Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus. 1. Introduction Globus pharyngeus, the sensation of something stuck in the throat, has been noted since the time of Hippocrates. Purcell first used the term globus hystericus in the early 18th century [1]. In 1968, Malcomson [2] suggested the term globus pharyngeus as a more accurate description since not all patients with globus were either hysterical or female. Typically, globus is relieved by ingestion of solids or liquids and tends to be worse on dry swallows. Globus may be associated with throat irritation, soreness, dryness, catarrh, or constant throat clearing. It forms a large part of ENT practice and may account for about 4% of referrals to our outpatient clinics [3]. The prevalence is much higher in the general population as most people may not present to hospital with it. A recent study by Ali and Wilson [4] found that up to 78% of patients presenting to non-ENT clinics had had globus-type symptoms. 2. Aetiology Despite the high prevalence in the community, the aetiology of globus remains unclear and highly controversial. It is slowly being accepted that it may be multifactorial and that when it occurs in isolation it rarely hides any sinister pathology [5]. Most of the recent work has suggested several mechanisms in isolation or not uncommonly in combination are to blame for the manifestation of globus pharyngeus; these include psychological factors, gastro-esophageal reflux (GOR), pharyngeal dysmotility, hypertonic upper oesophageal sphincter (UOS), and local anatomic abnormalities [6–11]. 2.1. Psychological Factors As its earlier name, globus hystericus, suggests, there has been a long history of links between globus and psychological factors. It is the fourth most discriminating symptom of a somatisation disorder after
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