Speech therapy for muscle tension 12.
  • Ablation for gastric inlet patch cases 10 11.
  • Psychological therapies as needed 4 5.
• Red flag symptoms (weight loss, true difficulty swallowing, pain, hoarseness) warrant urgent investigation to rule out serious disease 5.
• Most patients improve with appropriate reassurance and targeted therapy, and the overall prognosis is excellent.

Understanding globus sensation and its management can empower both patients and clinicians, turning a worrisome symptom into a manageable condition.