CHOKED UP

Globus Pharyngeus Is That Bizarre Lump in Your Throat—Even if You’re Not Crying

Nearly half the population experiences it, especially in middle age.

women clutching throat Globus Pharyngeus Lump in Your Throat When You're Not Crying cancer acid reflux

Photo Illustration by The Daily Beast

A lump in the throat is usually a sign that you’re about to burst into tears.

But for nearly half the population, particularly those who are middle-aged, that lump in the throat feeling could happen any time, even if you’re not sad or upset.

It’s a condition called “globus pharyngeus,” and nearly half the population experiences it, usually around middle age.

According to Michael J. Pitman, chief of the division of laryngology and associate professor of otolaryngology at Columbia University Medical Center in New York, that lump in the throat feeling has a name: globus pharyngeus, more casually referred to as globus sensation.

The reason why it’s been so confusing to researchers is because it’s caused by a variety of factors, from anxiety to acid reflux to allergies to excessive muscle tension to an ulcer to cancer.

Diagnosis is difficult. Pitman first ensures the patient doesn’t have difficulty swallowing. Then he takes a detailed medical history, performs a head and neck exam, followed by a laryngoscopy, threading a small camera down the throat to look for tumors. “I’ll often do another exam called a transnasal esophagoscopy, which is a longer camera that allows us to go down into the stomach and ensure the esophagus is normal,” he said.

Many physicians, after taking a patient’s history, opt for none of those, mainly because more invasive tests can cause more anxiety. “Unless the patient is really bothered by it, you really don’t have to do anything,” Alex Osborn, pediatric and adult otolaryngologist and head and neck surgeon at Toronto’s The Voice Clinic, which sees about two cases of globus daily, said. “A significant number of my patients don’t want treatment; they just want to know there’s nothing wrong.”

In fact, Osborn continued, “It’s pretty rare that globus sensation is the only presenting symptom [of cancer]. But I scope everyone in order to rule it out. The number of people with globus is much greater than the number of people with globus as a presenting sign of cancer.”

A significant number of my patients don’t want treatment; they just want to know there’s nothing wrong.
Alex Osborn, pediatric and adult otolaryngologist and head and neck surgeon at Toronto’s The Voice Clinic

As for treatment, Osborn favors speech therapy relaxation techniques when globus stems from stress. “When you think about emotional or psychological stress, it’s not uncommon for the body to channel that somewhere. And if it channels it to the muscles of your neck, you’re going to feel globus,” he said.

Osborn often refers such patients to a speech language pathologist like his colleague Aaron Low. “Aaron does laryngeal massage, which massages the muscles of the larynx, neck and pharynx to relax them, just as you would with a [regular] massage therapist,” he said. “I’ve had patients who have had globus for quite some time and after one or two sessions with him, it’s gone.”

But laryngeal muscle tension is not always the result of anxiety or stress, Osborn pointed out. “It can come from posture, if people are hunched over a computer for long periods, for example,” Osborn said. “It can also come from the way they speak, which can build up tension.”

Low explained that the mysterious prevalence of people with globus could come from how we talk—speaking in the monotone voice often associated with valley speak or too-low register can experience tightness in the throat. “In today’s voice and speech trends, both women and men are speaking more in what is called glottal fry […] which sounds like crackling,” Low said. “It doesn’t hold a harmonic tone and is typically heard in 18- to 23-year-old females.”

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Globus could also be a phantom figment. “Sometimes there is nothing there,” Pitman said. “It’s just a neurologic sensation like a phantom limb where patients feel pain in a limb that’s not there. Sometimes we’ll treat that with neurologic medication that may blunt the sensation.”

If anxiety, valley speak, or ghostly limbs are not the cause of globus, acid reflux could be. Physicians would then typically recommend lifestyle changes and/or medication, such as a proton pump inhibitor. If the culprit turns out to be allergies, then medications such as nasal steroid sprays, antihistamines and salt water rinses can help. Other remedies, such as acupuncture, would likely get about the same results as a placebo, Pitman said.

The same goes for Botox, another controversial treatment. “Botox doesn’t work for globus unless the cricopharyngeus is a problem,” Pitman said. “That muscle is too tight, and usually before you inject Botox you would do a myotomy study, where you place another catheter down the throat and have the patient swallow to measure the pressure of that muscle. If it doesn’t relax like it should, then botox could play a role in terms of relaxing that muscle. But that’s an extremely rare cause of globus.”

Cognitive behavioral therapy is not high on Osborn’s list of effective treatments either. “I would offer speech therapy before CBT, which trains patients to not focus on the issue,” he said. “Speech therapy has the possibility to eliminate the issue.”

Low recommended a simpler exercise to help ease the condition. “Call out the word ‘hey’ in a long low to high slide,” he said. “This activates blood flow in the muscles of your voice box and creates a stretch for the vocal cords. Or put your hands on your collar bone and pull down as you look to the ceiling, then stick out your chin like an underbite and stretch forward.  Try to hold this for about 15 to 20 seconds.”

Both Pitman and Osborn doubt globus sensation is on the rise, and neither can point to any recent, in-depth studies of the condition mostly because—to the relief of those who struggle with it—it’s not a deadly disease.

“It is frustrating but it’s important to understand that this is not a dangerous thing, once you rule out any underlying malignant pathology,” Pitman said. “Then you can [tell the patient], ‘You’re going to be okay.’ And very often, over time, it just takes care of itself.”