Globus sensation: a lump in the throat

What is globus?

Globus is the ongoing feeling of a lump, tightness or foreign body in the throat. It is often worse when you swallow saliva. It is typically not linked to eating, which separates it from true difficulty swallowing (the medical word is dysphagia). Patients describe it in many ways: a ball, a frog, something stuck, phlegm that will not clear, or a choking feeling without any choking.

It is one of the most common reasons people ask about their throat. Most cases are benign and do not point to a serious disease. Even so, the symptom can be distressing, and it is natural to worry about cancer. The purpose of an assessment is to check for red flags, find any treatable cause, and give you a clear plan.

What causes it?

Globus usually has more than one contributing factor. The most common are listed below.

• Reflux reaching the throatLaryngopharyngeal reflux (LPR) means stomach contents travelling up as far as the voice box. Acid and digestive enzymes, particularly pepsin, can irritate the sensitive lining of the throat. It can happen without heartburn, which is why it is often missed. It is the cause I discuss most in my practice.
• Muscle tension in the throat and voice boxThroat clearing, repeated swallowing and straining the voice keep the muscles tight and make the sensation worse.
• Postnasal drip and throat drynessMucus running down the back of the throat, a dry mouth or a sore throat can all keep the throat constantly "in focus".
• Enlarged tonsils or tonsil stonesA tonsil that is large, infected or full of stones can feel like something sitting in the throat.
• Anxiety and stressThese do not cause the sensation on their own, but they strongly amplify it. The sensation then causes more anxiety. Breaking that cycle is part of treatment.

Less common causes that a GP or specialist may consider include eosinophilic oesophagitis (an allergic inflammation of the gullet), a pharyngeal pouch (a small pocket in the upper gullet), and patches of stomach-type lining in the upper gullet.

When should I see my GP urgently?

What you can do at home

Many people improve significantly with simple measures. They are worth trying for at least four to six weeks.

Diet and eating habits

• Eat smaller, more frequent meals rather than large meals.
• Finish your last meal at least two to three hours before lying down.
• Limit the foods that commonly provoke reflux: alcohol, coffee and strong tea, fizzy drinks, chocolate, peppermint, spicy food, fatty or fried food, and citrus and tomato-based foods. Everyone is different, so keep a simple diary and cut back on what clearly makes you worse.
• Drink water regularly through the day to keep the throat moist.

Posture and sleep

• Raise the head of your bed by about 15 to 20 cm. Use blocks under the bed legs, not extra pillows, which only bend the body.
• Sleep on your left side where this is comfortable. Some people find this reduces night-time reflux.
• Do not lie down or slump for at least an hour after eating.

Voice and throat habits

• Avoid clearing your throat repeatedly. Take a sip of water or a gentle swallow instead. Repeated throat clearing irritates the lining and makes the sensation worse.
• Rest your voice when you are hoarse. Avoid whispering, which strains the voice box more than normal speech.
• Use steam or a humidifier if the air is dry, and stop smoking if you smoke.

Stress and muscle tension

• Relaxation techniques, regular exercise such as walking or swimming, and avoiding tight clothing around the waist can help.
• Gentle neck and shoulder stretches may ease muscle tension. Stop if they cause pain.

Medicines that can help

Alginates (liquid raft-forming medicine, for example Gaviscon Advance)

Alginates form a protective layer on top of the stomach contents. This helps to stop reflux reaching the throat. They are available without a prescription and are generally well tolerated. They are the treatment I most often suggest first for throat symptoms.

• Take it after meals and at bedtime, as directed on the product label.
• Continue for at least two weeks after symptoms settle, then reduce gradually.
• If the sensation returns, restart straight away. A few doses at the first sign of recurrence often control it before it becomes established.

Proton pump inhibitors (PPIs, for example omeprazole, lansoprazole or esomeprazole)

PPIs reduce stomach acid. They work very well for heartburn and indigestion. For throat symptoms alone, however, the evidence is weak. A large UK randomised trial of lansoprazole for persistent throat symptoms found no benefit over a dummy tablet (placebo) at 16 weeks or at 12 months. Because of this, I do not start a PPI for throat symptoms without heartburn, indigestion or other reflux symptoms.

If you have heartburn as well, or your GP recommends a PPI, please take it as prescribed. Long-term use should be reviewed regularly. Stopping suddenly can cause rebound acid symptoms, and long-term use is linked to side effects that need monitoring, including bone thinning and low magnesium.

Other medicines

Antihistamines or nasal steroid sprays may help if you have a runny or blocked nose and postnasal drip. My hay fever article explains how to use them properly. Your GP can advise.

Tests your GP may arrange or refer you to a specialist for

• Blood tests where indicated, including thyroid function and iron levels. See my private blood tests page.
• A trial of treatment, usually four to six weeks, as above.
• Referral to ENT (ear, nose and throat) if the symptoms persist despite these measures, if there are red flags, or if the throat looks abnormal on examination. An ENT specialist will usually look at the throat and voice box with a thin camera passed through the nose (flexible nasendoscopy). It takes only a few minutes.
• A swallowing X-ray (barium swallow) may be considered if there is a swallowing problem or a suspected pouch.
• Upper gastrointestinal endoscopy (a camera test of the gullet and stomach) is done when there are red flags, persistent symptoms with swallowing difficulty, or other signs of a gullet or stomach problem.
• pH monitoring (a test measuring acid in the throat or gullet) is used by specialists in selected cases, usually when treatment has not worked.

Summary

• Globus is common and usually benign, but it deserves a proper assessment.
• Reflux reaching the throat is a frequent cause, even without heartburn.
• Simple changes to diet, posture and voice habits often help within weeks.
• An alginate taken after meals and at bedtime is my usual first medicine for throat symptoms. PPIs are not recommended for throat symptoms alone.
• Seek urgent review for swallowing difficulty that is getting worse, weight loss, coughing blood, or a neck lump.

This information is for general guidance and does not replace an individual assessment. If you are unsure, or your symptoms are changing, please speak to your GP.