One way of explaining the globus phenomenon

Ears, nose and throat
1

13 May 2012 at 13:38PM

On "globus". Beeing an ENT doctor for 35 years I have met very many patients, whose complaints are: "I feel a lump in my throat". I remember, some time ago, I met 5 patients in the same day, with just this problem. My view is: the very simple cause of the various symtoms is dryness in the throat. There are different reasons for this condition, eg after a throat infektion, caused by medication, or just age. If the mucous membranes in the throat are too dry, you are beginning to "experience" the act of swallowing, and that feels strange. You experience this as something foreign in the throat, which can be called a "safety reflex", and then the trouble starts. You start to hawk, croak, and increase your swalloing frequency (normally you swallow about 1000 times/day, but in these circumstances perhaps up to 2000 times/day!) This increases the feeling of the lump, and now all the muscles around throat begins to get tired, and you get different secondary symtoms from that. Typically, there are no swallowing problems. What can you do about it? Not much I am afraid - but the knowledge helps a lot. Many patients with this problem are very worried and anxious.

2

I had the epstein barr virus and was told i have globus and CFS.  Generally my throat feels inflamed and tight and i am generally quite anxious and lethargic, also experience brain fog.  These are all common signs and symptoms surrounding this whole issue but i am not sure about the lump in throat, like i said it feels tight and inflamed around the glands and back of my throat.  I don't seem to have dryness or a need to swallow very often.  Any issue relating ot the throat is such a burden on life but where there's a will there's a way, every problem has a solution and this is just another problem needing solved.

3

Hi, im really interested if you can tell me anymore about the safety reflex. I had a baby 9 months ago, was rushing eating a chinese when she  was 7 weeks old and felt the sensation of either rice/chicken or bit of both caught half way in my throat and not go down properly. I could breathe but constantly tried to swallow this sensation of the food caught and therefore began to panic ALOT as it would not go. From there my life has been turned upside down. I have become phobic and cannot eat a single meal without thinking about every bite, chew, swallow. I feel that I eat differently, dont push the food to the back of my throat as I used to, bite my tongue, cant eat and talk, generally eating and swallowing is a chore. I always get a feeling near my oesophagus that food is caught but on rare occasions I cant feel a hard swallow move something further down. I do understand it is anxiety but I generally believe I cannot eat normally now due to the anxiety (like I have forgotten how to eat & wont let my subconcious take back over) and that my new style of eating is causing real problems and food is generally not going down as it should if I was relaxed. So a mixture of anxiety causing real actual swallowing problems. Any advise welcome. Reluctant to take the prozac my doctor prescribed. On a massive waiting list for extensive CBT since November haha!! I'm a rational normal person and every other aspect of my life is normal, Im not depressed im desperate to just get rid of this out of my mind and get on with my life x

4

Doctor, 

Thank you very much for your insight.  Would you be able to tell the difference between this and something like throat cancer?  I am having symptoms similar to the ones you describe - noticing swallowing, a very slight throat bleed that has gone away, swallowing a ton now.  I think the lymph nodes in my neck are swollen too possibly.  It is the middle of winter so dryness or infection make a lot of sense, I'm just trying to rule out something more serious so I can stop freaking out.  I am just now turing 36, so middle age seems like it could be a factor.  Would there be any more specific indications for something serious like cancer?  Thank you for any information you can provide and your time.

5

Hi! I will try to tell you some more about the "globus" phenomen. Now I have worked for 40 years as ENT-doctor, retired, still working parttime, I find the work so interesting. Last week I met 8-9 patients with globus. After careful examination  (which typically

reveals rather little) I give my view: what you describe, and what I find

is typical of "globus". You tell me about a feeling of something strange, uncomfortable in the throat, many say it feels like a "lump".

What is important for the diagnosis is that you have no real difficulty

swallowing drink and food. Some people experience when eating short episodes, when they feel the throat "tightens", a short spasm, but most of the time there is no difficulty swallowing, no breathing problems. You know that you hawk and croak a lot (and people around you also notice that), but most people are unaware of an increased swallowing frequency. I refer to the inborn "safety reflex", which alert us when something i stuck in the throat. In this case the safety reflex causes trouble - there is no foreign object in

your throat, but you have that distinct feeling. The hawking, croaking and not least increased swallowing cause a lot of extra muscular activity - every time you swallow 26 small muscles around the throat contract. The deep jaw muscles are involved, every time you swallow

you bite and these and all other muscles are "overworked", get sore, the voice can be affected, and the feeling of something foreign, strange in the throat is increased.

