In ENT (ear, nose, and throat) outpatient clinics, "Doctor, I always feel like something is stuck in my throat" is an extremely common chief complaint. Patients often describe a sensation deep in the throat, as if a mass is lodged there—impossible to swallow down or cough up. Symptoms fluctuate in severity but often cause no obvious discomfort during eating or drinking. This troubling sensation is medically termed "Globus Pharyngeus," one of the most common functional symptoms in ENT practice.
Globus pharyngeus is not a rare condition. According to international literature, approximately 45% of people experience globus symptoms at some point in their lives. Globus accounts for about 4-5% of ENT outpatient visits. It can occur at any age but is more common in middle-aged individuals, affecting both men and women, with some studies showing a slightly higher prevalence in women. It's worth noting that globus pharyngeus was previously called "Globus Hystericus," implying a link to hysteria or emotional problems. However, with advances in medical research, modern medicine has abandoned this label, as evidence confirms the causes of globus are far more complex than purely psychological factors.
The typical presentation of globus pharyngeus is a sensation of a foreign body, pressure, or tightness in the throat. Some patients describe it as feeling like a piece of phlegm stuck in the middle of the throat, or a lump of flesh or a ball-like object causing obstruction. This sensation is usually located in the midline of the neck, slightly lower, around the level of the thyroid cartilage (commonly known as the "Adam's apple").
Globus has several characteristic clinical features. First, symptoms are often most noticeable when swallowing saliva but are typically unaffected or even temporarily improved during eating solid food or drinking water. This fundamentally distinguishes globus from true dysphagia (difficulty swallowing), where patients experience worsening symptoms during eating, potentially feeling food obstruction, which in severe cases can affect nutritional intake.
Second, globus symptoms are often intermittent. They may appear frequently for a period, then spontaneously resolve for a while before recurring. Third, many patients notice that symptoms worsen significantly during times of emotional stress, increased pressure, fatigue, or sleep deprivation, and improve during periods of physical and mental relaxation.
The exact cause of globus pharyngeus remains not fully understood. The medical community generally considers it a multifactorial condition involving interactions between several physiological and psychological factors. The following are currently well-established major causes:
Laryngopharyngeal Reflux (LPR) is considered one of the most common factors associated with globus. Gastric acid and pepsin reflux from the stomach up the esophagus to the throat. Even small amounts can irritate the throat mucosa, triggering local inflammation and mucosal edema, thus producing the sensation of a foreign body. Unlike typical gastroesophageal reflux disease, patients with LPR may not experience obvious heartburn or acid regurgitation. Therefore, many patients are unaware of their reflux problem, which is why globus's underlying cause is often overlooked.
Upper Esophageal Sphincter (UES) dysfunction is also an important pathological mechanism. Studies have found that some globus patients have higher resting pressure in the UES, indicating a state of excessive muscle tension. This sustained increase in tension can cause a sensation of throat tightness and foreign body obstruction. Additionally, overall tension dysregulation of the muscles surrounding the throat, including coordination issues between the suprahyoid and infrahyoid muscle groups, may also contribute to globus.
Psychological factors play a significant role in globus. Extensive clinical research shows that the prevalence of anxiety and depression among globus patients is significantly higher than in the general population. Stress and negative emotions can influence throat muscle tension and sensory sensitivity through the autonomic nervous system, creating a vicious cycle—emotional tension causes throat discomfort, and persistent throat discomfort further exacerbates the patient's anxiety. Acknowledging the influence of psychological factors does not negate the reality of the patient's symptoms. The discomfort of globus is genuinely real; its mechanism simply involves the interaction between body and mind.
Besides the above major factors, post-nasal drip is also a common trigger. In patients with chronic sinusitis or allergic rhinitis, nasal secretions continuously flow from the back of the nose down the throat wall, chronically irritating the throat mucosa, leading to chronic throat inflammation and a foreign body sensation. Cervical spine osteophytes (bone spurs) may also be a contributing factor in some cases, where the spurs press against the back wall of the esophagus, producing a sensation of pressure in the throat. Additionally, thyroid diseases, throat mucosal dryness, and chronic mouth breathing may also be associated with globus.
