Effect of Oral Water Intake to Globus Pharyngeus with Non-Organic Diseases

BACKGROUND AND OBJECTIVES: Globus pharyngeus is a sensation of foreign body in the throat. There are many studies evaluate relationships between globus pharyngeus and organic diseases such as laryngopharyngeal reflux, esophageal motility disorders as well as psychotic causes. But, Also many patients without etiologic causes complain of globus sensation. The authors performed a study that evaluate association between oral water intake and symptoms of globus sensation on the basis of a belief that pharyngeal dehydration due to lack of oral water intake causes globus sensation. MATERIALS AND METHODS: A survey using visual analogue scale to evaluate symptoms was performed with 73 patients with globus pharyngeus. RESULTS: Patients who drink water less than 500 mL per day (p=0.04) and less than five times per day (p=0.02) were improved after 6 months due to education and doctor's recommendation. CONCLUSION: Frequent and enough water intake should be recommended to resolve symptoms of globus sensation.

Globus Pharyngeus: The Psychiatric Perspective

Globus pharyngeus or globus sensation is the painless sensation of a lump in the throat and may be described as a foreign body sensation, a tightening or choking feeling. It is often associated with persistent clearing of the throat, chronic cough, hoarseness, and catarrh. Its etiology remains unclear ; however, laryngopharyngeal reflux may play a role in a subset of patients. Psychogenic problems have often been thought to cause or trigger the globus sensation. Personality studies have found higher levels of alexithymia, neuroticism, and psychological distress (including anxiety, low mood, and somatic concerns) and lower levels of extraversion in patients presenting with globus. Globus patients with laryngopharyngeal reflux exhibited weaker psychological symptoms than non- laryngopharyngeal reflux globus patients, and globus patients who did not respond to proton pump inhibitor had significantly higher anxiety scores. In cases with negative clinical investigations and consistent globus symptom, other treatment strategies, including speech therapy, antidepressants, and cognitive-behavioral therapy, should be considered.

Incidence and Clinical Significance of Thyroid Lesions in Patients with Globus Pharyngeus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Globus pharyngeus represents 3-4% of new otolaryngology outpatient referrals. The globus symptom in the throat may be an indication of thyroid abnormalities. The purpose of this study is to estimate the incidence of impalpable thyroid lesions in patients with globus pharyngeus and investigate possible association between globus pharyngeus and thyroid lesion. MATERIALS AND MEHTODS: The thyroid glands of 128 patients with globus pharyngeus and 50 controls were examined by ultrasound by a consultant radiologist using a 7 MHz probe. RESULTS: Thyroid abnormalities were present in 69/128 (54%) patients with globus and in 11/50 (22%) controls (p<0.05). Of the thyroid lesions in globus pharyngeus, 42/69 (61%) had nodules. The diameter of the echoic nodules varied from 2 to 23 mm. Thyroid lesions were common (78%) in female patients with globus, between the ages of 30 and 40. CONCLUSION: Impalpable thyroid abnormalities are significantly more common in patients with globus pharyngeus than in controls. Abnormalities of the thyroid gland may be the cause of globus symptoms in some patients, and it is necessary to evaluate the thyroid gland for investigation of the cause of globus pharyngeus.

Relationship between globus pharyngeus and thyroid abnormalities / 第二军医大学学报

Objective: To investigate the possible association between globus pharyngeus and thyroid abnormalities. Methods: Forty six patients with globus pharyngeus and 50 non globus pharyngeus patients were investigated by using 7.5 MHz high resolution thyroid ultrasound. The micro abnormatities in 2 groups were compared. Results: The incidence of thyroid abnormalities in globus pharyngeus group was 58.9%(27/46),and it was significantly higher than that(18.0%,9/50)in non globus pharyngeus group( P

The Efficacy of Voice Therapy in Globus Pharyngeus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although globus pharyngeus is a common disorder, the treatment is by and large unsatisfactory because of unreliable diagnosis. When we examine the larynx in patients with this disease, it is easy to observe variations in the structure of larynx, including the posterior laryngitis. Physicians regard these findings as normal variations, however, the hyperkinetic movement of supraglottis will show symptoms of globus pharyngeus. This study examined the outcomes of a voice therapy which induced laryngeal relaxation of the signs and symptoms of globus haryngeus. MATERIALS AND METHODS: While the control group was treated with antireflux therapy, the experimental group was treated with antireflux therapy as well as with voice therapy for laryngeal relaxation. The outcome showed resolution of the symptoms. RESULTS: The symptoms responded more greatly to the combined treatment than to the control group. Granularity in the vocal process and the hyperkinetic movement of supraglottis responded to the combined treatment. CONCLUSION: This study showed that voice therapy is one of the effective treatments for globus pharyngeus.

A Study for Causative Diseases of Globus Pharyngeus Patients Who Have NoPathologic Conditions in Laryngopharynx / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Globus pharyngeus is the feeling of a lump or foreign body in the throat. Otolaryngologists are often confronted with this condition, and some authors report that it represents 3 percent of all new clinic referrals. Unfortunately, we still do not completely understand the etiologies of globus pharyngeus, but there are recently increasing evidences to link the globus symptoms with various diseases. MATERIAL AND METHODS: We selected 32 globus patients, who exhibited no pathologic condition in physical examinations, and were analysed by general work up, barium esophagogram, 24 hour-ambulatory double-probe pH monitoring, esophageal manometry test, Fuchs' series, and MMPI. RESULTS: The results were as follows, gastroesophago-laryngopharyngeal reflux disease (n=15: 46.9%), various psychotic problems (n=11: 34.4%), esophageal motility disorders (n=7: 21.9%), duodenal ulcer (n=2: 6.3%), Eagle's syndrome (n=2: 6.3%), and hiatal hernia (n=1: 3.1%). In 5 cases, we couldn't find the etiology of globus pharyngeus. CONCLUSION: Globus pharyngeus patients, who had no pathologic findings in layrnx and pharynx, might have laryngopharyngeal-gastroesophageal reflux diseases and psychologic problems.

Importance of Psychological Factors and Organic Factors in Globus Pharyngeus / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, researchers have come to believe that gastroesophageal reflux (GER) and esophageal motility disorders are the most important etiologic factors causing globus pharyngeus. On the other hand, psychological factors such as somatization or depression are regarded as relatively less important etiologic factors. In an attempt to verify this current belief, the authors performed a prospective study in patients who complained of globus sensation in the throat. MATERIALS AND METHODS: Among 62 adult patients with globus symptoms, 33 patients underwent 24-hour esophageal ambulatory pH-monitoring: 46 patients underwent esophageal manometry: 26 patients underwent Minnesota multiphasic personality inventory (MMPI): and 25 patients underwent Becks depression index (BDI) test. RESULTS: GER was diagnosed in 21.2% of the tested patients and non-specific esophageal motility disorder was found in 4.3%. MMPI showed abnormalities in 57.7% of the tested patients, and BDI showed a high index of depression in 96% of the tested patients. CONCLUSIONS: In contrast to the current belief, GER and esophageal motility disorder should be regarded as just one of the possible etiologic factors, and psychological factors should not be ignored in the evaluation of a patient with globus pharyngeus.