Lump in the throat is the sensation of a lump or mass in the throat, unrelated to swallowing, when no mass is present. (See Neck Mass Neck Mass Patients or their family members may notice a mass on the neck, or one may be discovered during routine examination. A neck mass may be painless or painful depending on the cause. When a neck... read more if a mass is present.)
Etiology of Lump in Throat
No specific etiology or physiologic mechanism has been established. Some studies suggest that elevated cricopharyngeal (upper esophageal sphincter) pressure or abnormal hypopharyngeal motility occur during the time of symptoms. The sensation may also result from gastroesophageal reflux disease Gastroesophageal Reflux Disease (GERD) Incompetence of the lower esophageal sphincter allows reflux of gastric contents into the esophagus, causing burning pain. Prolonged reflux may lead to esophagitis, stricture, and rarely metaplasia... read more (GERD) or from frequent swallowing and drying of the throat associated with anxiety or another emotional state. Although not associated with stress factors or a specific psychiatric disorder, globus sensation may be a symptom of certain mood states (eg, grief, pride); some patients may have a predisposition to this response.
Disorders that can be confused with globus sensation include cricopharyngeal (upper esophageal) webs, symptomatic diffuse esophageal spasm Diffuse Esophageal Spasm Symptomatic diffuse esophageal spasm is part of a spectrum of motility disorders characterized variously by nonpropulsive contractions and hyperdynamic contractions, sometimes in conjunction... read more , GERD, skeletal muscle disorders (eg, myasthenia gravis Myasthenia Gravis Myasthenia gravis is characterized by episodic muscle weakness and easy fatigability caused by autoantibody- and cell-mediated destruction of acetylcholine receptors. It is more common among... read more , myotonia dystrophica, autoimmune myositis Autoimmune Myositis Autoimmune myositis is characterized by inflammatory and degenerative changes in the muscles (polymyositis) or in the skin and muscles (dermatomyositis). Manifestations include symmetric weakness... read more ), and mass lesions in the neck or mediastinum that cause esophageal compression.
Evaluation of Lump in Throat
The main goal is to distinguish globus sensation from true dysphagia Dysphagia Dysphagia is difficulty swallowing. The condition results from impeded transport of liquids, solids, or both from the pharynx to the stomach. Dysphagia should not be confused with globus sensation... read more , which suggests a structural or motor disorder of the pharynx or esophagus.
History of present illness should elicit a clear description of the symptom, particularly as to whether there is any pain with swallowing or difficulty swallowing (including sensation of food sticking). Timing of symptoms is important, particularly whether it occurs with eating or drinking or is independent of those activities; association with emotional events should be queried specifically.
Review of systems seeks weight loss (as evidence of a swallowing disorder) and symptoms of muscle weakness.
Past medical history should include known neurologic diagnoses, particularly those causing weakness.
The neck and floor of the mouth are palpated for masses. The oropharynx is inspected (including by direct laryngoscopy). Swallowing (of water and a solid food such as crackers) should be observed. Neurologic examination with particular attention to motor function is important.
The following findings are of particular concern:
Neck or throat pain
Pain, choking, or difficulty with swallowing
Regurgitation of food
Palpable or visible mass
Progressive worsening of symptoms
Interpretation of findings
Symptoms unrelated to swallowing, with no pain or difficulty with swallowing, or sensation of food sticking in the throat in a patient with a normal examination imply globus sensation. Any red flag findings or abnormal findings on examination suggest a mechanical or motor disorder of swallowing. Chronic symptoms that occur during unresolved or pathologic grief and that may be relieved by crying suggest globus sensation.
Patients with findings typical of globus sensation need no testing. If the diagnosis is unclear or the clinician cannot adequately visualize the pharynx, testing as for dysphagia is done. Typical tests include clinical swallow evaluation, plain or video esophagography (video barium swallow), measurement of swallowing time, chest x-ray, and esophageal manometry.
Treatment of Lump in Throat
Treatment of lump in throat involves reassurance and sympathetic concern. No drug is of proven benefit. Underlying depression, anxiety, or other behavioral disturbances should be managed supportively, with psychiatric referral if necessary. At times, communicating to the patient the association between symptoms and mood state can be beneficial.
Globus symptoms are unrelated to swallowing.
Tests are not needed unless symptoms are related to swallowing, examination is abnormal, or there are red flag findings.