When a patient presents with globus, the most important tasks are to confirm the diagnosis of globus while excluding possible serious organic diseases that can cause similar symptoms, especially malignant tumors of the throat and esophagus. Therefore, a detailed history and thorough clinical examination are crucial.
During history-taking, the doctor will carefully inquire about the nature, duration, aggravating and relieving factors of the symptoms, as well as the presence of any "alarm symptoms" such as dysphagia, odynophagia (painful swallowing), hoarseness, unintentional weight loss, or neck masses. If any of these alarm symptoms are present, further aggressive investigation is needed to rule out malignancy.
Nasopharyngolaryngoscopy (flexible laryngoscopy) is the basic examination for evaluating globus patients. The doctor passes a thin, flexible fiberoptic endoscope through the nose to directly observe the structures of the nasopharynx, oropharynx, hypopharynx, and larynx, checking for tumors, polyps, cysts, or other structural abnormalities, while also assessing whether vocal cord movement is normal. If signs such as mucosal congestion, edema, or redness in the arytenoid area are found, it may suggest LPR. This examination can be performed in the outpatient clinic; it is simple and quick, with minimal discomfort for the patient.
Depending on clinical needs, additional auxiliary tests may be arranged. A barium swallow helps evaluate the structure and peristaltic function of the esophagus, ruling out abnormalities such as esophageal diverticula, strictures, or webs. If esophageal or gastric disease is suspected, referral to a gastroenterologist for esophagogastroduodenoscopy (upper endoscopy) may be needed. Neck ultrasound can assess for thyroid nodules or enlargement. In rare cases with high clinical suspicion, neck CT or MRI scans may also be useful.
Treatment for globus needs to be individualized based on the patient's specific situation, targeting the likely underlying cause.
For patients with suspected or confirmed LPR, proton pump inhibitors (PPIs) are first-line pharmacotherapy. Treatment courses generally last 8 to 12 weeks or longer to adequately control reflux and allow healing of the irritated throat mucosa. Simultaneously, lifestyle modifications are equally important, including avoiding eating 2-3 hours before bedtime, reducing intake of spicy, irritating, and high-fat foods, limiting caffeine and alcohol, and appropriately elevating the head of the bed.
For patients with concurrent post-nasal drip, treatment should target the nasal condition, such as using intranasal steroid sprays to control allergic rhinitis or chronic sinusitis.
Regarding psychological factors, if assessment reveals significant anxiety or depressive symptoms, appropriate psychological intervention can bring marked improvement. Cognitive Behavioral Therapy (CBT) has been shown effective for globus, helping patients identify and adjust maladaptive thought patterns, reducing excessive focus on symptoms and catastrophic thinking. In some cases, after evaluation by a psychiatrist, short-term use of low-dose anxiolytics or antidepressants may also help break the vicious cycle between symptoms and emotions.
Throughout the treatment process, reassurance and explanation by the physician are indispensable. Many globus patients' greatest fear is that they have throat or esophageal cancer. This fear alone can exacerbate symptoms. After thorough examination rules out serious disease, clearly and patiently explaining the nature of the condition—that globus is a benign functional disorder—has significant therapeutic value. Many patients experience marked symptom improvement after receiving a clear explanation and reassurance.
Although globus itself is a benign condition, the following situations warrant heightened vigilance and prompt medical attention: progressively worsening dysphagia (especially difficulty swallowing solid foods), painful swallowing, hoarseness lasting more than two weeks without improvement, unexplained weight loss, a palpable neck mass, and unilateral throat pain or ear pain. These symptoms may suggest a more serious condition requiring timely specialist evaluation. Particularly for long-term smokers and drinkers, who are at high risk for head and neck malignancies, prompt medical attention is even more critical when any of these alarm symptoms appear.
