Globus hystericus

Alternative names

Lump in the throat, globus sensation

Definition

This describes the subjective sensation of a lump or mass in the throat, which is usually associated with certain mood states.

Cause

The exact mechanism which causes this is not known. The sensation may result from frequent swallowing and drying of the throat associated with anxiety or other emotional states.

Globus is probably a physiological symptom of certain mood states.

It is not associated with a specific psychiatric disorder or set of stress factors. Certain people may have an inherent predisposition to respond in this way.

Symptoms and signs

The sensation resembles the normal reaction of being choked up during events which cause grief, pride or even happiness. Suppression of sadness is the usual reason found for this and the symptoms can be relieved by crying.

The sensation can also occur during times of extreme stress when the whole body feels tense.

Diagnosis

There are medical problems which can be confused with globus, such as membranous webs which occur in the upper part of the oesophagus, spasm of the oesophagus, reflux of acid into the oesophagus, muscle disorders such as myasthenia gravis or lesions in the neck which result in a mass.

A careful history and physical examination can usually rule these out. In globus, the symptoms occur during certain emotional states, and do not worsen during swallowing. Food does not stick and the symptom is often relieved by eating or drinking.

There is no pain or weight loss.

Treatment

Treatment is usually through reassurance and sympathetic concern about the sensation. There is no drug which has any proven benefit.

Any underlying depression or anxiety should be managed.

When to see your doctor

Any sensation of a mass in the throat or difficulty or pain on swallowing should be seen by a doctor.

Reviewed by Prof M. Simpson