Feeling of a lump in the throat: causes, red flags and when to get it checked

Globus is a sensation, not an obstruction. The throat muscles, especially the upper oesophageal sphincter, can be over-tight or over-sensitive, and irritation from acid or mucus makes the throat more aware. Because swallowing relaxes the area, the sensation often fades when you eat or drink.

• Laryngopharyngeal reflux: acid or pepsin irritating the throat, with throat clearing, hoarseness, a bitter taste and a sensation of mucus.

• Muscle tension in the throat and neck, often with stress or anxiety, and sometimes after a throat infection.

• Postnasal drip from allergy or sinus inflammation, with frequent throat clearing.

• Enlarged tonsils or tonsil stones, and an enlarged tongue base or thyroid gland.

• Hiatus hernia or gastro-oesophageal reflux.

• Eosinophilic oesophagitis and oesophageal motility disorders, which usually cause food to stick.

• Thyroid nodules or goitre pressing on structures in the neck.

• Throat or oesophageal cancer, which is uncommon and typically causes persistent hoarseness, pain on swallowing, weight loss or food sticking.

Difficulty swallowing food or liquids, food sticking, pain on swallowing that radiates to the ear, a hoarse voice for more than three weeks, unexplained weight loss, a lump in the neck, coughing blood, a history of heavy smoking and alcohol use, or being over 50 with new symptoms warrant prompt referral.

• Call 999 or go to A&E: difficulty breathing, noisy breathing or inability to swallow saliva.

• GP urgently (suspected cancer pathway): persistent hoarseness over three weeks in a smoker aged over 45, difficulty swallowing, or a neck lump.

• GP within weeks: globus lasting more than a few weeks, or with weight loss.

• Routine: a lump sensation that eases with eating and comes with stress or reflux.

Doctors ask whether the sensation is there between meals or when swallowing, any pain, food sticking, voice change, weight loss, reflux symptoms, smoking and alcohol, stress and sleep. They examine the mouth, throat and neck for lumps, thyroid and lymph nodes.

• Flexible nasendoscopy (camera through the nose): to see the throat and voice box directly.

• Gastroscopy: if swallowing difficulty or red flags suggest an oesophageal cause.

• Barium swallow or manometry: for suspected motility problems.

• Neck ultrasound and thyroid tests: if there is a neck swelling.

• Blood tests: where iron deficiency or thyroid disease is suspected.

Avoid habitual throat clearing, which irritates the lining; sip water or swallow instead. Eat smaller meals, avoid eating late, cut back on caffeine, alcohol and smoking, and treat reflux with lifestyle measures. Neck and shoulder relaxation exercises and speech and language therapy techniques can ease muscle tension. Reassurance after a normal examination often helps in itself.

The NHS route is a GP, with urgent referral for red flags and ENT for persistent symptoms. Private ENT consultation with nasendoscopy can be arranged directly for reassurance.