Globus is a sensation of a lump in the throat. The evolution of the term itself is interesting; in ancient times, the womb [Latin. Hyster] was thought to be a floating organ, and when it got stuck in your throat, you had globus hystericus. Thus, globus was a symptom singularly attributed to hysterical women. Although this is completely wrong, for generations physicians considered globus to be a sign of neurosis in women.
I almost single-handedly chased the word hystericus out of the medical literature. If I was sent an article to review, I rejected it if they would not remove the term, and for decades, when I spoke at national medical meetings, I would point out the error of the diagnosis, globus hystericus.
For Globus, Which Doctor Should I See and What Tests Might I Have?
If you have globus, the doctor to see is an otolaryngologist (ear, nose, and throat doctor); s/he will place an ultrathin flexible instrument through your nose with a camera on the end, and examine your throat (transnasal flexible laryngoscopy, TFL). This is the singe most important test as it will allow the doctor to see if you have LPR; and it will rule out other causes of globus, such as throat tumor.
Your doctor may also order a barium swallow-esophagram in which you swallow a thick concoction while the radiologist sees swallows in real time, from the mouth all the way down to the stomach. This test may show if the upper valve (UES) is in spasm — a finding called a cricopharyngeal bar. It also may show whether you have reflux, working valves (UES and LES), or even a lazy esophagus (esophageal dysmotility). But the main reason for ordering this X-ray is to make certain that there is no structural abnormality or tumor in or below the throat.
A word of warning: if you have a cricopharyngeal bar, the correct diagnosis is LPR reflux, and you should not have surgery to “loosen” UES. Some ENT doctors think that if the valve is too tight, it should be surgically opened. This is a bad idea since the problem is reflux, and the surgery will make the UES less effective.
Some doctors want to order a scan like an MRI or CT scan for globus; however, unless something abnormal is seen on the TFL or barium study, this is overkill. Most of the time, scanning is unnecessary, and should not be done routinely.
What Actually Causes Globus?
In 1987, I established the world’s first reflux testing laboratory for LPR using new technology, high-definition pharyngeal/UES/esophageal manometry and ambulatory double-probe (simultaneous esophageal and pharyngeal) pH-monitoring. (Almost all the patients I have seen with globus have pH-documented reflux and abnormalities on manometry.)
The manometry test is done with small tube that contains a series of sensitive, closely-spaced pressure transducers that can measure throat and UES pressures (and their coordination) during swallowing. Remember, the upper esophageal valve, UES, is just behind the voice box.
The results of manometry hold the answer to the globus question; UES pressures may be abnormally high (UES in spasm) or even sometimes too-low, but the most common abnormality is that the UES closes prematurely during the middle of the swallow. This is called dyssynchrony, which means that the pharynx (throat) and UES are out of sync. This also explains why some people with globus also have dysphagia.
How Is Globus Treated and Can It Resolve Completely?
It is important to re-emphasize that surgery is rarely, if ever indicated, except possibly in the case of a Zenker’s diverticulum. Even when a Zenker’s is present, surgery should be reserved for those cases wherein the diverticulum is large.
In the past, we repeated the manometry after the globus symptoms resolved, but we no longer do that, because we found that the manometric abnormalities virtually always resolved with globus symptom resolution. We no longer bother to re-test.
In closing, effective treatment for globus and dysphagia is a healthy anti-reflux diet and lifestyle; no other treatment works as well.