[Dysphagia with no obvious cause: globus pharyngeus]

Area of Science:

• Otolaryngology
• Gastroenterology
• Speech Pathology

Context:

• Globus pharyngeus (globus sensation) is a frequent otolaryngology (ENT) referral.
• Characterized by a persistent or intermittent, painless sensation of a lump, foreign body, tightness, or choking in the throat.
• Typically a chronic condition with a tendency for recurrence.

Purpose:

• To outline the diagnostic and management principles for globus pharyngeus.
• To emphasize the importance of clinical history and examination in identifying red flags.
• To provide a stepwise approach to management, including initial medical therapy and subsequent interventions.

Summary:

• Diagnosis relies heavily on thorough patient history and clinical examination to rule out serious conditions.
• Proton pump inhibitors (PPIs) are recommended as a first-line therapeutic trial in the absence of red flags.
• Paraclinical assessments may be considered for non-responsive cases, with reassurance and speech therapy as management options for refractory symptoms.

Impact:

• Provides a clear, evidence-based approach to managing a common yet often frustrating condition.
• Aims to reduce unnecessary investigations and optimize patient care pathways.
• Highlights the multidisciplinary nature of managing globus pharyngeus, involving ENT, gastroenterology, and speech pathology.