LARYNGOLOGY: DYSPHAGIA (A AL-HUSSAINI, SECTION EDITOR)
What Is the Available Evidence for the Treatment of Globus Pharyngeus?
Published online: 14 April 2018
Springer Science+Business Media, LLC, part of Springer Nature 2018
Purpose of Review Globus pharyngeus is a persistent or intermittent, painless sensation of a foreign body in the throat that
represents around 4% of ENT referrals from primary care. The aetiology of this condition is poorly understood and therefore there
is no current universally accepted investigation pathway or treatment approach. This review aimed to provide a summary of the
established evidence for the treatment of globus pharyngeus. The review used an eight-step, rapid review methodology to create
an evidence summary.
Recent Findings Recent case-control studies have demonstrated positive results in the treatment of globus using selective
serotonin reuptake inhibitors and amitriptyline. Positive findings were also seen with the use of proton pump inhibitors, cognitive
behavioural therapy and speech and language therapy.
Summary Despite positive conclusions, strength of evidence is limited by lack of control groups in most studies, short follow-up
periods and small study populations. Therefore, there is much room for further research studies and subsequent meta-analysis to
move towards an evidence-based treatment algorithm. The authors suggest a case by case approach to the management given the
evidence but recommend consideration of speech and language therapy review and potentially cognitive behavioural therapy in
Keywords Globus pharyngeus
Speech andlanguage therapy
Cognitive behavioural therapy
Globus pharyngeus is defined as an intermittent or persistent,
painless sensation of a foreign body in the throat. By its na-
ture, this condition is difficult to treat and recurs often . It is
a clinical diagnosis made in the absence of objective clinical
‘Globus’ in Latin means ‘ball’, and the condition itself was
first appreciated by Hippocrates in the fifth century BC. This
diagnosis was further described in 1707 by Purcell as ‘globus
hystericus’ . This terminology however was later
abandoned in favour of the more accurate ‘globus
pharyngeus’, as the link between symptoms and hysterical
personality was disproved .
Research has shown that globus symptoms account for
over 4% of new referrals to ENT outpatient clinics . The
prevalence however in the general population is thought to be
much higher, as healthcare advice may not be sought .
Indeed, Tang et al. found the lifetime prevalence of these
symptoms to be 21.5% .
There is much uncertainty surrounding the aetiology of
this condition, with multiple different theories put for-
ward. Research has proposed that the following aetiol-
ogies, either in isolation or in combination, may account
for the symptoms of globus: gastro-oesophageal reflux
disease, upper oesophageal sphincter hypertonicity,
dysmotility of the pharynx or oesophagus, anatomical
anomalies and psychological factors [7–11].
Management of these patients is mostly conducted by ENT
surgeons. Initial investigation centres around a detailed history
and a thorough head and neck examination, including flexible
nasendoscopy, in order to screen for patients that may be high
This article is part of the Topical Collection on LARYNGOLOGY:
* J. Heyman
Department of Otolaryngology, Queen Alexandra Hospital,
Department of Otolaryngology, University Hospital of Wales,
Current Otorhinolaryngology Reports (2018) 6:189–195