The diagnosis and management of globus pharyngeus: our perspective from the United Kingdom

Purpose of review To review recent literature on diagnostic and treatment options for globus pharyngeus. Recent findings There are no controlled studies looking at the use of proton pump inhibitors specifically for globus. The small volume of level I evidence has failed to demonstrate superiority of proton pump inhibitors over placebo for treatment of laryngopharyngeal reflux symptoms (including globus). A recent pilot non placebo-control led study has shown promising results for treating laryngopharyngeal reflux symptoms with liquid alginate suspension. The role of cognitive-behavioural therapy may hold hope for patients with refractory symptoms. A small randomized trial showed promising results for treating globus with speech therapy, but larger trials are required. There is no evidence for the use of antidepressants or anxiolytics. Summary After many decades of interest, the most popular organic theory that 'a lump in the throat' is reflux related is still challenged by lack of strong evidence for empiric antacid treatment of this symptom. Globus pharyngeus is a clinical diagnosis and not a diagnosis of exclusion and overinvestigating these patients is unnecessary. Complete history and otolaryingological examination, fibreoptic laryngoscopy or transnasal oesophagoscopy with reassurance and monitoring of symptom progress with validated symptom questionnaires appear to remain the mainstay of management.