Globus Hystericus

Are you suffering from a persisting lump in your throat along with some pain and swallowing difficulties? If yes, you may be suffering from Globus Hystericus (GH). Read and know what is Globus Hystericus as well as learn all about its causes, symptoms, diagnosis and treatment.

Globus Hystericus Definition

It is a sensation of having some object blocking the passage of the throat. The condition is also sometimes known as “Globus sensation”. Colloquially, the phenomenon is also sometimes referred to as having a lump or frog in the throat.

This is a rare disease and its exact incidence is not known.

Globus Hystericus ICD 9 Code

The ICD 9 Code for this disorder is 300.11.

Globus Hystericus Symptoms

This condition is primarily characterized by a lump in the throat, not related with eating in any way. This sensation does not arise after choking while eating. Actually, the sensation may be alleviated by eating or drinking. Patients suffering from this condition usually feel as if something has firmly lodged in the throat. The obstruction cannot be swallowed or washed down by drinking hot water or beverages.

Although this condition does not interfere with the swallowing process in any way, it tends to make the activity slightly uncomfortable.

The symptoms of this condition are more or less straightforward. A feeling of obstruction in the throat is the main difficulty that is experienced by patients. There is generally no other discomfort or pain. In more serious cases, patients may suffer from some amount of discomfort in the upper chest. In some cases, suffering individuals may also experience some pain during swallowing. However, even with minor discomfort there is some possibility for patients to swallow normally.

Globus Hystericus Causes

Some possible causes of this condition are:

Throat inflammation

The discomforting sensation of “lump in the throat” often arises due to an inflammation of one or more throat sections, such as the Hypopharynx or Larynx. This frequently occurs due to the presence of underlying disorders like Gastroesophageal Reflux (GERD), Oesophageal Dysmotility or Cricopharyngeal Spasm.

Cold infection

In some cases, lumps in the throat may be sensed due to an underlying cold infection. Throat lump may be an early sign of an impending head cold or a developing sore throat.

Anxiety

Psychogenic factors like stress or anxiety can trigger or aggravate the symptoms of this disorder. People are often found to suffer from Globus hystericus while being under a lot of stress or coping with a situation that makes them anxious or nervous.

Somatoform disorder

Somatoform disorder is a psychiatric disease in which a patient suffers from discomforting symptoms, even in the absence of an actual physical condition. The symptoms of GH may often arise due to an underlying Somatoform disorder. Anxiety is often regarded as one of the most common causes of GH development.

Depression

GH is also associated to depression. In cases where the symptoms of this condition arise due to an underlying depression, anti-depressive treatment is useful in improving the situation.

However, “lumpy” sensations in the throat may also arise due to minor causes like not swallowing foods or drinks properly. Presence of excess saliva or mucus in the throat can also make healthy patients experience this problem. It is best to observe the symptoms for 2-3 days before seeking medical remedies. The problem often tends to resolve by itself, without the aid of any external treatment. Proper rest and other lifestyle measures can also help alleviate the condition, especially when it arises due to minor causes.

Globus Hystericus and Menopause

Menopause is the period of the life of any woman in which her menstrual cycle comes to an end. It is described as a phase of transition that women typically go through around the age of 50. Globus hystericus is one of the rare physical symptoms that menopausal women can experience. Many middle-aged women around the world complain of having a lump in their throat, which is often associated with menopause. If throat lumps are accompanied by other symptoms like insomnia, headaches, changes in libido or hot flushes, the underlying problem can be menopause. The problems usually go away in the post-menopausal stage. However, it is best to consult a professional medical practitioner to avoid any serious underlying problem being ignored. Medical consultation should be sought depending on the severity of the symptoms. Minor or temporary symptoms can be ignored. More persistent cases, however, require immediate medical attention.

Globus Hystericus Diagnosis

The condition can be diagnosed by imaging tests. High resolution MRI or Computed Tomographic (CT) scan of the larynx can help physicians fully detect any abnormalities in laryngeal anatomy. The disorder may also be detected with the aid of other diagnostic examinations like:

Endoscopy

This can help differentiate GH from Reflux Oesophagitis as well as other oesophageal problems. The process involves inserting an instrument known as endoscope into the body of the patient. The endoscope is a type of long slender medical equipment that helps examine the inner part of a bodily organ or even perform a small surgery.

CXR

Chest X-ray (CXR) is often conducted as a diagnostic test for GH. The test helps rule out the presence of Mediastinal tumors.

Barium swallow

This is a controversial technique that is used to exclude pharyngeal or oesophageal cancer in patients with normal endoscopy but atypical symptoms. If barium swallow results are found normal and medical history divulges psychosocial factors as the cause, further diagnostic investigations may not be necessary. This process is rarely productive as patients with diverticula, cervical tumors or other blockages rarely exhibit problems like throat lumps. However, the test can successfully determine occasional abnormalities.

In some cases, the symptoms may persist and there can be difficulties in diagnosis. There may also be treatment failure. In such cases, these diagnostic tests may be helpful:

Oesophageal manometry

This can help diagnose problems in patients with GH who experience Upper Oesophageal Sphincter Hypersensitivity.

Videofluorography

It is useful in cases where physicians suspect structural pathology of the Oesophagus. Pharyngeal dysfunction is identified in many patients with GH.

