Review: Current Trends in the Diagnosis and Management of Globus Pharyngeus

Scott Mitchell, Oladejo Olaleye, Matthew Weller

Department of Otolaryngology, Dudley Group of Hospitals, West Midlands, UK.

DOI: 10.4236/ijohns.2012.13013                

Abstract

Aim: To review recent literature on the diagnosis and management options for globus pharyngeus. Recent Findings: Strong evidence for the cause of globus pharyngeus is lacking however there is some research to suggest a possible link between laryngopharyngeal reflux (LPR) and globus pharyngeus. Radiological investigations used to find the cause of globus pharyngeus are often normal with little evidence to support their routine use. There are no long term controlled studies investigating the effectiveness of proton pump inhibitors (PPI’s) for the treatment of globus pharyngeus however, these are commonly used. A recent nonplacebo-controlled study has shown promising results using liquid alginate suspension to treat laryngopharyngeal reflux symptoms. Other treatment modalities used, such as speech and language therapy, have shown some improvement in symptoms but these are often small trials. Summary: Globus pharyngeus is a clinical diagnosis. Investigations should be reserved for those with atypical symptoms. Thorough clinical evaluation and examination, including fibreoptic laryngoscopy, are key points in management.

Keywords

Globus Pharyngeus; Hystericus; Laryngopharyngeal Reflux

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	A. J. G. Batch, “Globus Pharyngeus (Part 1),” Journal of Laryngology & Otology, Vol. 102, No. 2, 1988, pp. 152158. doi:10.1017/S0022215100104384
[2]	R. P. S. Harar, S. Kumar, M. A. Saeed and D. J. Gatland, “Management of Globus Pharyngeus: Review of 699 Cases,” Journal of Laryngology & Otology, Vol. 118, No. 7, 2004, pp. 522-527. doi:10.1258/0022215041615092
[3]	H. Rowley, T. P. O’Dwyer, A. S. Jones and C. I. Timon, “The Natural History of Globus Pharyngeus,” Laryngoscope, Vol. 105, No. 10, 1995, pp. 1118-1121. doi:10.1288/00005537-199510000-00019
[4]	A. G. Kerr, Ed., “Scott-Brown’s Otolaryngology,” In: J. A. Wilson, Ed., Laryngology and Head & Neck Surgery, Vol. 5, Reed Educational and Professional Publishing Ltd., Oxford, 1997, pp. 1-31.
[5]	J. L. Lancaster, S. Gosh, R. Sethi and S. Tripathi, “Can Heterotopic Gastric Mucosa Present as Globus Pharyngeus?” Journal of Laryngology & Otology, Vol. 120, No. 7, 2006, pp. 575-578. doi:10.1017/S0022215106001307
[6]	A. Alaani, P. Jassar, A. T. Warfield, D. R. Gouldesbrough and I. Smith, “Heterotopic Gastric Mucosa in the Cervical Oesophagus (Inlet Patch) and Globus Pharyngeus— An Under-Recognised Association,” Journal of Laryngology and Otology, Vol. 121, No. 9, 2007, pp. 885-888. doi:10.1017/S0022215106005524
[7]	F. O. Agada, A. P. Coatesworth and A. R. Grace, “Retroverted Epiglottis Presenting as a Variant of Globus Pharyngeus,” Journal of Laryngology & Otology, Vol. 121, No. 4, 2007, pp. 390-392. doi:10.1017/S0022215106003422
[8]	L. M. Masterson, I. A. Srouji, P. Musonda and D. G. I. Scott, “Autoimmune Disease as a Risk Factor for Globus Pharyngeus: A Cross-Sectional Epidemiological Study,” Clinical Otolaryngology, Vol. 36, No. 1, 2011, pp. 24-29. doi:10.1111/j.1749-4486.2010.02243.x
[9]	P. Jarunchinda, A. Saengsapawiriya, S. Chakkaphak, S. Somngeon and K. Petsrikun, “The Study of Allergic Skin Test in Patients with Globus Pharyngeus: A Preliminary Report,” Journal of the Medical Association of Thailand, Vol. 92, No. 4, 2009, pp. 531-536.
[10]	I. J. Deary, A. Smart and J. A. Wilson, “Depression and ‘Hassles’ in Globus Pharyngis,” British Journal of Psychiatry, Vol. 161, 1992, pp. 115-117. doi:10.1192/bjp.161.1.115
[11]	I. J. Deary, J. A. Wilson and S. W. Kelly, “Globus Pharyngis, Personality, and Psychological Distress in the General Population,” Psychosomatics, Vol. 36, No. 6, 1995, pp. 570-577. doi:10.1016/S0033-3182(95)71614-0
