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The diagnosis and management of globus pharyngeus: our perspective from the United Kingdom

Karkos, Petros Da; Wilson, Janet Ab

Current Opinion in Otolaryngology & Head & Neck Surgery: December 2008 - Volume 16 - Issue 6 - p 521–524
doi: 10.1097/MOO.0b013e328316933b
Laryngology and bronchoesophagology: Edited by Peter C. Belafsky

Purpose of review: To review recent literature on diagnostic and treatment options for globus pharyngeus.

Recent findings: There are no controlled studies looking at the use of proton pump inhibitors specifically for globus. The small volume of level I evidence has failed to demonstrate superiority of proton pump inhibitors over placebo for treatment of laryngopharyngeal reflux symptoms (including globus). A recent pilot nonplacebo-controlled study has shown promising results for treating laryngopharyngeal reflux symptoms with liquid alginate suspension. The role of cognitive–behavioural therapy may hold hope for patients with refractory symptoms. A small randomized trial showed promising results for treating globus with speech therapy, but larger trials are required. There is no evidence for the use of antidepressants or anxiolytics.

Summary: After many decades of interest, the most popular organic theory that ‘a lump in the throat’ is reflux related is still challenged by lack of strong evidence for empiric antacid treatment of this symptom. Globus pharyngeus is a clinical diagnosis and not a diagnosis of exclusion and overinvestigating these patients is unnecessary. Complete history and otolaryngological examination, fibreoptic laryngoscopy or transnasal oesophagoscopy with reassurance and monitoring of symptom progress with validated symptom questionnaires appear to remain the mainstay of management.

aDepartment of Otolaryngology, Liverpool University Hospitals, Liverpool, UK

bDepartment of Otolaryngology, The Freeman Hospital, Newcastle University, Newcastle upon Tyne, UK

Correspondence to Mr Petros Karkos, MPhil, AFRCS, Specialist Registrar in Otolaryngology, 36 Hopkinsons Court, Walls Avenue, Chester, CH1 4LN, UK Tel: +44 1244340098; e-mail: pkarkos@aol.com

© 2008 Lippincott Williams & Wilkins, Inc.