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A 42-year-old male presented with 3-month history of constant right-sided frontal headaches, severe right-sided intermittent sharp jaw pain, odynophagia, globus pharyngis, and worsening episodes of blurry vision in his right eye. Cervicocerebral angiography demonstrated a prominent, 4 cm right sided styloid process with close proximity to the right internal carotid artery (ICA). The patient was referred to otorhinolaryngology for styloidectomy and continued care.

Das „Klosgefuhl“ im Hals ist eine haufig genannte Beschwerde in der Hals-Nasen-Ohren-arztlichen Praxis. Das Symptom ist unspezifisch und deutet aufgrund der sensorischen Versorgung des oberen Aerodigestivtrakts und der Halsweichteile nicht prazise auf den Ursprungsort der Beschwerden hin. So muss die Ursachenklarung als Grundlage therapeutischer Bemuhungen eine ganze Reihe an Organ- und Funktionsstorungen umfassen.

In patients with laryngopharygeal reflux (LPR), gastric contents exhibit retrograde flow into the upper aero-digestive tract, causing extraesophageal symptoms including chronic cough, hoarseness, indigestion, difficulty swallowing, globus pharyngis, and asthma. The following on laryngopharyngeal reflux includes commentaries on the use of patient-completed questionaires and anti-human pepsin antibodies and other non-invasive tests in diagnosis; the role of pepsin and acid in the etiologies of laryngeal cancers; and the application of proton pump inhibitor (PPI) therapy for the treatment of LPR.

In patients with chronic cough, nearly 40% of the population does not experience definitive improvement of their cough despite correctly applying the anatomic diagnosis. In many of these patients with refractory cough, laryngeal symptoms are frequent. The region of the larynx/pharynx is configured as a bridge between the esophagus and the upper and lower respiratory tract. The association of reflux in patients with chronic cough and symptoms such as globus pharyngis, itchiness or the need to clear one's throat have recently been given attention due to the possibility of joint therapeutic intervention of the gastroesophageal reflux and larynx, both with new medications as well as with laryngeal rehabilitation therapies, with observed benefits in the disappearance of chronic cough in cases that had been previously labeled as refractory.

To investigate the differences and correlation between the Voice Handicap Index-10 (VHI-10) and the Voice-Related Quality of Life (V-RQOL) in teachers in China with and without voice disorders.This is a cross-sectional descriptive analytical study.The participants were 864 teachers (569 women, 295 men) whose vocal cords were examined using a flexible nasofibrolaryngoscope. Questionnaire results were obtained for both the VHI-10 and the V-RQOL.Of the 864 participants, 409 teachers had no voice disorders and 455 teachers had voice disorders. The most common voice complaint was hoarseness (n = 298) and the most common throat complaint was globus pharyngis (n = 79) in teachers with voice disorders. Chronic laryngitis (n = 218) and polyps and nodules (n = 182) were the most frequent diagnoses in teachers with voice disorders. Significant differences were seen on the VHI-10 between teachers with and those without voice disorders (P 0.05) and in function between female and male teachers with voice disorders (P 0.05) and between those with different voice disorders (P 0.05). Moderate to strong correlations were observed between VHI-10 total score and those for the three domains of the VHI-10 and the V-RQOL (P 0.0001).There is a high prevalence of voice disorders in teachers. Teachers with voice disorders have poor voice-related quality of life, with more impairment seen among female than male teachers. Different groups of voice disorders have different effects on voice-related quality of life. A moderate correlation was found between the results of the VHI-10 and the V-RQOL.

