Episode 157. Globus and Cough with Dr Andrew Martin (part 3)
Globus, a persistent or intermittent sensation of a lump or foreign body in the throat, is a well-defined clinical symptom. Though it is non-painful, it can be long-lasting, difficult to treat, and prone to recurrence. Interestingly, this sensation often improves with eating and typically does not accompany dysphagia (difficulty swallowing) or odynophagia (painful swallowing). Globus is a common condition, accounting for about 4% of new referrals to ear, nose, and throat (ENT) clinics, and is reported by up to 46% of apparently healthy individuals, with peak incidence in middle age. The condition affects men and women equally, though women are more likely to seek medical care for it.
The origins of globus pharyngeus trace back to Hippocrates, who noted it around 2,500 years ago. In 1707, Purcell provided the first accurate description, attributing it to pressure on the thyroid cartilage from the contraction of the neck's strap muscles. Historically, the condition was labeled as "globus hystericus" due to its frequent association with menopause or psychological factors. However, in 1968, Malcomson introduced the more accurate term "globus pharyngeus" after discovering that most patients with globus did not have a hysterical personality. The exact cause of globus remains unknown, but it appears to be multifactorial.
While data are limited, recent studies suggest that factors such as gastroesophageal reflux disease (GERD), abnormalities of the upper esophageal sphincter (UES), psychological and psychiatric disorders, and stress may contribute to the sensation of globus. The variety of potential causes has made it challenging to establish standard investigation and treatment strategies, requiring an open mind when considering possible causes.
Dr. Andrew Martin, a practicing ENT surgeon based in the southeastern suburbs of Melbourne and Northern Tasmania, sheds light on this condition. He completed his MBBS at The University of Queensland in 2008, following a Bachelor of Pharmacy Sciences with Honours from Monash University in 2003. In 2021, he earned his fellowship with the Royal College of Surgeons in Otolaryngology and Head and Neck Surgery in New Zealand and completed an Advanced Fellowship in Head and Neck Surgery at The Royal Melbourne Hospital in 2022. Dr. Martin has special interests in nasal obstruction, obstructive sleep apnea, ear and balance issues, chronic sinus disease, mid-facial pain, pediatric ENT, as well as swallowing, voice, and throat disorders.
Beyond his professional achievements, Andrew is a dedicated family man with two young daughters and enjoys hunting and fishing in his free time. It was a privilege to have this insightful conversation with him about globus symptoms. Please welcome Dr. Andrew Martin to the podcast.
References:
"Globus pharyngeus: A review of its etiology, diagnosis and treatment." World Journal of Gastroenterology. 2012 May 28; 18(20): 2462–2471. Published online 2012 May 28. doi: 10.3748/wjg.v18.i20.2462