Globus Pharyngeus

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This is a very common condition in which the patient, not infrequently a young girl, complains of a sensation of a lump in the throat. The site indicated is the cricoid region.

When taking the history, a helpful direct question is to ask whether the lump is most apparent on swallowing food, fluid, or saliva. The patient with globus will consistently reply that saliva is the problem, and that the symptom occurs between meals.

Cricoid Cartilage Lump

Fig. 4.107 Globus pharyngeus. The patient is indicating the region of the cricoid cartilage which is the site of discomfort with globus pharyngeus.

The symptom of discomfort in the region of the cricoid is not infrequently associated with nasal symptoms of postnasal discharge or chronic rhinitis where frequent swallowing predisposes and accentuates the globus symptom.

Fig. 4.107 Globus pharyngeus. The patient is indicating the region of the cricoid cartilage which is the site of discomfort with globus pharyngeus.

The symptom of discomfort in the region of the cricoid is not infrequently associated with nasal symptoms of postnasal discharge or chronic rhinitis where frequent swallowing predisposes and accentuates the globus symptom.

Fig. 4.108 Barium swallow. Globus pharyngeus is a psychosomatic condition, but there is a demonstrable spasm of the cricopharyngeus on barium swallow, where the barium column is seen to be "nipped." Over-attention by the patient perpetuates the spasm, and usually reassurance and explanation are the only treatments required.

Globus pharyngeus is not necessarily nonorganic, and "globus hystericus" is a misnomer. It is a condition that may call for investigation, particularly in the older age group, when it may be the presenting symptom of disease in the esophagus or stomach. Hiatus hernia and esophageal reflux commonly cause cricopharyngeal spasm, and gastric ulcers and neoplasms may also present with globus. A barium swallow and meal is, therefore, an important investigation (Fig. 4.108). Cervical osteoarthritis (Fig. 4.109a, b, arrow) with marked changes in the region of the 6th cervical vertebra may also give rise to globus.

Postcricoid

Fig. 4.109 Cervical osteoarthritis. a Projection of cervical osteophytes into the postcricoid region of the upper esophagus causes cricopharyngeal spasm and the symptom of globus. b In this radiograph, gross osteophytes have caused "nipping" of the barium (arrow) by the cricopharyngeus muscle.

Fig. 4.109 Cervical osteoarthritis. a Projection of cervical osteophytes into the postcricoid region of the upper esophagus causes cricopharyngeal spasm and the symptom of globus. b In this radiograph, gross osteophytes have caused "nipping" of the barium (arrow) by the cricopharyngeus muscle.

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