What is globus pharyngeus?
Globus (as it is often shortened to) is a sensation of a lump or tightening in the throat, with no physical reason for it being there. In addition to, or instead of, feeling a lump in your throat, you may feel that the throat is dry, or feel a thickening in the throat and a need to clear mucus from it all the time. Your voice may sound strained or hoarse, and swallowing may feel difficult, with more of an effort to get things down.
What causes globus pharyngeus?
It is due to tightening of the muscles at the back of the throat and the circular muscle at the top of the gullet, called the cricopharyngeus muscle. These muscles are not under your direct control, and normally swallowing and speech are purely reflex and unconscious movements. It is when you become more aware of them and try to influence them that the problems begin. It is therefore often the case that globus takes hold when you are anxious, stressed or tired. By its very nature it becomes a vicious circle, as the more anxious you become about it, the worse it gets.
There may be underlying physical causes that exacerbate globus, in particular acid reflux from your stomach (see our Swallowing Difficulty and Laryngopharyngeal Reflux leaflet) or long-standing sinusitis. Both these issues may lead to chronic irritation of your throat and may need specific treatment.
What should I do if I have symptoms suggestive of globus?
Many people worry that the feeling of a lump in the throat is due to a sinister cause, in particular cancer of the throat or gullet. The first thing to do is therefore to see us and allow us to thoroughly investigate you, in order to exclude any such serious underlying cause (which is the case in all but a very small percentage of cases).
This will involve an endoscopic evaluation of your nose and throat in outpatients. We may organise a barium swallow X-ray for your further reassurance. Sometimes a short examination of your throat and gullet under general anaesthetic is necessary, but this is certainly the exception rather than the rule. As outlined above, it is also important to exclude other physical issues that may be causing the globus, such as chronic post-nasal drip of mucous seen with sinusitis, and/or acid reflux into the gullet from the stomach.
All of these measures are designed to reassure you and to exclude any serious underlying reason for this symptom, which we must emphasise is virtually always the case in this scenario.
What can I do to get rid of the symptoms?
There are both physical and psychological measures you can take to cure this problem.
- Drink plenty of cool, clear fluids each day (about 2 litres or 4 pints a day, unless there are specific medical reasons for you to restrict your fluid intake). Have a water bottle with you at all times to facilitate this.
- Treat acid reflux and chronic sinus issues via the advice and drug prescriptions given to you by us or your GP.
- Stop throat clearing. This actually causes the tightness in your throat to get worse, as well as causing trauma and damage to the vocal cords if prolonged. If you feel what you think is mucous in your throat, have a sip of water to wash it away, or have a silent ‘huff’ (exhale sharply with your mouth open) to dislodge it.
- Work on relaxation techniques for the muscles of your throat, head and neck:
- Stretch the back of the throat by yawning silently as often as you feel necessary.
- Lift your shoulders to your ears, hold for a count of 6, and release. (Repeat 3 times.)
- Look to your left shoulder, hold for a count of 3, then look to your right shoulder. (Repeat 3 times.)
- Tilt your left ear down to your left shoulder, hold for a count of 3, then tilt your right ear down to your right shoulder. (Repeat 3 times.)
- Drop your chin onto your chest, and very slowly roll your head up to one shoulder, open your mouth and roll to the other shoulder. Bring your chin slowly back into the middle and rest it on your chest. Hold for a count of 6. Repeat in the opposite direction.
- Work on general relaxation techniques:
- Consider mindfulness meditation as part of your daily routine. There are excellent apps, such as Headspace, that you can use on your smartphone or tablet.
- See whether there are certain times of day or pursuits that make these symptoms worse. If so, work on changing or stopping these factors.
- Introduce pursuits into your life that you find relaxing or enjoyable — reading, listening to music, exercising, walking, running or going to the gym. Over time, this will allow you to think of these pursuits in a positive way.
- Realise that your energy and time are not inexhaustible. Be prepared not to do everything yourself, and to delegate some tasks so as to allow yourself time to relax.
- Whatever you decide suits you, make sure it is non-negotiable ‘you’ time, and stick to it.