Causes of a Lump in Your Throat

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Lump in the throat refers to the persistent sensation that there is something stuck in your throat unrelated to swallowing, even when there is nothing in your throat. Unfortunately, as in many difficult to diagnose disorders, a feeling of having a persistent lump in your throat used to be considered a psychiatric disorder and referred to as globus hystericus (which is a term that was discontinued and should not be used to refer to this disorder). As is usually also the case with these types of difficult to diagnose disorders, there is growing evidence, that indeed this feeling is not just "in your head" and there are reasons why you are having this sensation.

Now that having a lump in throat sensation is better understood, this feeling is commonly also referred to as globus pharyngeus, globus sensation, or simply globus.

How Prevalent Is Globus Sensation?

Many people have experienced this sensation at one point in their lifetime. It is estimated that at least 46 out of 100 people have experienced globus sensation, and this actually accounts for 4 percent of all new appointments scheduled with an ENT specialist (otolaryngologist). Globus sensation also appears to be equally prevalent among men and women regardless of their state of health. You are not alone, and there are tests available to help identify any problems that you should be concerned about.

What Can I Expect During My First Appointment?

Your ENTs primary objective during your visit will be to determine whether you are experiencing dysphagia (difficulty swallowing). Dysphagia and globus are different in that dysphagia is accompanied by a structural or functional problem with your pharynx (throat) or esophagus. Treatment will vary between the two different diagnoses. Your doctor will take a thorough history to help identify potential causes of your symptoms. Common questions that you can expect include:

  • Sudden, unexpected weight loss
  • Pain with swallowing
  • Neck pain
  • Vomiting
  • Muscle weakness
  • Onset of symptoms
  • Progressive worsening or things that make symptoms worse

While you may feel that the health history is not as important as what you are currently feeling, it is actually very important in differentiating whether you have any of the following disorders that can be associated with globus:

What Testing Will Be Performed?

There currently is not an identified best method for testing for the sensation of a lump in your throat. However, once your doctor has taken a thorough history, they will likely target one of two different first approaches:

  1. Treat with medication for GERD
  2. Cancer screenings and work-up if cancer is suspected (rarely the case)

Because GERD can be associated with 23-68 percent of cases of globus, your ENT may simply start you on a short trial of a proton pump inhibitor (PPI) medication to see if this resolves your sensation of a lump in your throat. If your symptoms resolve, you may simply be referred back to your primary care physician or a gastroenterologist. If you have a partial resolution of symptoms, your PPI dose may be increased. However, if you do not have any changes in symptoms, your ENT may continue to evaluate reflux disease or other esophageal disorders by performing the following procedures:

  • Multichannel intraluminal impedance
  • Acid (pH) monitoring
  • Endoscopy
  • Manometry
  • Barium swallow study
  • Videofluoroscopy

What Happens If All The Tests Are Negative?

If all the tests are negative, you are likely feeling very frustrated. Try to relax and think positive. If you have made it this far, your condition is at least benign (not immediately harmful). However, you will not have a resolution of symptoms that you are looking for. In these cases, there are several treatments that may be worth trying:

  • Speech therapy
  • Learn relaxation techniques
  • Antidepressant trial (takes 6 weeks before effectiveness can be evaluated)

Speech therapy can teach you techniques to strengthen your swallow and vocal use. This may have varied success rates. Antidepressant use and relaxation techniques have a similar line of rationale. Mood can be associated with feelings of having a lump in your throat and could be useful in trying to treat causes of your symptoms without any other known causes.

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