A Case study of Taeumin Esophagus Cold Pattern Patients with Gastro-esophageal Reflux Disease(GERD) and Irritable Bowel Syndrome(IBS) Hyun-Shang Shin, Byung-Joo Park, Yun-Seong Pak, Je-Sin Kim, Eui-Ju Lee, and Byung-Hee KohDept of Sasang Constitutional Medicine, Graduate school of Korean Medicine, Kyung Hee University. Seoul. KoreaDept of Sasang Constitutional Medicine, College of Korean Medicine, Kyung Hee University. Seoul. Korea ObjectivesRate of gastroesophageal reflux disease accompanied by irritable bowel syndrome is on the increase. This case study reports significant improvement of patients with gastroesophageal reflux disease and irritable bowel syndrome who had suffered from chest pain, globus pharyngis and diarrhea after taking Sasang constitutional treatment.MethodsThis patient was diagnosed as Large Yin type Esophagus Cold pattern(Taeeumin Wiwanhanjeung). Herb medicine(Jowiseungcheong-tang) was taken by the patient, three or two times per day during treatment periods. We assessed the changes of the main symptoms such as chest pain, globus pharyngis, defecation discomfort, insomniaet al. using visual analogue scale(VAS).ResultsThe symptoms of chest pain, globus pharyngis, defecation discomfort, insomnia decreased from VAS 7~8 to VAS 0~1 for about three monthsConclusionsThis case shows that Sasang constitutional medicine treatment can be effective treatment method for gastroesophagealreflux disease accompanied by irritable bowel syndromeKey Words: Gastro-esophageal reflux disease(GERD), Irritable bowel syndrome(IBS), Jowiseungcheong-tang

Detailed observation reveals a lump of translucent sticky mucus standing in the epipharynx of most globus patients, suggesting that the mucus adherent to the epipharynx causes a globus sensation. The epipharyngeal mucus of 70 consecutive globus patients was sampled via the nasal cavity. Fucose and sialic acid, the determinants of the viscoelasticity of mucus, were measured. Twenty-three patients were also asked to complete the Throat Questionnaire so we could evaluate the correlation between the degree of globus sensation and the viscoelasticity of the mucus. The mucus of 10 healthy subjects was sampled, analyzed, and compared with the data of the patients. The fucose and sialic acid concentrations found in the patients with globus pharyngis were significantly higher than those in the control subjects (Mann-Whitney U test, p < .01). The fucose concentrations correlated significantly with the globus pharyngis scores (Spearman correlation, p < .05). We conclude that there is a close association between stagnant mucus in the epipharynx and globus sensation.

In a series of subjects studied prospectively over a three-month period, 21 subjects undergoing anterior cervical spinal surgery were evaluated preoperatively and postoperatively using subjective measures for evidence of dysphonia and dysphagia, and at six weeks postoperatively were sent a questionnaire evaluating their perceptions of their voice and swallowing. Twelve subjects reported dysphonia or features of voice change following surgery, ten of whom noted their symptoms resolving within six weeks. Nineteen subjects reported symptoms of dysphagia, 15 reporting resolution of symptoms within six weeks. No subject reported dysphonia in isolation from dysphagia. In those subjects reporting dysphagia, symptoms included odynophagia, globus pharyngis, food sticking in the pharynx and coughing/choking episodes. There was no association between the severity of symptoms and their duration. Mechanisms of injury are postulated and recommendations for speech pathology intervention with regard to voice and ...

The aim of this study was to investigate the origin of globus pharyngis with particular reference to esophageal disorders such as gastroesophageal reflux disease (GERD), motility disorders, structural abnormalities, other gastrointestinal tract diseases, and psychological profile. Previous studies on this subject using 24-hour pH monitoring give conflicting results and are hampered by the high background prevalence of asymptomatic GERD in the normal Western population. The local Chinese population is known to have a very low background level of GERD and therefore is an ideal study population. Twenty-six patients with globus pharyngis underwent 24-hour ambulatory pH monitoring, esophageal manometry, and esophagogas-troduodenoscopy with lower esophageal biopsy. A control group of 20 patients presenting with non-ulcer dyspepsia was similarly investigated. Personality profiles of the globus pharyngis subjects and an appropriate control group were assessed. Eight of the globus pharyngis group (30.7%) had evidence of GERD, whereas only one of the controls (5%) demonstrated GERD on 24-hour esophageal pH monitoring (P < 0.05). The manometric and personality profile studies did not show significant differences between study and control groups. We concluded that the finding of GERD in patients with globus pharyngis is not a coincidental finding but that there is a true association between GERD and globus pharyngis.