You get very "focused" on the symtoms - you feel them almost all the time! Of course you get worried! Sooner or later you are beginning to

consider - what is this feeling - is it cancer!? If you were focused before, now it gets much worse (especially if you have gone through examinations and been told - it is nothing! Many persons tell me this

and some start to cry). When the feeling is strong you may be afraid to swallow - what if food get stuck! Then the normal, automatic swallowing precess  becomes still more disturbed. Not so few start their problems with an episode where food really got stuck in the throat. To "feel" the act of swallowing is disturbing.

The observations I do is typical: I find the  mucous membranes in the throat to dry - and there are different causes for that. I tell: "you have lost to much of the good mucous in the throat, what is left is more thick, gluey mucous". Can you change that? No is my answer.

The other findings are signs of increased muscular tension - in the  mouth often abraded teeth, pressure marks in the tounge from the

teeth, muscles sore when palpated around the head and neck.

That can be treated by physiotherapi whith the intention that you must daily take a short brake,"feel" your muscles and use a program

to relax. The knowledge that globus is totally harmless also helps a

lot - perhaps that is the most important message.

I have met people from other cultures and have found that all have different sayings: worries, anxiety, stress have a tendency to

be expressed as globus, lump (heart) in the throat. What examinations can you do? You don´t need to do any more examinations! About CBT - I have no knowledge.

Best regards

old doctor

 

6

Hi doctor,

I have found your information very helpful. I myself have suffered from globus for about 18 months. It hasn't been very bad for the last 6 months, but last week I had a throat infection and was prescribed penicillin. The sore throat went the doctor said I had an ulcers down my throat, but not I am left with globus again!! Strange feeling tightness in the throat and also excess phlem.

I do suffer with acid so I think this contributed to the situation. It's such an odd feeling. I went to ENT 2013 and they said everything was normal but I can't help worrying it's something else now, do you think I should ask for an endoscopy?

Thanks

Amy

7

Thank you very much for this information and guidance. It's very clear to me now ,I don't have pain swallowing nor pain when not eating. No cough, no spasms or hoarseness. I've GERD and suffers from anxiety and  I am a serial worrier  to be frank. It's just that feeling of hair, trapped food in my throat .I managed to palpate my throat and felt that spiny projection on the right side pointing upwards  right after my tonsils but smooth on the left side.Is that a bone that I felt ?

It relieved me from  the discomfort by gargling Apple Cider Vinegar and directly concentrating on the area head facing upwards and tried to swallow  a bit amount just to moisten the area but I will spit it.The taste is absolutely revolting but it helped me,Read your posts and said that there's no cure for this but PT to relax the muscles are there any home remedies you could recommend?

Many thanks and more power to you .

8

Thank you!!!! I just made a post trying to figure out why my tongue is swollen because I have bad teeth imprints on both sides. Must just be the tension. Thank you for posting this. God bless you.

9

I am suffering with this feeling for 6 months and can you teach me how to live with it >? i just quit my job because i am planning to go see ENT soon and see how to deal with it . any suggestion for me please ? 

10

This is me!!!!!! I mouth breath and I think it's related as it all started this year. Now the globes is there all the time. I'm so worried about cancer

 

11

Thank you What do u think of neck exercises for globus?confused

12

I have a GERD / Acid reflux, ugh!  I can't imagine living like this for 2 years.  I was diagnoised Gerd / Acid reflux / LPR / Silent reflux / Shortnes of breath.  Sometimes I feel phglem in my throat...I have to watch what I eat.  To make sure no high acidity food.  Always eat high or medium Alkaline food.  It is so much better without a medication (pantoprazole)  I stopped taking it recently because it harms to health later on.  I must use a natural healing instead of medication.  I hope it helps real soon.

13

Can globus also give you the feeling of something sharp below your Adam's apple? Like a fish bone but no fish bone present?

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hi jim64492 how long did you take the anti hystymen for thanks martin

15

Katie, I am experiencing that sensation as well - like a fish bone wedged horizontally across my esophagus that moves up and down across multiple swallows. It feels like it’s scraping. Did you ever have any luck figuring it out or finding a way to treat it?

16

Hi candice, unfortunately not 😒😩 nearly a year on and I still have the feeling of phlegm or something similar being stuck, the fish bone feeling only lasted a couple of months though, I also don’t feel like I’m being strangled anymore, I’ve had an endoscopy which showed a very slightly loose sphincter, Barium swallow which apparently is fine and sibo tests which are negative, I’m seeing the gastroenterologist next week and I’ll ask for the ph 24 hour test just to see if the acid is coming up into my oesophagus.

Do you just have that as a symptom or do you have acid?