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 PPI/ Alginate if oesophageal symptoms, 1 month high dose and 1 month maintenance dose.
  • See 1.3 Antisecretory drugs and mucosal protectants
  • See 1.1 Dyspepsia and gastro-oesophageal reflux disease

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 2 Week Wait criteria are taken into account.

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 2 Week Wait criteria are taken into account.

Referral Instructions

e-Referrals Service Selection:

• Specialty: ENT
• Clinic: Throat (inc voice & swallowing)
• Service: DRSS-Western-ENT- Devon ICB-15N

Referral Form

DRSS referral form

Patient Information

Patient.co.uk leaflet - Globus hystericus

Pathway Group

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

Publication date: April 2017

Updated: July 2021