Globus Hystericus Differential Diagnosis

The differential diagnosis of Globus Hystericus involves distinguishing its symptoms from those of other similar disorders like:

• Gastro-oesophageal reflux disease (GERD)
• Laryngo-pharyngeal reflux disease
• Cricopharyngeal web
• Parkinson’s disease
• Neurological disease
• Stroke
• Cranial Nerve Palsy
• Benign or malignant tumors of the mediastinum
• Symptomatic Diffuse Oesophageal Spasm (Unco-Ordinated Oesophageal Muscular Spasm)
• Skeletal muscle disorders (such as Myotonic Dystrophy, Polymyositis and Myasthenia Gravis)
• Benign or malignant neck tumors (which causes Oesophageal Compression)

Globus Hystericus Treatment

It is essential to detect the origin of GH during its treatment. If there is no swelling in any area of the throat, some type of anxiety is generally the probable cause. Treatment usually aims at reducing the anxiety and alleviating any pain or discomfort related with inflammation. If physicians detect a throat inflammation as the cause, the condition can be usually treated by medications.

In very uncommon cases, a physical abnormality in the tissue construction inside the throat can be a cause for the “lumpy” sensation. In such cases, the situation can often be corrected by a surgical operation. If diagnostic tests reveal some form of anatomical abnormality to be the cause of GH, a physician can arrange the mode of treatment that is most appropriate for the patient.

Globus Hystericus Home Relief

In some patients, GH symptoms can be relieved at home with the aid of hot water and massages. This has to be done in a proper way and the steps are described as below:

• Heat a bowl of water until it is warm, but not hot. Otherwise, scalding hot water may burn your skin.
• Find a quiet, isolated spot.
• Soak a face-cloth or warm flannel into the water. Squeeze off the extra water and press the cloth against your neck and throat for a minute. Then take the flannel away.
• Stand straight with your back pressed against a wall. Alternately, sit on a stool to keep your back straight. Tilt back your head as far as you can comfortably go. This will let you experience a stretch in your throat. Now look up at the ceiling and hold the posture for five seconds.
• Now, slowly roll your head to the left and then to the right, still maintaining the stretch in your throat. Take 5 seconds to complete one complete left to right roll. Do this 10 times.
• Place your hand at the spot where the throat meets the chest. Try to find the two ‘stringy’ muscles that pass down either side of the Adams apple and vanish behind the chest bones. Use either or both hands to firmly massage the muscles lengthwise. Massage the muscles strongly but comfortably to ease any tension. Practice this for 2-3 minutes or until you feel comfortable. If you spot any more tense neck muscles on each side of the windpipe, give them a gentle massage to ease the tension.
• Continue to perform the head rolls for five more repetitions and relax.
• Sit motionless for a few minutes. This will allow your muscles time to relax. Get up slowly and walk around.

This massage technique may not produce immediate effects. However, practicing this 3-4 times every day can dramatically improve the discomforting symptoms.

Globus Hystericus and Herbs

GH symptoms may also be cured with the aid of certain herbs, such as:

Radix Achyranthis Bidentatae

It is extracted from the dried root of the plant Achyrantes bidentata Bl. It is sour and bitter in taste. Neutral in nature, the herb is disseminated to the kidney and liver channels.

Radix Polygalae

It originates from the dried root of the plant known as Polygala tenuifolia L. This drug is warm in nature and pungent as well as bitter in taste. It is distributed to the channels of the lungs, heart and kidney.

Radix Platycodi

The herb is neutral in nature. It comes from the dried root of the plant Platycodon grandiflorum. Pungent and bitter in taste, it is dispersed to the lung channel.

Bombyx Batryticatus

It comes from the dried body of Bombyx mori L. and is pungent and salty in taste. It is neutral in nature and acts on channels of the lungs, stomach and liver.

Semen Sinapis Albae

It originates from Anhui and is grown in some areas of China. It is warm in nature and acrid in taste. Its therapeutic effect is associated to the lung channel.

Globus Hystericus Complications

GH arising from psychogenic causes does not cause any complications apart from those resulting due to underlying psychopathology. If not recognized or treated in time, GH caused by persistent gastro-oesophageal reflux or laryngo-oesophageal reflux disease can give rise to cancer of the oesophagus and larynx.

Globus Hystericus Prognosis

The condition is generally found to have a good prognosis. As per a recent study conducted on 80 patients, 25% had no symptoms when evaluated after 27 months while 35% were seen to have significant improvement in discomforts. Outcome was found to be good in males who did not suffer from any associated throat symptoms. Certain factors found to influence prognosis include factors like:

• Gender of the patient
• Duration of symptoms during diagnosis
• Associated symptoms in throat

Globus Hystericus Prevention

The prevention of this condition involves stress management skills. Taking rest and reducing stress can help reduce the “lump-like” sensation in the throat. The risk of recurrence of this disorder can also be lowered by controlling acid reflux. If you are suffering from acid reflux symptoms, do not drink beverages like tea or coffee. These can only aggravate the symptoms and add to the discomfort.

If you are suffering from persisting sensations of “obstruction” in your throat along with pain or other discomforting symptoms, immediate medical treatment can be essential. If diagnosed and treated on time, this disease can go away without causing further discomforts. It is important to manage stress to control this condition as much as possible.

References:

http://www.patient.co.uk/doctor/Globus-Hystericus.htm

http://www.medterms.com/script/main/art.asp?articlekey=9023

http://www.nexiumresearch.com/2004/02/15/globus-hystericus/

http://www.well-women.com/Globus-hystericus.html