Globus pharyngeus: the feeling of a lump in the throat

The word globus is Latin for ball, and pharyngeus refers to the pharynx, the part of the throat behind the mouth. Together they describe a sensation of a ball in the throat. It is a symptom rather than a diagnosis of a throat disease.

People often describe it as a tightness, a choking feeling, a persistent need to swallow, or a feeling that a pill or a piece of food is stuck. The East Kent leaflet adds that the throat and mouth may feel dry and tight, the voice may become hoarse and swallowing may seem more of an effort.

The East Kent leaflet calls it a common problem. Because tension is one of the associations, worry about the sensation can itself keep the throat muscles tight, which is one reason reassurance is part of treatment.

The cause is not fully understood and probably varies from person to person. The leaflet from East Kent Hospitals points to tension or stress and possible acid reflux as the usual associations, noting that reflux may increase the tone of the throat muscles.

NHS Borders guidance lists several everyday factors in its self-management advice: caffeine, alcohol and late-night eating, smoking and fizzy drinks, dry swallowing and throat clearing, poor hydration and psychological stress. Those factors can irritate the throat or keep it tense, and reducing them is part of the plan.

• Stress, anxiety or periods of emotional strain.

• Acid reflux, including reflux that causes little heartburn.

• Habitual throat clearing or dry swallowing.

• Dehydration, caffeine, alcohol or late meals.

• Smoking and fizzy drinks.

It is important to separate globus from swallowing difficulty. The NHS describes dysphagia as having problems swallowing, with signs such as coughing or choking when eating or drinking, food coming back up, food feeling stuck in the throat or chest, and over time weight loss, dehydration and repeated chest infections. It advises asking for an urgent GP appointment or contacting NHS 111 if you notice these.

NHS Borders guidance lists the features that prompt an urgent referral to ENT: difficulty swallowing, hoarseness that lasts for more than 3 weeks, a lump in the neck, progressive or one-sided symptoms lasting more than 3 weeks, a change in the voice, unexplained weight loss, and being a heavy smoker aged 40 or over. These features can point to other conditions in the throat or voice box, which is why they are taken seriously even though globus on its own is almost always harmless.

If you cannot breathe properly, or you are choking or struggling to swallow your own saliva, call 999 or go to A&E.

Assessment starts with a conversation about what the sensation is like, whether eating or drinking is normal and whether any of the warning features are present. Your GP may examine your mouth, neck and throat. If everything points to globus and nothing concerning is found, reassurance is often the main treatment.

If there are red flags, or if reassurance is wanted, an ENT specialist may look at the throat and voice box with a thin flexible camera passed through the nose. The NHS Borders toolkit describes a routine referral route for people who want reassurance: they are sent written information on globus and can then opt in to a face-to-face appointment. Arrangements differ between areas, so ask your GP what is available locally.

The East Kent leaflet recommends steps that can be tried at home: drinking plenty of cool fluids, about two litres a day; yawning to stretch the back of the throat; avoiding throat clearing and instead taking a drink or doing a silent huff followed by a strong gulp; building relaxation into your day through a hobby such as yoga, walking, meditation or tai chi; and gentle neck, shoulder and head stretching exercises.

It also suggests taking an antacid if you have acid reflux and speaking to your GP if symptoms continue. The leaflet says most people find the symptoms slowly fade and stop being a problem, and recommends going back to a speech and language therapist or the ENT department if symptoms persist after following the advice for six weeks.

NHS Borders guidance adds vocal hygiene advice, psychological support for stress, cutting down on caffeine, alcohol and late-night eating, and stopping smoking and fizzy drinks.

The East Kent leaflet says most people find that following the advice makes their symptoms slowly fade until they stop being a problem. New symptoms such as difficulty swallowing, voice change or weight loss should be reported rather than assumed to be globus.

On the NHS, most people with a lump-in-the-throat sensation are assessed by a GP first and reassured, with an ENT referral reserved for those with warning features or where the cause is unclear. Waiting times for routine ENT clinics vary by area.

Some people prefer to see a private ENT consultant for a throat examination, particularly if they are anxious that something serious is being missed. The examination and the advice are typically the same as in the NHS, so it is the speed and the chance to talk it through that differ. Whichever route you take, mention any difficulty swallowing, voice change, weight loss or one-sided symptoms, since those are what change the plan.