Feeling of Lump in Throat When Swallowing (Globus Sensation)
A feeling of lump in throat when swallowing or even without swallowing, when no such lump exists, is termed as globus sensation.
It is different from dysphagia which is a feeling of difficulty in swallowing food or drinks. A physical lump in the neck or throat, such as a palpable growth or mass, is also different from globus sensation. Some people describe globus sensation as a tightening of the throat.
Causes
The actual reason for globus sensation has not been fully explained. Excess tension in the throat muscles, especially when a person experiences emotional upheaval such as profound sadness, joy, or anger results in this feeling. People who have gastroesophageal reflux disorder frequently feel globus sensation.
Having globus sensation is not a cause of worry, as it is not a harmful or an extremely distressing condition in itself. Occasionally, some serious esophageal conditions may be causing a similar symptom which is interpreted mistakenly as globus sensation. Disorders of the esophagus such as spasms, reflux disease, cross webbing in the esophagus etc., and certain tumors, produce symptoms which could be mistaken for globus sensation. Polymyositis, myotonic dystrophy and myasthenia gravis are some neuromuscular disorders causing similar symptoms. Hence, it is important to have a correct diagnosis when a person is having the sensation of lump in throat.
Evaluation
Globus sensation may not need medical attention unless it is accompanied by warning signs such as the ones given below.
Warning signs: When other symptoms listed below are present along with globus sensation, it may be due to a disorder requiring medical attention.
- Pain in the throat or neck
- Significant weight loss without apparent reason
- Dysphagia or difficulty in swallowing, choking
- Regurgitation or bringing the swallowed food back up
- A lump which can be seen or felt
- General weakness of muscles
- Sudden appearance of the symptom in people aged over 50 years
- Symptoms persisting and worsening
When to see a doctor: When any of the warning signs are present along with the sensation of lump in throat, people should seek urgent medical attention. When warning signs are absent, the lump in throat sensation is most probably due to globus sensation; but it is recommended that people should visit the doctor as soon as possible to confirm the diagnosis and to rule out other disorders.
When a person visits the doctor with the complaint of lump in the throat sensation, doctor performs a physical examination of the mouth, throat and the neck. Doctor will ask about the previous medical history of the patient with special emphasis on disorders affecting the upper digestive tract and the chest. Doctor may want to know if there is pain or discomfort during swallowing. It is important to tell the doctor if any of the warning signs are present. Based on the physical examination, details of the symptoms described by the patient, and the previous medical history, doctor may either give a diagnosis or order some diagnostic tests to detect the exact cause.
During physical examination doctor may feel the neck and the floor of mouth for abnormal lumps. A narrow tube with a viewing scope attached, may be inserted into the throat to examine the larynx as well as the back of the throat. A swallow test with fluids and solid foods may be conducted in front of the doctor so that any difficulty associated with swallowing may be detected. It is important to determine if the lump in the throat sensation is associated with ingestion of food or with emotional stress. If the sensation recurs in a patient during periods of distress or grief, and if the act of crying seems to alleviate it, the condition may be assessed as globus sensation without doubt.
Testing: If the feeling of having a lump in the throat is not associated with any difficulty in swallowing and it is not accompanied by any of the warning signs, and the physical examination by the doctor does not show any abnormality in the throat or neck, the condition may be diagnosed as globus sensation without any further testing.
Imaging tests such as X-rays, or viewing the throat and the esophagus by endoscopy, are some tests which may be conducted to rule out any abnormality or abnormal growth in the region which may be causing the lump in the throat sensation. Tests to measure swallowing time as well as esophageal manometry also may be done.
Treatment
No treatment is necessary, and no drugs are available, for treating globus sensation. Doctors may explain the benign nature of the condition, and its relation to the emotional state of mind. When the patient realizes that globus sensation has no serious consequence, he may be reassured and relieved.
If motility disorders or physical blocks are found to be the reason for the symptom, they may be treated surgically or with drugs.
If doctor observes signs of depression or behavioral problems in the patient, which may be worsening the condition, he may suggest an evaluation by a psychiatrist or prescribe antidepressants.
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Yasser Elnahas
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