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Lump in the Throat (Globus) 
by Norman J. Harris, MD
Affiliated Ear, Nose and Throat of Orange county
reprinted with permission from 

We ordinarily don't feel our throats. When we become aware of our throats in any way something is wrong.  The throat is a marvelous mechanism that we use to breathe, sort and direct air, liquids and solids in their passage to the proper places, and to produce our voices. Disorders of these activities often produce a sensation of a lump - called globus. The feeling of a lump indicates that one of the muscles along the way is tightened when it should be relaxed. A lump sensation in the throat often creates the illusion of needing to swallow twice to get food down.  Although globus usually doesn't represent a serious problem, when present steadily for more than two weeks or intermittently for two or three months, a thorough examination of the oral cavity and throat is in order - especially in smokers.

The most common cause for this symptom is mild infection, usually due to viral sore throats. Occasionally, a more serious infectious disease can be responsible. The term "strep" throat can be used in two ways. Medically speaking, strep throat means a culture has been taken and is positive for the strep organism. Not all severe sore throats are caused by this organism more are the sore throats that it causes always severe. On the other hand, some folks use the term "strep" for any particularly severe sore throat, regardless of cause.

Tumors (swellings), benign or malignant, can cause a lump sensation. A complete examination for tumor includes direct inspection using proper lighting, inspection by a mirror, office fiberoptic flexible laryngoscopy, and possibly direct inspection in the operating room. X-rays using various thicknesses of contrast can be helpful. Modern video imaging of the throat and larynx helps analyze the cause for the complaint.

Viral infections usually pass on their own.  Bacterial infections frequently benefit from an appropriately chosen course of antibiotics. Some medicines are applied directly to the throat by tradition. Gargling, for example, does not get past the molar teeth, and therefore, is of no benefit to any condition further than the back teeth. The same is true of throat sprays. Lozenges, especially those with Phenol or Benzocaine, are the most soothing and effective of the traditional over-the-counter medications. Adequate humidification with a vaporizer keeps the area lubricated and reduces irritation.

Lump sensation in the throat can reflect incoordination in the food pipe. The esophagus, the muscular pipe which connects the back of the throat to the stomach, has a valve at the bottom end of the top of the stomach and another one just behind the voice box. If the bottom valve malfunctions, allowing leakage back up the food pipe, the upper valve will tighten up trying to compensate and produce the sensation of a lump in the throat. Leakage of the bottom valve may be associated with the anatomical condition called a hiatus hernia. Leakage, experienced as heartburn, occurs often in pregnancy when the hormones loosen in the lower valve and the weight of the baby increases back pressure against the valve in the stomach.  Leakage often occurs in overweight folks and responds well to weight loss. Fat in the stomach triggers chemical changes which make the lower esophageal valve loose.  For this reason, fatty meals (not the spices in them) tend to be associated with heartburn. Leakage doesn't always cause heartburn, so only the lump sensation may be left to signal leakage at the lower valve. Avoiding fatty foods, particularly before bedtime, and sleeping in a partially upright position have been effective traditional treatments. Medications can be prescribed which reduce the amount of acidity in the stomach and gut to be one way - down, and improve function of the lower esophageal valve.

There has long been a notion that a lump in the throat sensation is a sign of emotional distress. While it is true that the first stage of crying includes increased tension in these muscles producing a choked sensation, in most cases lump sensations are associated with the causes mentioned above.  Emotional explanations for this sensation should not be accepted until these other causes have been investigated.

Copyright 2000 Norman J. Harris, MD

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