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?

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

• Reassure patient, no further intervention
• Advise the patient to return if they develop any new symptoms
• Induction dose trial of a compound alginate if oesophageal symptoms

Of note, a recent multicentre, double blind, randomised, placebo controlled trial has demonstrated that PPIs offered no symptomatic benefit over matched placebo for patients with persistent throat symptoms.

• If symptoms are no better in 6 weeks or new symptoms are presented, consider a referral to ENT.

Referral Criteria

If symptoms are no better in 6 weeks after watchful waiting +/-alginate or new symptoms are presented, consider a referral to ENT.

Referral Instructions

e-Referral Service Selection

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

Referral Form

DRSS Referral Form

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.

The BMJ: Use of proton pump inhibitors to treat persistent throat symptoms: multicentre, double blind, randomised, placebo controlled trial

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: November 2017

Updated: September 2021

Reviewed: April 2024