Globus- The lump in the throat!

Most of us would have, at some moment or the other felt a clutching or lump in the throat associated with fear or extreme anxiety. Many patients complain of a similar feeling of something sticking in the throat without there being an actual lump. Surprisingly, there is no associated pain or difficulty in swallowing liquid or solid food. Many of these patients are concerned about this being a symptom of cancer. The panic associated with COVID has resulted in a disproportionate increase in this symptom.

‘Globus hystericus’ was a term used for these symptoms which were thought to have a psychogenic origin and presented with a sensation of a lump in the throat, commonly in the fairer sex. The term ‘Globus pharynges’ is a more unbiased terminology for the same symptom complex. Dryness of the throat following mouth breathing, the postnasal dripping of infected secretions from the sinuses or more commonly, the reflux of the acidic gastric juices into the food pipe may all contribute to these symptoms. Rarely a forgotten fishbone in the throat or early cancer of the upper aerodigestive tract may present similarly.

I frequently encounter cancer-phobia among my patients. Often, the trigger is the diagnosis of cancer in a close relative or friend. Internet searches and self-examination in the mirror only worsens the fears, and a vivid imagination further fuels the apprehensions. I recall the unfortunate events that led to the suicide of a beautiful young lady who had a morbid fear of cancer. She was obsessed with her looks, and the thought of the possible changes in her appearance after the cancer treatment made her decide that life was not worth living. The said lady committed suicide one fine afternoon much to the sorrow of her inconsolable near and dear ones. All this, of course, quite unnecessarily even before visiting a doctor to confirm her doubts. How I wish I could have intervened in time to prevent the mishap! The sensation of a lump in the throat does not always indicate cancer. Cancer, especially in the later stages, presents with actual difficulty in swallowing and not a feeling alone. However, it is wise to seek a medical opinion for confirmation.

One of the most common conditions presenting with this symptom is the gastroesophageal reflux disorder (G.E.R.D.), associated with the reflux of the acidic material in the stomach into the food pipe for various reasons. The acidic gastric juices scald the lining mucosa of the food pipe, and anti-reflux medications give only temporary relief as hyperacidity is a lifestyle disorder. The cure lies in lifestyle modifications such as frequent small meals with no more than a 4 to 6-hour interval between meals, avoidance of acid stimulators like tea, coffee, pulses, tapioca etc. and of course stress. It is best to avoid going to bed on a full stomach, and the last meal of the day should be taken about two hours before the bedtime. The response to the anti-reflux medications is useful as a diagnostic tool.

I frequently see patients with complaints of granules in the throat or on the tongue posteriorly, which they happen to notice while peering in the mirror. In this selfie era, they even come with photographs of the inside of their mouth and throat and most often all I see is just normal anatomy! Some are so obsessed with the phlegm in the throat and keep clearing the throat which itself irritates the throat further, worsening the condition. I would advise them to desist and seek a medical opinion in case of any doubts, to avoid further heartburn as there are many variations in the normal anatomy.

At the other end of the spectrum are a group of people, who despite having genuine difficulty in swallowing choose to ignore the symptoms mostly because they want to negate the diagnosis and the delay often proves costly. Early diagnosis is crucial to cure. Recently I had a patient who was symptomatic for about a year but did not seek a medical opinion at all. It was his twenty-year-old daughter who brought him to the hospital as she had noticed her father peering into the throat whenever he thought no one was watching him. It was too late to offer him a curative treatment as cancer had spread extensively beyond the base of his tongue, and he had to make do with palliative therapy.