Question: I have a problem in my throat area. I have no problem swallowing food, but I feel like I am being choked or something is pushing on my esophagus all the time. I can't wear any clothing that touches my throat or sides of my neck nor can I sleep with any covers touching my throat. I have had an ultrasound test done on my thyroid but it appears to be fine. Last year an ENT doctor put a scope in my nose and looked into my throat but did not see any obstructions. I would appreciate any guidance on tests you would recommend.
Dr. Hibberd's Answer:
You are describing a condition that is commonly known as globus sensation (also known as globus hystericus). Globus is the sensation of something in your throat unrelated to swallowing that occurs in the absence of tissue mass or obstruction. Usual studies include video esophagoscopy, and occasionally esophogram, esophageal motility study and CTT or MRI of the neck looking for tumor or soft tissue obstruction.
Since these studies are most likely going to be normal, I suggest you consider addressing directly any other concerns that are disturbing you, especially any untreated anxiety or depression. Though globus is not associated with any one mood disorder, it tends to occur as a physical symptom with mood disorder in predisposed patients. Though this symptom may occur in association with GERD (acid reflux) and spasm of the upper esophageal sphincter, the treatment is supportive and usually involves the use of counseling and reassurance.
I encourage you to satisfy yourself that no structural disease is evident, as well as esophageal webs, esophageal spasm, GERD, mass lesions of the neck, or chest or muscular disorders such as myasthenia gravis.
A trial of PPI (proton pump inhibitors) medication with concurrent cognitive behavioral therapy is often useful. Once the association between symptoms and mood state is appreciated, treatment becomes easier.
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