Have you ever woken up and noticed a lump in your throat? This may happen to anyone at any age or gender. The lump in the throat sensation is also known as globus pharyngeus or hystericus and is a fairly common symptom that individuals tell their physicians about.
If present for more than a couple of weeks or if this occurs from time to time over a period of 2 or 3 months then a complete exam of the oral cavity as well as the throat is needed – particularly in those individuals who are smokers.
Causes of Lump in throat
What is the cause of this? There are 2 valves in the esophagus or the swallowing tube. They are usually lightly contracted as well as relaxed when an individual swallows – this allows the food to pass thru them going to the stomach. Then they squeeze closed again to prevent the regurgitation of the stomach contents. At this time if the standard tightening turns into a spasm these symptoms can begin. Stress frequently makes these spasms much worse. Even if not caused by stress, stress can make the spasm worse. Relaxation of different types such as alcohol to meditation can often relieve these symptoms.
Problems which can be confused with globus sensation include:
- Cricopharyngeal or upper esophageal webs
- Symptomatic diffuse esophageal spasm
- Mass lesions in the neck or mediastinum that cause esophageal compression
- Skeletal muscle disorder such as myasthenia gravis
First should be a complete exam of the neck as well as throat to eliminate any serious problems. In most individuals the first thing that enters their minds is that a lump in the throat could be cancer. But in practice, real lumps in the throat such as cancer are not felt. This is the reason why cancer can get so big before being discovered.
The following red flag findings are of some concern:
- Throat or neck pain
- Loss of weight
- After the age of 50 any abrupt onset
- Pain, difficulty or choking when swallowing
- Food regurgitation
- Weakness of the muscles
- Visible or palpable mass or lump
- Progressively worsening of any symptoms
Symptoms not related to swallowing, without any difficulty or pain when swallowing, or the sensation of food getting stuck in the throat in a patient with an otherwise good exam is an indication of globus sensation. Any of the above mentioned red flag findings on exam can suggest a motor or mechanical disorder with swallowing. Symptoms which are chronic and occur during unresolved or pathologic grief and which can be relieved by crying indicates globus sensation. These findings of globus sensation need no further testing.
But if the diagnosis is not clear or the physician is unable to visualize the pharynex, testing for dysphagia should be done.
Treatment for globus normally is just reassurance and show concern. No drugs have been proven beneficial. Any underlying anxiety or depression or other behavioral disturbances needs to be managed with psychiatric referral if needed.