Correlating videofluoroscopic swallow study findings with subjective globus location

Abstract

Objective Patients with globus, the sensation of something stuck in the throat, are evaluated by otolaryngologists, gastroenterologists, and speech pathologists and often undergo multiple tests and interventions. We hypothesize that a videofluoroscopic swallow study (VFSS) is useful to characterize globus etiology and correlate subjective globus location to atypical VFSS findings. Method Retrospective chart review of all patients undergoing VFSS over a 24‐month period with a primary complaint of globus. Globus was characterized by the patient as above the thyroid notch, between the thyroid notch and sternum, or substernal. VFSS findings were categorized as oropharyngeal, pharyngoesophageal, or esophageal based on nine VFSS abnormalities and then further broken out for subgroup analyses. Results Of 216 patients meeting study criteria, 109 patients localized globus above the thyroid notch, 74 between the thyroid notch and sternum, and 33 substernal. One hundred ninety‐five patients (90.3%) had at least one finding on VFSS that could account for symptoms, and the majority had multiple. In fact, 21 patients (9.7%) with dysphagia localized above the thyroid notch had evidence of distal esophageal abnormalities, and 15 (6.9%) with dysphagia localized substernal had oropharyngeal abnormalities. Conclusion Whereas VFSS was likely to identify abnormalities, these areas relate poorly overall with the patient's subjective globus location, and the clinical utility of the study is questionable. Level of Evidence 4 Laryngoscope, 129:335–338, 2019

ESNM/ANMS Review. Diagnosis and management of globus sensation: A clinical challenge

“…Idiopathic globus is diagnosed when the clinical history is supportive and after alternate medical conditions have been excluded using prudent and specific investigation, including laryngoscopic evaluation, endoscopy with biopsy, high‐resolution manometry (HRM), and in some instances, ambulatory reflux monitoring 1 . Although as many as 90% of patients presenting to ENT clinics are reported to have abnormal bolus propulsion on videofluoroscopic examination, these do not necessarily correlate to the location or nature of the symptom 3,11 . Abnormal endoscopy (22%), abnormal pH testing (20%), motor abnormalities on HRM (63%), and abnormal barium swallow (24%) were reported in 172 patients presenting to ENT clinics for evaluation 12 .…”

“…While globus is common, prevalence varies widely depending on the definition utilized. In one study, only 51% of 216 patients localized globus to the high neck; of the remainder, 35% localized the symptom between the thyroid notch and sternum, and 15% substernally 3 . Prevalence rates as low as 0.1% and as high as 46% have been reported, with females presenting for evaluation more often than males 4‐6 .…”

Aspects of the assessment and management of pharyngoesophageal dysphagia

“…Early fluoroscopic studies suggested symptoms above the sternal notch represented pharyngeal dysfunction with decent accuracy, but more recent fluoroscopic and manometric data indicate frequent discordance between symptom localization and abnormal objective findings. [32][33][34][35][36][37] A 2018 study investigating patients with pharyngeal swallowing symptoms that were found to have a structural cause identified structural abnormality in the pharynx in only 41%. 37 Nineteen out of 48 (39%) esophageal cancers found in this study presented with pharyngeal symptoms alone.…”