Lump in the throat

Sensation of something in the throat is a common complaint. The specialist will take steps to ensure that there is indeed no lump or obvious visible disease process that is contributing to the sensation. When no obvious abnormality is found on examination the term Globus (Greek for "ball") sensation is the name given to the condition.

Typically the sensation of the lump in the throat disappears momentarily on swallowing. Patients frequently clear their throat and feel the need to swallow. It can be associated with an intermittent change in voice quality. By definition, there are no abnormal findings on examination of the throat although there may be signs of laryngeal swelling associated with reflux. The patient may admit to being the anxious type.

What is the cause of the “globus” sensation?

The exact mechanism and cause for globus pharyngis is unknown and may differ between individuals. Some cases may be due to increase tension in the muscles of the throat, others due to irritation, dryness or swelling of the lining of the throat.

Increase tension in the muscles of the throat

Muscle spasm/tension: Increased anxiety may give rise to spasm of muscles in the throat. There is a higher incidence of anxiety and depression in patients with globus. Globus may be experienced by individuals at times of emotional stress. This is not helped by the fact that patients are often naturally worried that there is a serious cause for the globus sensation. There is often the fear that they may have cancer. This causes increased anxiety and causes a vicious circle, thereby increasing the sensation and the associated anxiety. Often insuch cases all that is necessary is to carry out a thorough examination and reassure the individual that there is no sinister cause for their symptoms.

Irritation of the lining of the throat

Laryngopharyngeal reflux: This is the condition in which the stomach contents reflux up to the level of the larynx ('voice box'). It differs from classical gastroesophageal reflux in that it is not always associated with heartburn but can be associated with chronic throat clearing, and changes in the voice. The irritation of the throat lining is thought to contribute to the globus sensation in some individuals.

What investigations will I have?

Often no tests other than a detailed examination of the throat and voice box are necessary. If one of the major symptoms is difficulty swallowing then a Barium swallow X ray may be requested. Occasionally if the symptoms persist it may be necessary to carry out a more detailed examination of the throat under general anaesthesia.

What is the treatment for this condition?

Treatment consists of one or more of the following:

Reassurance: Many patients are worried that they have cancer or some serious disease and once reassured their anxiety and associated symptoms then settle.

Antireflux therapy:If there is a suggestion that the symptoms may be due to laryngopharyngeal reflux, then antireflux therapy may be advised.

Vocal hygiene advice/speech therapy: If there is associated intermittent alteration of voice then sometimes following simple “vocal hygiene advice” or voice therapy may be advised.

Read more about Laryngopharyngeal or "silent reflux"