Globus

Globus Globus is a subjective sensation of a lump, foreign body, or tightness in the throat that occurs without an observable obstructive lesion on laryngoscopic or radiographic examination. First described in historical clinical reports from European physicians and discussed in otolaryngology and psychiatry literature, the symptom straddles disciplines including otolaryngology, gastroenterology, psychiatry, and neurology. It is encountered in outpatient clinics associated with gastroesophageal reflux, functional somatic symptoms, and post-viral presentations and is considered distinct from dysphagia, odynophagia, and airway compromise.

Etymology and name variations

The term derives from Latin roots used in classical medicine and was popularized in modern clinical texts from the 19th and 20th centuries. Historical descriptions appear alongside works by physicians associated with institutions such as Guy's Hospital, St Bartholomew's Hospital, and writers contributing to the Lancet and New England Journal of Medicine. Alternative labels adopted in specialty literature include nomenclature used in the contexts of otolaryngology at Mayo Clinic, gastroenterology at Cleveland Clinic, and psychosomatic medicine at Johns Hopkins Hospital. Variants have been discussed in consensus statements from organizations like the American Academy of Otolaryngology–Head and Neck Surgery and in guidelines from European bodies such as the European Society for Swallowing Disorders.

Anatomy and physiology

Anatomic considerations emphasize structures of the head, neck, and upper aerodigestive tract examined in training at centers like Harvard Medical School, University College London, and Karolinska Institutet. Relevant tissues include mucosa of the hypopharynx, laryngeal structures described in atlases from Gray's Anatomy, and neuromuscular elements detailed in texts used at Massachusetts General Hospital. Sensory innervation involves cranial nerves mapped in neurology literature from Johns Hopkins University and physiological research at Max Planck Institute for Brain Research. Physiology models draw on studies of esophageal motility performed at Mayo Clinic and Mount Sinai Health System and on research into upper esophageal sphincter function from UCLA Medical Center and University of Tokyo. Proposed pathophysiologic mechanisms cited in reviews from Oxford University Press and specialty journals include altered visceral sensation observed in studies at Karolinska Institutet and central processing changes explored by researchers at Stanford University School of Medicine.

Clinical significance and diagnosis

Clinical significance is assessed in settings ranging from primary care clinics affiliated with Kaiser Permanente to tertiary referral centers such as Cleveland Clinic. Differential diagnostic pathways reference disorders cataloged by specialty services at Guy's Hospital, Royal Free Hospital, and Beth Israel Deaconess Medical Center. Investigation often begins with fiberoptic nasolaryngoscopy performed in units modeled on protocols from Mayo Clinic and Massachusetts Eye and Ear Infirmary and may include radiologic evaluation techniques described in textbooks used at Johns Hopkins Hospital and Charité – Universitätsmedizin Berlin. Gastroenterological assessment may involve pH monitoring and manometry standards from American College of Gastroenterology and motility laboratories at University of California, San Francisco. Psychiatric evaluation follows frameworks from American Psychiatric Association and cognitive assessments used at Yale School of Medicine to identify comorbid anxiety, depression, or somatoform presentations. Red-flag features prompting urgent referral mirror guidance from National Institute for Health and Care Excellence and include progressive dysphagia, weight loss, and hemoptysis which would initiate diagnostic pathways involving MD Anderson Cancer Center, Memorial Sloan Kettering Cancer Center, and oncologic multidisciplinary teams.

Management and treatment

Management strategies integrate therapies developed in multidisciplinary clinics at institutions such as Mayo Clinic, Cleveland Clinic, and Johns Hopkins Hospital. When acid reflux is implicated, pharmacologic regimens based on trials cited by the American Gastroenterological Association and protocols from Mount Sinai Health System include proton pump inhibitors and alginate therapies. Behavioral interventions draw on speech-language pathology programs from University of Iowa Hospitals and Clinics and swallow rehabilitation techniques refined at University College London Hospitals. Cognitive-behavioral therapy models and psychopharmacology approaches reference guidelines from the National Institute for Health and Care Excellence and therapies delivered in clinical trials at Massachusetts General Hospital and University of Oxford. Botulinum toxin injection and cricopharyngeal procedures have been described in surgical series from Mayo Clinic and Cleveland Clinic for select patients with demonstrable upper esophageal sphincter dysfunction. Multidisciplinary care pathways have been advocated by consortia including the European Laryngological Society and interprofessional teams at tertiary centers like Royal National ENT and Eastman Dental Hospitals.

Epidemiology and prognosis

Epidemiologic data derive from primary care cohorts studied in populations served by Kaiser Permanente, community surveys analyzed by researchers at University of Washington, and specialty clinic case series reported from Mayo Clinic and Cleveland Clinic. Prevalence estimates vary across studies published in journals associated with Elsevier and academic centers such as University of Toronto and Monash University, reflecting heterogeneity in referral patterns and diagnostic criteria. Age distributions reported in cohorts from Johns Hopkins Hospital and St Thomas' Hospital show occurrence across adult age groups with peaks in middle-aged populations; sex differences have been reported in analyses from Karolinska Institutet and University of Melbourne. Prognosis is generally favorable when reversible causes identified by teams at Mayo Clinic and Cleveland Clinic are treated, though persistent symptoms managed by multidisciplinary programs at Massachusetts General Hospital and Guy's Hospital can be chronic and require long-term supportive care. Category:Otolaryngology