A feeling of a lump in the throatBMJ 2014; 348 doi: https://doi.org/10.1136/bmj.f7195 (Published 07 January 2014) Cite this as: BMJ 2014;348:f7195
- N Foden, registrar in otolaryngology1,
- M Ellis, registrar in otolaryngology1,
- K Shepherd, general practitioner2,
- T Joseph, consultant in otolaryngology1
- 1Royal National Throat Nose and Ear Hospital, London, UK
- 2Manor Health Centre, Wirral, UK
- Correspondence to: N Foden
- Accepted 12 September 2013
A 58 year old woman presents with a six month history of what she describes as a sensation of a lump in her throat. This has been intermittent in nature and is not worsening, but is causing great concern. She also complains of producing excessive amounts of phlegm. She has not lost weight and has no pain on swallowing. She is a non-smoker and has otherwise been well.
What you should cover
A feeling of a lump in the throat or an abnormal sensation is a subjective feeling, and there may not be an identifiable physical cause for the symptom.
How long the feeling of a lump has been present. Ask the patient to describe this feeling. Try to distinguish from a pain (which may be a more significant pathology). Globus is often described as a feeling that is central and suprasternal.
Is it getting worse, and do the symptoms come and go? Persisting symptoms would raise more concern.
Difficulties swallowing (dysphagia). If so, then ask specifically about dysphagia to liquids or solids, or both. Ask about symptoms of regurgitation, which may indicate the possibility of a pharyngeal pouch.
Pain on swallowing (odynophagia). Is the pain central or does it lateralise? Pain would not be expected with globus pharyngeus.
Does the feeling improve on swallowing solids or liquids? Globus pharyngeus is typically worse when swallowing saliva (dry swallow) and is often less noticeable on swallowing food and drink.
Change in voice or hoarseness. If so, is this intermittent or progressive (with the latter possibly being of more concern, especially if no history of voice overuse)?
Dyspepsia. If so, ask about relevant risk …