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Lump in Throat

(Globus Sensation)

by Norton J. Greenberger, MD

Some people feel as if they have a lump or mass in their throat when no mass is actually there. If this sensation is unrelated to swallowing, it is termed globus sensation, or globus hystericus (which does not mean the person is hysterical). If people have the sensation but also notice difficulty swallowing, see Difficulty Swallowing. Some people can actually feel a lump on the side of their neck (see Neck Lump).

Causes

Doctors are not sure what causes globus sensation. It may involve increased muscle tension in muscles of the throat or just below the throat or it may also be due to gastroesophageal reflux. The sensation sometimes comes when people experience certain emotions, such as grief or pride, but is often independent of such feelings.

Globus sensation is not dangerous and does not cause complications. However, certain more serious disorders that affect the esophagus can sometimes be confused with globus sensation. Such disorders include upper esophageal webs; esophageal spasm; gastroesophageal reflux disease (GERD); muscle disorders such as myasthenia gravis, myotonic dystrophy, or polymyositis; and tumors in the neck or upper chest. Such disorders typically affect swallowing and/or cause other symptoms besides the sensation of a lump.

Evaluation

People with globus sensation rarely require immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation.

Warning signs

In people with globus sensation, certain symptoms and characteristics suggest another disorder is present and are cause for concern. They include

  • Neck or throat pain

  • Weight loss

  • Abrupt appearance after age 50

  • Pain, choking, or difficulty with swallowing (dysphagia)

  • Spitting up (regurgitation) of food

  • Muscle weakness

  • A mass that is visible or that can be felt

  • Progressive worsening of symptoms

When to see a doctor

People who have warning signs should see a doctor within a few days to a week. People who have no warning signs should call their doctor. Depending on the severity and nature of the sensation, doctors may suggest people wait to see how symptoms develop or suggest a mutually convenient time.

What the doctor does

Doctors ask questions about the person's symptoms and medical history and do a physical examination. What doctors find during the history and physical examination helps decide what, if any, tests need to be done.

The history is focused on distinguishing globus sensation from difficulty swallowing, which suggests a structural or motility (movement) disorder of the throat or esophagus. Doctors ask people to clearly describe their symptoms, particularly their relationship to swallowing (such as a sensation of food sticking) and emotional events. They also seek any other warning signs.

The physical examination is focused on the mouth and neck. Doctors inspect and feel the floor of the mouth and the neck for masses. Doctors look down the throat with a thin, flexible viewing scope to inspect the back of the throat and the voice box. Doctors also observe the person swallowing water and a solid food such as crackers.

Warning signs or abnormal findings found during the examination suggest a mechanical or motility disorder of swallowing. People who have chronic symptoms that occur during episodes of grief that may be relieved by crying suggest globus sensation.

Testing

People who have symptoms that are not related to swallowing, have no warning signs (particularly no pain or difficulty with swallowing), and a normal examination (including swallowing observed by the doctor) most likely have globus sensation. Such people rarely need tests.

If the diagnosis is unclear, warning signs are present, or the doctor cannot adequately see the throat, swallowing tests (as for difficulty swallowing—see Symptoms of Digestive Disorders:Testing) are done. Typical tests include plain or video esophagography, measurement of swallowing time, chest x-ray, and manometry (see Manometry) of the esophagus.

Treatment

Globus sensation does not require any treatment besides reassurance and sympathetic concern. Sometimes, simply understanding that globus sensation comes with certain moods is all the help people need. No drugs are helpful. However, if any underlying depression, anxiety, or other behavioral disorder seems to be making symptoms more disturbing to people, doctors may try giving an antidepressant drug or referring people to a psychiatrist.

Key Points

  • Globus symptoms are not related to swallowing.

  • People do not need tests unless their symptoms are related to swallowing, their physical examination is abnormal, or they have warning signs.