BACKGROUND Globus pharyngis is a frequent symptom in patients who consult an otolaryngologist. In many cases, routine diagnostic work-up including history, clinical examination, and barium swallow fail to revealing the underlying pathogenesis. PATIENTS AND METHOD In a retrospective study, we present 51 selected patients suffering from globus pharyngis of unknown origin who were investigated by high-speed cineradiography in a standardized manner. RESULTS Twenty-four of the patients enrolled in the study (47.1%) showed functional and/or structural swallowing disorders. In 13 cases (25.5%) dyskinesias of the superior esophagus sphincter muscle were found. Five of these patients (9.8%) also had an inconstant hypopharyngeal diverticulum. Six cases (11.8%) showed laryngeal penetration or tracheal aspiration. In four cases (7.8%) functional disorders of pharyngeal, and in three cases (5.9%) functional disorders of oral bolus transport were found. Furthermore one hypopharyngeal web (1.9%) and two benign tumors (3.9%) were detected. In many cases, varying combinations of these findings occurred. CONCLUSION Using high-speed cineradiography for evaluation of globus pharyngis results in an increased incidence of pathologic findings, and thus is an important method for interdisciplinary diagnostic work up of patients suffering from this symptom.

Fifty patients with a diagnosis of globus pharyngis and 33 control patients attending the same ENT clinic were interviewed using the (Royal Holloway &) Bedford College Life Events and Difficulties Schedule (LEDS). Information was elicited concerning life events and difficulties over the 12 months before globus onset, and this was compared with the experiences of the control patients for the year before symptom onset or, where appropriate, before the interview. Globus patients had significantly more severe events than the control patients throughout the year. Moreover, globus patients had significantly fewer close confiding relationships with their partners than did controls. There is evidence, therefore, for both psychological diathesis and social stress factors in the etiology of globus pharyngis.

One hundred and five consecutive patients attending an ENT out-patients' clinic with a diagnosis of globus pharyngis completed a 10-item questionnaire concerning common throat symptoms. Principal components analysis of the questionnaire revealed a general throat pathology factor, and three orthogonal rotated factors which were related to dysphagia, globus sensation, and pain/swelling in the throat. Of 10 throat symptoms, the globus patients most commonly complained of: "Feeling of something stuck in the throat," "Discomfort/irritation in the throat," and "Want to swallow all the time." These were the symptoms which had highest loadings on the 'globus' factor. The clear factor structure and the satisfactory internal consistency of the Glasgow-Edinburgh Throat Scale (GETS) suggest that it offers a clinically useful instrument for assessing and monitoring the severity of some common throat ailments. The degree of distress caused by throat symptoms was predicted independently by the intensity of the globus sensation and by anxiety level.

Twenty-four out-patients with globus were assessed for current and past psychiatric illness with the 'Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety' version. Patients then received amitriptyline or placebo in a double-blind fashion. Treatment outcome was assessed using an inventory of throat symptoms, Beck Depression Inventory, Spielberger State Anxiety Scale, Crown-Crisp Experimental Index and General Health Questionnaire. Nine patients met the DMS-III criteria for psychiatric disorder in the past; six had suffered from panic disorder. Two further patients had been troubled by classic panic attacks. Nine of the 12 patients treated with amitriptyline and two of the placebo group discontinued treatment. In conclusion, clinical and psychometric associations were found between pathological anxiety and globus, and it appears that the recommendation that globus be treated 'aggressively' with tricyclic antidepressants is likely to lead to a high proportion of treatment failures.

A Part of a research programme in the ORL outpatient clinic, 22 (13 women, 9 men) patients with sensation of a lump in the throat, ‘a globus hystericus’ were referred for a psychiatric evaluation. The mean age of the patients was 48.2 years. The symptoms had been well tolerated by the patients, as the mean duration of the symptoms was 27 months. The overall psychopathology was not severe: by the DSM-IH-R only 5 of 22 received a diagnosis. In addition, narcissistic and rigid personality features were frequent. One-year follow-up showed that half of the patients were better or totally without symptoms. No correlation to history, psychologic mindedness, or the situation at the time of the interview could predict the outcome. A broad ‘life situation mapping’ is recommended as an integrated part of the general examinations.

