Feeling of something stuck in the throat

Scope

To distinguish between globus pharyngeus and significant throat pathology.

Assessment

Signs and Symptoms

Symptoms suggesting benign globus pharyngeus:

  • Noticed at midline or suprasternal notch?
  • Intermittent
  • No true dysphagia

History and Examination

On physical examination does the patient have:

  • Normal oral cavity, head and neck examination?
  • No pain?
  • Normal voice quality?

Red Flags

If the patient has any of the following refer as Head and Neck 2 week wait:

  • Persistent unexplained hoarseness i.e., more than 3 weeks, with negative chest X-ray.
  • An unexplained persistent sore throat especially if associated with dysphagia, hoarseness, or otalgia.
  • Referred otalgia (as a symptom of laryngeal or pharyngeal malignancy).
  • Dysphagia (with obstruction in pharynx of cervical oesophagus).
  • An unexplained lump in the neck i.e., of recent onset or a previously undiagnosed lump that has changed over a period of 3 – 6 weeks.

On the day emergency advice/admission should be sought if the patient presents with:

  • Stridor

Management

If symptoms are no better in 6 weeks or new symptoms are presented, consider a referral to ENT. When considering this, it is recommended that potential risk factors e.g., significant smoking or alcohol history and examination findings e.g., lymph nodes and the Head and Neck 2ww criteria are taken into account.

Referral

Referral Criteria

  • Induction dose trial of PPI/ Alginate if oesophageal symptoms, 1-month high dose and 1-month maintenance dose.
  • If symptoms are no better in 6 weeks or new symptoms are presented, consider a referral to ENT. When considering this, it is recommended that potential risk factors e.g., significant smoking or alcohol history and examination findings e.g., lymph nodes and the Head and Neck 2ww criteria are taken into account.

Referral Instructions

e-Referral Service Selection

  • Specialty: ENT
  • Clinic: Throat (inc voice & swallowing)
  • Service: DRSS-Eastern-Ear Nose and Throat-Devon CCG- 15N

Referral Forms

DRSS Referral forms

Supporting Information

Patient Information

Patient.co.uk leaflet - Globus hystericus

Evidence

This guideline has been developed by Royal Devon and Exeter Healthcare Foundation Trust based on local guidelines.

Pathway Group

This guideline has been signed off by the Eastern Locality on behalf of NEW Devon CCG.

Publication date: April 2017

Updated: July 2021

Last updated: 02-07-2021

 

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