[12]	R. Fass, S. R. Achem, S. Harding, R. K. Mittal and E. Quigley, “Supra-Oesophageal Manifestations of GastroOesophageal Reflux Disease and the Role of Night-Time Gastro-Oesophageal Reflux,” Alimentary Pharmacology and Therapeutics, Vol. 20, No. 9, 2004, pp. 26-38. doi:10.1111/j.1365-2036.2004.02253.x
[13]	B. K. Bender, “Nonspecific Swallowing Complaints: Is It Reflux?” Topics in Geriatric Rehabilitation, Vol. 23, No. 4, 2007, pp. 308-318.
[14]	A. Alaani, S. Vengala and M. N. Johnston, “The Role of Barium Swallow in the Management of Globus Pharyngeus,” European Archives of Oto-Rhino-Laryngology, Vol. 264, No. 9, 2007, pp. 1095-1097. doi:10.1007/s00405-007-0315-z
[15]	C. Hickson, B. Simpson and R. Falcon, “Laryngeal Pseudosulcus as a Predictor of Laryngopharyngeal Reflux,” Laryngoscope, Vol. 111, No. 10, 2001, pp. 17421745. doi:10.1097/00005537-200110000-00014
[16]	D. M. Hicks, T. M. Ours, T. I. Abelson, et al., “The Prevalence of Hypopharynx Findings Associated with Gastroesophageal Reflux in Normal Individuals,” Journal of Voice, Vol. 16, No. 4, 2002, pp. 564-579. doi:10.1016/S0892-1997(02)00132-7
[17]	K. Zelenik, P. Matousek, O. Urban, P. Schwarz, I. Starek and P. Kominek, “Globus Pharyngeus and Extraesophageal Reflux: Simultaneous pH <4.0 and pH <5.0 Analysis,” Laryngoscope, Vol. 120, No. 11, 2010, pp. 21602164. doi:10.1002/lary.21147
[18]	J. P. Noordzij, A. Khidr, E. Desper, et al., “Correlation of pH Probe-Measured Laryngopharyngeal Reflux with Symptoms and Signs of Reflux Laryngitis,” Laryngoscope, Vol. 112, No. 12, 2002, pp. 2192-2195. doi:10.1097/00005537-200212000-00013
[19]	R. A. Franco, “Laryngopharyngeal Reflux,” Allergy and Asthma Proceedings, Vol. 27, No. 1, 2006, pp. 21-25.
[20]	G. W. Back, P. Leong, R. Kumar and R. Corbridge, “Value of Barium Swallow in Investigation of Globus Pharyngeus,” Journal of Laryngology & Otology, Vol. 114, No. 12, 2000, pp. 951-954. doi:10.1258/0022215001904437
[21]	D. Hajioff and D. Lowe, “The Diagnostic Value of Barium Swallow in Globus Syndrome,” International Journal of Clinical Practice, Vol. 58, No. 1, 2004, pp. 8689. doi:10.1111/j.1368-5031.2003.0096.x
[22]	C. J. Webb, Z. G. G. Makura, J. E. Fenton, S. R. Jackson, M. S. McCormick and A. S. Jones, “Globus Pharyngeus: A Postal Questionnaire Survey of UK ENT Consultants,” Clinical Otolaryngology, Vol. 25, No. 6, 2000, pp. 566569. doi:10.1046/j.1365-2273.2000.00386.x
[23]	Y. M. Takwoingi, U. S. Kale and D. W. Morgan, “Rigid Endoscopy in Globus Pharyngeus: How Valuable Is It?” Journal of Laryngology & Otology, Vol. 120, No. 1, 2006, pp. 42-46. doi:10.1017/S0022215105006043
[24]	J. N. Marshall, G. McGann, J. A. Cook and N. Taub, “A Prospective Controlled Study of High-Resolution Thyroid Ultrasound in Patients with Globus Pharyngeus,” Clinical Otolaryngology, Vol. 21, No. 3, 1996, pp. 228-231. doi:10.1111/j.1365-2273.1996.tb01731.x
[25]	P. C. Belafsky, G. N. Postma and J. A. Koufman, “Laryngopharyngeal Reflux Symptoms Improve before Changes in Physical Findings,” Laryngoscope, Vol. 111, No. 6, 2001, pp. 979-981. doi:10.1097/00005537-200106000-00009
[26]	P. D. Karkos and J. A. Wilson, “The Diagnosis and Management of Globus Pharyngeus: Our Perspective from the United Kingdom,” Current Opinion in Otolaryngology & Head and Neck Surgery, Vol. 16, No. 6, 2008, pp. 521524. doi:10.1097/MOO.0b013e328316933b
[27]	F. Millichap, M. Lee and T. Pring, “A Lump in the Throat: Should Speech and Language Therapists Treat Globus Pharyngeus?” Disability and Rehabilitation, Vol. 27, No. 3, 2005, pp. 124-130. doi:10.1080/09638280400007448
[28]	P. D. Karkos, L. Thomas, R. H. Temple and W. J. Issing, “Awareness of General Practitioners towards Treatment of Laryngopharyngeal Reflux: A British Survey,” Journal of Otolaryngology—Head and Neck Surgery, Vol. 133, No. 4, 2005, pp. 505-508. doi:10.1016/j.otohns.2005.06.013
