Pharyngeal globus sensation generally refers to various abnormal sensations in the throat, excluding pain.
Etiology
Diseases of the Pharynx and Adjacent Organs
These include conditions affecting the pharynx, tonsils, and hypopharynx, such as lymphoid follicular hyperplasia of the posterior pharyngeal wall, tonsillar keratosis, lingual tonsil hypertrophy, and epiglottic cysts. Diseases involving adjacent organs include elongated styloid process, cervical vertebral osteoma, excessive superior cornu of the thyroid cartilage, masses in the parapharyngeal space or neck, nasal conditions such as sinusitis, and both benign and malignant tumors of the larynx. Oral diseases are also included.
Reflux-Induced Pharyngolaryngitis
Further details are provided in related sections.
Diseases of Distant Organs
Digestive tract diseases, such as peptic ulcers and biliary tract disorders; cardiovascular diseases, including hypertension, left ventricular hypertrophy, and aortic aneurysms; pulmonary diseases, such as tracheitis and bronchitis; and conditions like diaphragmatic hernia contribute the disease.
Systemic Factors
Severe iron-deficiency anemia, autonomic nervous system dysfunction, prolonged chronic irritation (e.g., smoking, alcohol, dust, and chemical substances), hypothyroidism, allergic diseases, endocrine dysregulation during menopause, and obstructive sleep apnea (OSA) are the precipitating factors.
Psychological Factors and Functional Disorders
Functional pharyngeal dysfunction without organic diseases of the pharynx, trachea, or esophagus, primarily caused by brain dysfunction, may cause the disease. Some patients may develop symptoms following depression, cancer phobia, or emotional trauma.
Clinical Manifestations
The condition commonly occurs in women aged 30–40 years. Patients often report sensations such as a foreign body obstruction, burning, itching, tightness, or stickiness in the throat or central neck region. The discomfort is often located along the midline of the pharynx or slightly lateralized, commonly at the level of the cricoid cartilage or thyroid cartilage, followed by regions above the sternum, and rarely at the level of the hyoid bone. Swallowing food or liquids typically remains unaffected. Patients with a prolonged disease course often exhibit accompanying psychological symptoms such as anxiety, irritability, or tension, with cancer phobia being particularly common.
Examinations
Exclusion of Organic Lesions
Organic factors should be considered to avoid misdiagnosis in patients with pharyngeal globus sensation.
Examination of the Pharynx and Larynx
Observations should focus on whether there is mucosal congestion, swelling, atrophy, lymphoid hyperplasia, scarring, or tumors. Other aspects such as minor mucosal erosions in the folds between mucosa, openings of pharyngeal bursae at the nasopharyngeal roof, adhesions in the pharyngeal recess, submucosal nasopharyngeal carcinoma, lesions within the tonsillar substance, or mucosal congestion, swelling, or granulation in the arytenoids region should also be assessed. In addition to visual inspection, combined palpation of the pharynx, neck, and the pharyngeal-neck region is required.
Examination of Adjacent Organs or Overall Systemic Evaluation
A thorough examination of the eyes, ears, nose, throat, neck, digestive tract, heart, and chest regions is necessary, with special attention to pharyngeal globus sensation caused by gastroesophageal reflux. Fiberoptic laryngoscopy, esophagoscopy, gastroscopy, X-ray imaging of the chest, styloid process, cervical spine, or esophageal barium swallow, as well as ultrasound of the neck and thyroid, may be employed when needed.
Diagnosis
The diagnosis is made after a comprehensive analysis of symptoms and examination findings. Differentiation between organic and functional factors, as well as systemic and local contributors, is required.
Treatment
Etiological Treatment
Treatment should be directed at the underlying cause, such as the suppression of gastroesophageal reflux.
Psychological Treatment
Once organic lesions are excluded, attention should be given to the patient’s psychological factors, such as cancer phobia. Providing patient explanations and alleviating psychological burdens are key.
Other Treatments:
Irritants like smoke, alcohol, and dust should be avoided.
Sedatives may be used for patients with hysteria, anxiety, or emotional trauma.