A persistent feeling of a lump in the throat, despite swallowing normally, is known as globus pharyngeus. It is a common reason for ENT consultation and can be associated with throat tightness, mucus sensation and repeated throat clearing. Although often benign, persistent symptoms deserve an appropriate assessment to identify treatable causes and exclude significant disease.
What is globus sensation?
Globus is typically a painless, intermittent or persistent sensation of a lump or foreign body in the throat, occurring without an identifiable obstructing lesion. A key distinction is that patients with typical globus can generally swallow food and liquids normally. This differs from dysphagia, which describes difficulty swallowing.
The pharynx is a muscular passage connecting the mouth to the oesophagus and larynx. During swallowing, coordinated muscle contractions propel food towards the oesophagus, while the upper oesophageal sphincter relaxes to allow passage. The cricopharyngeus muscle forms a major component of this sphincter.
Altered muscle tension, oesophageal motility and increased sensitivity to normal throat sensations have all been proposed as contributors. However, no single mechanism explains every case of globus [1,2].
What causes globus?
Cricopharyngeal dysfunction
Increased upper oesophageal sphincter pressure has been reported in some patients with globus, but findings are inconsistent. Cricopharyngeal spasm should therefore be considered a possible mechanism rather than assumed to be the diagnosis in every patient.
Reflux
Gastro-oesophageal reflux may contribute to symptoms in a subgroup of patients. However, the relationship between reflux and globus is complex, and laryngeal appearances or symptoms alone cannot reliably establish reflux as the cause.
In the UK TOPPITS randomised controlled trial, 346 patients with persistent throat symptoms received lansoprazole or placebo for 16 weeks. Lansoprazole did not produce a statistically significant improvement over placebo in the primary symptom outcome [3]. Although this trial did not study isolated globus exclusively, it provides important evidence against routinely prescribing proton pump inhibitors for persistent throat symptoms without appropriate clinical justification.
Stress and sensory sensitivity
Anxiety and emotional stress may increase throat muscle tension and awareness of bodily sensations. This is consistent with a biopsychosocial model, in which physiological and psychological factors can interact without symptoms being imaginary.
Dryness and throat clearing
Dehydration, mouth breathing, nasal symptoms and environmental irritants can contribute to throat discomfort. Repeated throat clearing may perpetuate irritation and reinforce awareness of the sensation.
How is globus diagnosed?
Assessment begins with a detailed history, including symptom duration, swallowing function, reflux symptoms, voice changes, smoking history and associated symptoms.
An ENT examination may include flexible nasendoscopy to inspect the pharynx, larynx and surrounding structures. In patients with typical globus and a reassuring examination, extensive investigations are not always necessary. Additional tests, such as oesophageal endoscopy, manometry or ambulatory reflux monitoring, should be selected according to the clinical findings [1,2].
Progressive swallowing difficulty, painful swallowing, unexplained weight loss, persistent hoarseness, a neck lump or coughing up blood require prompt medical assessment.
What treatments are supported by evidence?
For typical globus with no concerning findings, explanation and reassurance are important first steps. Patients may benefit from adequate hydration, avoiding irritants and replacing habitual throat clearing with a sip of water or a gentle swallow.
Speech and language therapy may help reduce laryngeal tension and modify unhelpful swallowing or throat-clearing habits. In a small randomised controlled study, Khalil and colleagues found greater short-term improvement with speech therapy than with reassurance alone [4]. The small sample size means the results should be interpreted cautiously.
Reflux treatment should be targeted to patients with a credible reflux diagnosis or relevant symptoms, rather than prescribed automatically for globus. Psychological approaches may be considered when symptoms persist and stress or heightened sensory awareness are important contributors.
A 2026 systematic review identified 15 intervention studies involving 784 patients with functional globus. It reported encouraging results for several pharmacological and psychological approaches but also highlighted substantial limitations in the evidence base, including small studies and risk of bias [5]. These findings support individualised care rather than a single treatment for everyone.
How can Kent and Sussex ENT help?
Globus sensation is often benign, but its cause and appropriate management vary between individuals. An ENT assessment can help distinguish typical globus from swallowing disorders or other pathology, identify potentially treatable contributors and determine whether further investigation is needed.
For patients experiencing a persistent lump-in-the-throat sensation, Kent and Sussex ENT offers an assessment-led approach focused on accurate diagnosis, evidence-based management and appropriate follow-up.
References
- Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World Journal of Gastroenterology. 2012;18(20):2462–2471. doi:10.3748/wjg.v18.i20.2462
- Harar RPS, Kumar S, Saeed MA, Gatland DJ. Management of globus pharyngeus. International Journal of Otolaryngology. 2012;2012:297642. Read the review
- Wilson JA, Stocken DD, Watson GC, et al. Lansoprazole for persistent throat symptoms in secondary care: the TOPPITS RCT. Health Technology Assessment. 2021;25(3):1–118. doi:10.3310/hta25030
- Khalil HS, et al. The use of speech therapy in the treatment of globus pharyngeus patients: a randomised controlled trial. See the study discussed in Lee and Kim’s review [1].
- Iurina E, Kosonogov V. Therapeutic approaches for functional Globus Pharyngeus: A systematic review of studies from 2000 to 2025. General Hospital Psychiatry. 2026;102:1–13. View the review