Globus sensation

History of Otolaryngology: Globus Pharyngeus as "Globus Hystericus"

Globus pharyngeus is the uncomfortable sensation of a "lump in the throat," and at present it has many recognized pathophysiologic causes. However, until relatively recently, this condition was often labeled "globus hystericus" and was thought to be a manifestation of hysteria or anxiety. In this commentary, we briefly review the history surrounding the initial treatment of globus pharyngeus sensation as a hysterical condition rooted in anxiety/psychological causes; then, we briefly review the emerging evidence that roots globus pharyngeus sensation within a constellation of pathophysiologies that are related to pharyngoesophageal inflammation and irritation rather than psychological disorders.

Globus sensation and psychopathology in men: the Vietnam experience study

OBJECTIVE

To assess whether globus is associated with psychopathology in men. Globus-a persistent sensation of having a lump in the throat with no detectable physical cause-has long been thought a predominantly female disorder. Several small studies, based wholly or largely on women, suggested that globus is associated with higher levels of depression, anxiety, and somatic concern.

METHODS

Participants were 4240 male U.S. veterans who underwent detailed medical and psychological examinations in middle age. Psychological health was assessed by structured diagnostic interview and the clinical scales of the Minnesota Multiphasic Personality Inventory (MMPI). The MMPI includes an item on the presence of globus.

RESULTS

The prevalence of globus was 6.4%. Men with globus had an increased risk of being diagnosed with somatization disorder, odds ratio (OR) = 5.92, 95% Confidence Interval (CI) = 3.22, 10.9l; major depression, OR = 4.98, 95% CI = 3.63, 6.67; generalized anxiety disorder, OR = 3.70, 95% CI = 2.75, 4.90; posttraumatic stress disorder, OR = 3.50, 95% CI = 2.54, 4.76; and drug abuse or dependence, OR = 1.89, 95% CI = 1.15, 3.13; and they scored significantly higher on nine of the ten MMPI clinical scales. Globus was also associated with lower cognitive ability, socioeconomic and educational disadvantage, a higher pulse rate, and increased likelihood of being on antihypertensive medication.

CONCLUSIONS

Globus is linked with a wide range of psychopathology in men, notably depression and somatization disorder. Men presenting with globus might have developed that particular symptom to "represent" other, related and treatable psychopathology, which should also be investigated.

A prospective controlled study of high-resolution thyroid ultrasound in patients with globus pharyngeus

The sensation of a lump in the throat may be the presenting symptom of thyroid enlargement, but the majority of thyroid abnormalities are undetectable by clinical examination. The thyroids of 43 patients with globus pharyngeus and 33 controls were prospectively examined by high-resolution ultrasound, to test the hypothesis that a higher incidence of impalpable thyroid abnormalities exists in patients with globus pharyngeus than in the normal population. Abnormalities were present in 31/43 (72%) patients with globus and in 11/33 (33%) controls (P < 0.001). Of the patients with globus, 17 had solitary nodules or cysts, 10 had multiple abnormalities and diffuse abnormality was present in four patients. Solitary nodules ranged from 4 to 29 mm. Impalpable, ultrasound-detectable abnormalities are significantly more common in patients with globus pharyngeus than in controls. Abnormalities of the thyroid gland may be responsible for globus symptoms.

Globus pharyngis, personality, and psychological distress in the general population

The authors approached 1,158 middle-aged women, who were assessed for the presence of the globus sensation in the prior 3 months. Seventy globus "cases" (6.0%) were identified. Twenty-eight women with globus and 35 control subjects completed a series of questionnaires designed to assess personality traits and psychological distress. The globus subjects were significantly higher on neuroticism and low on extra-version and had significantly elevated levels of psychological distress, including anxiety, low mood, and somatic concern when compared with the control subjects. Severity of throat symptoms, but not personality or psychological distress scores, predicted the degree of medical help sought for the symptom.

The natural history of globus pharyngeus

While globus pharyngeus is a common disorder, accounting for 3% to 4% of new otolaryngology outpatient referrals, few long-term follow-up studies have been conducted on patients with this condition. The authors of this study followed 74 patients with a diagnosis of globus pharyngeus for an average of 7 years, 7 months (range: 7 years to 8 years, 10 months). During the follow-up period, 55% of patients were asymptomatic and 45% of patients had persistent symptoms. An in-depth analysis of features at clinical presentation failed to reveal any reliable prognostic indicators. A number of patients developed other conditions during the follow-up period, but no patient developed upper aerodigestive tract malignancy. This study represents the longest follow-up of globus patients to date and, to the authors' knowledge, is the first to address the issue of malignancy in globus.