‘Doctor, I have a lump in my throat’

It’s not uncommon as an otolaryngologist—a doctor who specializes in ailments of the ear, nose and throat (ENT)—to have someone come into my office with this specific complaint.

“Doctor, I have a lump in my throat,” they tell me. “I can’t swallow it down and I can’t cough it up.”

Understandably, this sensation can be worrisome and my patients want to know what’s going on. Fortunately, that question most often has a simple answer: Globus.

Globus? What’s that?

The globus sensation is the persistent feeling that you have a foreign body stuck in your throat, like a pill or even a ball. (In fact, “globus” is the Latin word for ball.) The truth is that you don’t.

I first learned about globus in medical school as something called “globus hystericus,” which linked it with anxiety. People were understandably anxious that there was something stuck in their throats.

The globus sensation occurs right about the level of your larynx or Adam’s apple. It generally affects adults ages 35 and older. Symptoms of globus include:

• Mild hoarseness
• Slightly altered speech
• Nagging cough that won’t go away
• Perception that your swallowing is impaired
• Feeling that you need to drink more fluids than usual

Globus is a very common complaint. Hundreds of patients a year come in with this concern. People report there is a sensation of a flap of skin in their throats. They insist that there’s something there, even when it’s been looked at directly with an endoscope.

Oftentimes there’s a cancer phobia that goes with it. A patient may have a friend or relative who died with throat cancer. They think that perhaps because they smoked a little bit years ago, they might have throat cancer now. The fear gets exaggerated, which is why it was called globus hystericus.

What causes the globus sensation?

The actual cause is much less scary. Most cases of globus are caused by acid reflux. Your stomach acid comes up into your throat and irritates the mucosa, the lining of your throat, which causes a little bit of swelling. The way your throat lining defends itself against injury like acid is by producing mucus. Mucus is a protective barrier. So if acid is frequently coming up as high as your throat in an abnormal way, it’s going to cause injury and incite inflammation in your throat lining. In reaction to that, your throat is going to weep mucus and phlegm. That’s probably what gives you this globus sensation.

Another cause of globus might be post-nasal drainage and excessive mucus from allergies. In this case, the sensation is coming from sticky phlegm and mucus hanging in your throat. You might not be able to clear it as well as you want. If you can’t get it to go down your throat, it can annoy you.

How to treat globus

If you experience the globus sensation, are younger than 50 and don’t drink and smoke heavily, follow this plan of action:

• Take 14 days of Prilosec, a stomach-acid reducer you can find at drug or grocery stores.
• Carefully monitor globus symptoms.
• If the globus sensation eases off or goes away, you likely have acid reflux.
• If the symptoms do not improve, see your primary care physician. He or she may refer you to an otolaryngologist or a gastroenterologist.

How is globus diagnosed?

Patients are often referred to otolaryngologists because primary care physicians may not have the tools necessary to perform a thorough examination of the throat.

In our clinic, we use a soft fiber-optic laryngoscope that’s passed down through the nose. We use a topical anesthetic in your nose to numb it first. A lot of patients come in and are afraid that it’s going to hurt, but it doesn’t.

The laryngoscope takes a 90-degree turn at the back of your nose and goes down into your throat. That gives us a panoramic view of all the anatomy of your vocal chords and the entrance to your esophagus.

We can survey all those mucus membranes and that part of the throat and either identify an abnormality or, in the phenomenon of the globus sensation, most of the time we don’t find anything like cancer or other serious problems that you’ve been worried about.

With a thorough examination of your throat, you’ll have peace of mind knowing there’s no phlegm, no foreign body, no pill that’s stuck, no fish bone and no cancer.

Find an otolaryngologist at Baylor Scott & White Health.