Lump in the throat

One the common problems that we see in our ENT Clinics in Singapore is the sensation of a lump in the throat. This is often called a globus sensation. The feeling is not painful but rather like a distension in the throat.

What is globus sensation?

A globus sensation is present all the time regardless of whether a patient is swallowing food or fluids. There is often no hindrance to the passage of food down the swallowing passage of oesophagus. It is important to make this distinction with difficulty in swallowing which is known as dysphagia and painful swallowing which is known as odynophagia.

Who gets globus or a sensation of a lump in the throat?

Globus is common and about 4% of patients presenting to an ENT Specialist will report this. It is said to be equally common amongst women and men but women are more likely to seek treatment. Patients with co-existing ENT conditions suggest as acid reflux, sleep apnoea, and sinusitis may suffer this symptom. Globus is rare amongst children.

Can globus sensation be due to something else?

Globus can be due to a real physical obstruction to the swallowing passage or external compression. These include:

• Enlarged tonsils
• Tongue base tumours
• Enlarged neck lymph nodes
• Enlarged thyroid glands
• Masses that abut the oesophagus (paraoesophageal masses)
• An oesophageal tumour or inlet patch
• Postcricoid webs
• Hiatus Hernia

Other common conditions that can cause globus include:

• Gastro-oesophageal Reflux Disease (GERD)
• Achalasia

What should I do if I have a ‘lump in the throat’?

Patients with the persistent feeling of a lump in the throat should seek medical attention from an ENT Specialist. This is especially so for patients that smoke or consume alcohol regularly. It is helpful if you are able to identify any trigger factors to your globus sensation such as:

• Severity
• Time of day when it is worse
• Foods that exacerbate the symptom
• Associated symptoms such as voice change, coughing when you drink, true swallowing difficulty, heart burn, blood in your sputum/saliva, weight loss

What investigations may be necessary?

The ENT Speclialist will undertake a careful examination of the head and neck. This may involve the following investigations:

• Nasal endoscopy
• Laryngeal Videostroboscopy
• Ultrasound scan of the neck and thyroid gland
• Contrast or Barium Swallow
• CT scan of the neck
• pH manometry

What can be done for globus sensation?

When there is no obvious cause for the sensation of a lump in the throat, ENT specialists will often try several strategies to help with this symptom. They include:

• Managing acid reflux by changing your diet and lifestyle
• Medicines to reduce acid production by your stomach
• Relaxants such as Amitryptiline
• Drugs that normally used for convulsions such as Gabapentin
• Relaxation and stress management

Summary

The sensation of a lump in the throat can be very worrying. It is a common complaint that ENT specialists in Singapore see. It is often not worrisome but it is best to have it checked. Seek out your GP or visit your local ENT Clinic to have this assessed.

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