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

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

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 CCG-15N

Referral Forms

DRSS referral form

Supporting Information

Patient Information

Patient.co.uk leaflet - Globus hystericus

Pathway Group

This guideline has been signed off by the Western Locality on behalf of NEW Devon CCG.

Publication date: April 2017

Updated: July 2021

Last updated: 02-07-2021

 

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