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

  • 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

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 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.

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 by the Northern Locality on behalf of NHS Devon CCG.

Publication date: November 2017

Updated: September 2021

Last updated: 23-09-2021

 

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