A follow-up study of 104 patients with globus sensation was performed by postal questionnaire. All were asked to complete the Eysenck Personality Questionnaire (EPQ) and a 12-item Throat Symptom Questionnaire. Seventy-two of these patients were sent a follow-up General Health Questionnaire (GHQ). Replies were received from 89 patients (86%), 68 females and 21 males, a mean of 31 months after initial presentation. The feeling of something stuck in the throat had disappeared completely in 27% of patients, but only 4% were never aware of the throat. Throat symptoms showed a reduction with increasing age, but not with increasing interval since presentation. The 15 patients initially treated with antacid therapy had significantly greater dyspepsia scores at review than untreated patients, but no other difference was found between the two groups. GHQ scores showed a small but significant reduction over time. Of EPQ parameters, only the lower lie score in female patients showed any significant difference on repeat testing. Those with persistently high throat scores had significantly lower EPQ lie scores and a trend towards higher GHQ scores at follow-up. None of the psychological parameters measured at the first interview was found to be of prognostic significance. We conclude that, although there is a reduction in occult psychiatric morbidity in patients with the globus sensation over time, underlying personality traits remain stable and that there is a remarkable persistence of pharyngeal symptoms.

Introduction It is a popular notion that personality traits may influence the state of a person's physical health. The image of the stressed, aggressive businessman being liable to have a heart attack is so common as to have become a cliche, yet, as we shall see, it has little evidential basis. If personality traits do influence health, then this is one of the prime reasons to measure personality traits in medical settings. However, there are difficulties in establishing the true nature of the relationship between personality and health, including measurement, the distinction between subjectively reported symptoms and objective signs of illness, and the direction of causation. In addition, it is virtually impossible to assess the amount of risk that personality traits pose on their own – the separate impact they might have over and above that of poverty or working conditions, for example. The best solution is to try to design studies and use statistical analyses that are appropriate to the study of complex interactions. In this chapter we first discuss models of personality and health, then go on to describe more specific areas such as personality, stress and heart disease. Finally, we briefly discuss the connection between personality and clinically defined ‘psychosomatic’ disorders such as irritable bowel syndrome and globus pharyngis. Models of the association between personality and health We begin by reviewing possible causal relationships between personality and health.

Corniculate cartilage subluxation is a pathology that has not been reported in the medical literature. Causing vague pharyngeal symptoms, this disease entity may be overlooked or misdiagnosed as chronic nonspecific pharyngitis, globus pharyngis, or laryngopharyngeal reflux disease. A careful laryngoscopic examination is the key to detect this disorder. In this article, we present a 45-year-old patient with the complaints of foreign-body sensation in the throat, difficulty in swallowing solid food, and an urge to turn his head toward the left during the act of swallowing. His laryngeal examination revealed corniculate cartilage subluxation, and excision of the subluxated cartilage was performed by microlaryngoscopic surgery. The patient was free of his symptoms immediately after the operation and remained as such in the 6 months of follow-up.

The authors approached 1,158 middle-aged women, who were assessed for the presence of the globus sensation in the prior 3 months. Seventy globus "cases" (6.0%) were identified. Twenty-eight women with globus and 35 control subjects completed a series of questionnaires designed to assess personality traits and psychological distress. The globus subjects were significantly higher on neuroticism and low on extra-version and had significantly elevated levels of psychological distress, including anxiety, low mood, and somatic concern when compared with the control subjects. Severity of throat symptoms, but not personality or psychological distress scores, predicted the degree of medical help sought for the symptom.

A group of 25 patients (16 women, 9 men) attending an ENT department with globus sensation and 25 matched ENT controls were assessed using the Beck Depression Inventory and scales for daily stressful events (‘hassles’). Globus patients of both sexes were significantly more depressed than controls and had Beck scores suggestive of significant depression. Thirteen patients, but only two controls, had an independent life event within two months of disease onset, and patients had higher hassles scores than controls.

