At Home with Chris Jessen 2018 - 119

it is commonly felt when swallowing
saliva. People who experience globus
pharyngeus don't tend to experience
any difficulty with swallowing food
- in fact, some people find that their
symptoms are better while eating and
drinking. The globus sensation is usually
felt in the front of the neck, and it can
move up and down or sideways.
The important thing to remember,
however, is that globus is just an
abnormal 'sensation' of a lump, rather
than an actual lump or growth.
HOW COMMON IS GLOBUS
PHARYNGEUS?
Globus is a common condition that
accounts for approximately 20% of
new referrals to ear, nose and throat
(ENT) clinics. It is reported by up to
50% of healthy individuals, with a

THE MOST IMPORTANT
THING TO REMEMBER
IS THAT GLOBUS
IS AN ABNORMAL
'SENSATION' OF A
LUMP, RATHER THAN
AN ACTUAL LUMP
OR GROWTH
peak incidence in middle age. This
condition is equally prevalent in men
and women, although women are more
likely to seek medical advice for it.
 
WHAT ARE THE SYMPTOMS OF
GLOBUS PHARYNGEUS?
The feeling of a lump in the throat
Throat clearing
Symptoms similar to heartburn
Post-nasal drip - the sensation of
mucus trickling down the throat.
WHAT ARE THE POTENTIAL CAUSES
OF GLOBUS PHARYNGEUS?
Acid reflux There is evidence to
suggest that many patients with globus
have accompanying acid reflux and
that there is a true association between
acid reflux and globus. The acid from
the stomach rises up the oesophagus
into the throat, thickens the saliva,
causing irritation that feels like 'a
lumpiness' in the throat.
The acid also affects the upper
oesophageal sphincter and causes
unco-ordinated muscular activity, which
again results in an abnormal sensation
of having a 'lump in the throat'
Post-nasal drip Mucus runs from the
nose into the back of the throat

Stress and tiredness
Voice strain
Smoking.
WHAT ARE THE INVESTIGATIONS?
Nasal endoscopy Usually undertaken
in the clinic, a flexible fibre-optic camera
is passed through the nose to view the
nose, throat and voice box
Barium swallow This happens in the
radiology department. The patient is
asked to drink a preparation containing
barium sulfate, which shows up on
X-rays. The path of the compound is
tracked through the upper digestive
system and any abnormalities in
the oesophagus and stomach
become apparent
Cervical spine X-ray This is a simple
X-ray of the neck to check for any
arthritis or osteophytes in the spine.
Osteophytes, or bony projections, can
cause the symptoms of globus
Endoscopy A tube is inserted into the
oesophagus and stomach via the mouth
to check for any abnormalities. The
patient is sedated during this procedure.
 
WHAT CAN BE DONE TO HELP?
Given the benign nature of the
condition, patients with typical globus
pharyngeus do not generally need
further investigation. Instead, a
three-month course of treatment with
a high-dose anti-reflux medication has
proved to be an effective option.
Treatments include:
Acid reflux medications Omeprazole,
lansoprazole, ranitidine and Gaviscon
Advance can give relief
Nasal sprays These help with the
treatment of post-nasal drip
Lifestyle modifications Reducing
the intake of caffeine, spirits, fruit juice
and spicy food can help to minimise
acid reflux. Giving up smoking, avoiding
fizzy drinks and eating at least three
hours before going to sleep, can
also be effective
Avoiding throat clearing If a patient
feels the urge to clear their throat,
something that tends to exacerbate
the globus symptoms, they are
advised to drink lukewarm water as
this helps to relieve throat spasms
(cricopharyngeal spasm). Drinking
plenty of fluids is advised generally
Speech and language therapy This
is often helpful, especially for children
with throat-clearing habits
Relaxation techniques It may be
that a person's globus symptoms are
associated with moments of stress.
Patients are advised to keep a note
of when their symptoms are most
likely to occur. If they do seem
stress-related, steps can be taken to

MEET THE EXPERT
Mr Ravinder Singh
Natt, BSc DO-HNS
FRCS (ORL-HNS), is
a consultant adult
and paediatric
ear, nose and
throat Surgeon
at the Royal Free
Hospital in London.
Mr Natt graduated from the Guy's,
King's and St Thomas' School of
Medicine and has completed extensive
postgraduate training in London,
Liverpool and Manchester, with
advanced fellowships in nasal-sinus
surgery and facial aesthetic surgery.
He also gained valuable experience
working at Stanford University
Hospital in California, US.
Mr Natt stays up to date with the
latest technology and treatments in
his field, allowing him to treat all
aspects of ear, nose and throat
disorders in both adults and children.
He is actively involved in teaching
and education at both undergraduate
and postgraduate level within the
University College London Medical
School and Hospital sites. He is also
an examiner for the Royal College
of Surgeons. His private practice is
based in centres across north and
central London.

reduce levels of stress. Relaxation
techniques such as yoga and meditation
can be particularly beneficial.
IS THERE A CHANCE THAT THESE
SYMPTOMS COULD BE CANCER?
Globus pharyngeus symptoms can
cause a great deal of unnecessary
anxiety among patients who are
smokers or heavy drinkers because
they fear they may have cancer.
However, patients who do experience
'red flag signs', such as dysphagia
(difficulty swallowing), odynophagia
(painful swallowing), throat pain,
weight loss and hoarseness of voice
should undergo immediate and
extensive evaluation.

FOR MORE INFORMATION
Call 07518 530 406
Visit www.entsurgeon.london
Email: marydhiya.joseph@nhs.net


http://www.entsurgeon.london/

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