[29]	P. D. Karkos, J. Benton, S. C. Leong, A. Karkanevatos, K. Badran, et al., “Trends in Larygopharyngeal Reflux: A British ENT Survey. European Archives of Oto-RhinoLaryngology, Vol. 264, No. 5, 2007, pp. 513-517. doi:10.1007/s00405-006-0222-8
[30]	J. Dumper, B. Mechor, J. Chau and M. Allegretto, “Lansoprazole in Globus Pharyngeus: Double-Blind, Randomized, Placebo-Controlled Trial,” Journal of Otolaryngology—Head and Neck Surgery, Vol. 37, No. 5, 2008, pp. 657-663.
[31]	N. Oridate, H. Takeda, M. Asaka, N. Nishizawa, Y. Mesuda, M. Mori, et al., “Acid-Suppression Therapy Offers Varied Laryngopharyngeal and Esophageal Symptom Relief in Laryngopharyngeal Reflux Patients,” Digestive Diseases and Sciences, Vol. 53, No. 8, 2008, pp. 2033-2038. doi:10.1007/s10620-007-0114-9
[32]	P. C. Belafsky, G. N. Postma and J. A. Koufman, “Laryngopharyngeal Reflux Symptoms Improve before Changes in Physical Findings,” Laryngoscope, Vol. 111, No. 6, 2001, pp. 979-981. doi:10.1097/00005537-200106000-00009
[33]	D. J. Kibblewhite and M. D. Morrison, “A Double-Blind Controlled Study of the Efficacy of Cimetidine in the Treatment of the Cervical Symptoms of Gastroesophageal Reflux,” Journal of Otolaryngology, Vol. 19, No. 2, 1990, pp. 103-109.
[34]	P. D. Karkos and J. A. Wilson, “The Diagnosis and Management of Globus Pharyngeus: Our Perspective from the United Kingdom,” Current Opinion in Otolaryngology & Head and Neck Surgery, Vol. 16, No. 6, 2008, pp. 521-524. doi:10.1097/MOO.0b013e328316933b
[35]	F. Millichap, M. Lee and T. Pring, “A Lump in the Throat: Should Speech and Language Therapists Treat Globus Pharyngeus?” Disability and Rehabilitation, Vol. 27, No. 3, 2005, pp. 124-130. doi:10.1080/09638280400007448
[36]	H. S. Khalil, M. W. Bridger, M. Hilton-Pierce, et al., “The Use of Speech Therapy in the Treatment of Globus Pharyngeus Patients. A Randomised Controlled Trial,” Revue de Laryngologie Otologie Rhinologie, Vol. 124, No. 3, 2003, pp. 187-190.
[37]	H. S. Khalil, V. M. Reddy, M. Bos-Clark, A. Dowley, M. H. Pierce, C. P. Morris and A. E. Jones, “Speech Therapy in the Treatment of Globus Pharyngeus: How We Do It,” Clinical Otolaryngology, Vol. 36, No. 4, 2011, pp. 371392. doi:10.1111/j.1749-4486.2011.02326.x
[38]	P. Burns and C. Timon, “Thyroid Pathology and the Globus Symptom: Are They Related? A Two Year Prospective Trial,” Journal of Laryngology and Otology, Vol. 121, No. 3, 2007, pp. 242-245. doi:10.1017/S0022215106002465
[39]	K. H. Maung, D. Hayworth, P. A. Nix, S. L. Atkin and R. J. A. England, “Thyroidectomy Does Not Cause Globus Pattern Symptoms,” Journal of Laryngology and Otology, Vol. 119, No. 12, 2005, pp. 973-975. doi:10.1258/002221505775010760
[40]	I. J. Deary, J. A. Wilson, M. B. Harris and G. MacDougall, “Globus Pharyngis: Development of a Symptom Assessment Scale,” Journal of Psychosomatic Research, Vol. 39, No. 2, 1995, pp. 203-213. doi:10.1016/0022-3999(94)00104-D
[41]	P. C. Belafsky, G. N. Postma and J. A. Koufman, “Validity and Reliability of the Reflux Symptom Index (RSI),” Journal of Voice, Vol. 16, 2002, pp. 274-277. doi:10.1016/S0892-1997(02)00097-8
[42]	R. A. Cathcart, N. Steen, B. G. Natesh, K. H. Ali and J. A. Wilson, “Non-Voice-Related Throat Symptoms: Comparative Analysis of Laryngopharyngeal Reflux and Globus Pharyngeus Scales,” The Journal of Laryngology & Otology, Vol. 125, No. 1, 2011, pp. 59-64. doi:10.1017/S0022215110001866
[43]	P. C. Belafsky, G. N. Postma and J. A. Koufman, “The Validity and Reliability of the Reflux Finding Score (RFS),” Laryngoscope, Vol. 111, No. 8, 2001, pp. 13131317. doi:10.1097/00005537-200108000-00001
[44]	C. Timon, D. Cagney, T. O’Dwyer and M. Walsh, “Globus Pharyngeus: Long-Term Follow-Up and Prognostic Factors,” Annals of Otology, Rhinology and Laryngology, Vol. 100, No. 5, 1991, pp. 351-354.