Much research has suggested that anxiety is involved in the temporomandibular joint syndrome (TMJ), but it is not clear whether it is a cause or a consequence of the disorder. The present study attempts to resolve this issue. Thirty-two patients suffering from temporomandibular joint syndrome and 32 sex- and age-matched dental clinic controls completed the Spielberger State-Trait Anxiety Inventory, the Eysenck Personality Questionnaire and a standardized inventory of bodily symptomatology. TMJ patients scored significantly higher on Eysenck's neuroticism and introversion scales (both P less than 0.05) and had higher trait anxiety scores (P less than 0.005) when compared with controls. These results suggest that TMJ patients have personalities that are vulnerable to life stresses, but that they are not more anxious than controls at any given time. Such a personality profile is similar to that found in other 'functional' syndrome patient groups, such as individuals with globus pharyngis. We suggest that certain stress prone personalities express anxiety in the form of a predictable set of physical syndromes which may be subject to changes with time.

Oesophageal manometry and prolonged ambulatory pH monitoring were performed in 47 patients with the globus sensation, 48 control subjects and 28 patients with documented oesophagitis. Globus patients also underwent video-recorded barium examination and rigid endoscopy. Manometry was normal in 38 of the globus group (94%). The mean percentage time below pH 4 was 4.16 in controls, 5.11 in globus patients (NS) and 18.54 in oesophagitis patients (P less than 0.0005). Oesophageal acid exposure did not correlate with sex, smoking or heartburn and correlated with age only in oesophagitis patients (P less than 0.001). Biopsy showed mild laryngitis in 2 globus patients and distal oesophagitis in 6 (13%). Abnormal oesophageal acid exposure and distal oesophageal dysmotility are not aetiological factors in the majority of patients with globus pharyngis.

The common symptoms of gastro-oesophageal reflux are heartburn and regurgitation and these are often readily recognizable. Reflux is also one of the causes of several other symptoms, e.g. globus pharyngis, chronic laryngitis and pulmonary fibrosis, and the knowledge that reflux is present may be of paramount clinical importance in these conditions. Conventional radiographic tests of reflux during barium meal examinations are unreliable, and pH monitoring and manometric tests are not practicable for routine use. In the acid-barium test, oesophageal peristalsis is observed during perfusion with barium sulphate suspension containing 0·35 per cent hydrochloric acid (pH 1·7). Delayed emptying and non-peristaltic contractions are the indicators of a positive test. The test was done in 350 patients and the results compared with the clinical evidence of reflux. The test correlated only moderately well with the clinical features, mainly because of unexpected positive tests in patients without other eviden...

The complaint of a lump in the throat without obvious local causes was investigated in a series of 77 patients. Conventional and acid barium studies of the upper alimentary tract revealed pathology in

Granular cell myoblastoma is an unusual benign tumour, which, when occuring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis.These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma.In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.

There is currently little agreement concerning the aetiology of globus pharyngis (nec hystericus), and both physical and psychological factors have been suggested as primary causes of this common disorder. Using validated research questionnaires we tested the hypothesis that there is significant psychiatric morbidity in female globus patients but not in males. One hundred and twenty-one globus patients (90F, 31M) were tested on the Crown-Crisp Experiential Index (CCEI), the General Health Questionnaire (GHQ), the Hysteroid Obsessoid Questionnaire (HOQ) and the Eysenck Personality Questionnaire (EPQ). Female globus patients, but not males, have low extraversion scores and high GHQ scores when compared with age- and sex-matched ENT patient controls, and high mean levels of anxiety, depression and somatic concern on the CCEI. In females the mean total CCEI score was not significantly different from the mean of a psychiatric out-patient group. The males had total CCEI scores similar to a group with no psychiatric symptoms. Globus patients did not have hysteroid traits. We conclude that a substantial minority of globus patients has significant psychiatric morbidity. It is important to exclude mild, reactive-type depression and conversion disorder in these patients, in whom invasive physical investigations are inappropriate.