Work-up of globus: assessing the benefits of neck ultrasound and videofluorography

Abstract

Globus patients with normal ear, nose, and throat (ENT) status are a diagnostic challenge. The symptom may be long lasting and cause concern about malignancy, leading to possibly unnecessary further investigation. The aim of the study was to assess whether radiological examinations are useful in globus diagnostics, how often patients suffer from persistent globus, and whether globus patients with normal ENT status develop a malignancy during a follow-up. We reviewed medical records of all 76 globus patients referred to Helsinki University Hospital, Department of Otorhinolaryngology-Head and Neck Surgery in 2009. Patient history and findings in physical and radiological examinations were registered. A questionnaire concerning patients' present pharyngeal symptoms was sent 3 and 6 years after their initial visit. Data from the Finnish Cancer Registry revealed whether patients developed malignancies within a 3-year follow-up. Based on medical records, neck ultrasound was performed for 37 (49 %) and videofluorography for 22 patients (29 %), with nonsignificant findings. After a 3- and 6-year follow-up, half patients indicated that they were asymptomatic or had fewer symptoms, whereas the rest had persistent symptoms. The Finnish Cancer Registry data confirmed that globus patients developed no head and neck malignancies during a 3-year follow-up. In the present study, neck ultrasound and videofluorography showed no additional benefit to evaluate the globus etiology in patients whose ENT status was normal. Half the globus patients suffered from persistent symptoms after a 3- and 6-year follow-up, indicating that globus may cause discomfort chronically. However, no patients developed malignancies during a 3-year follow-up.

A prospective cohort study of 122 adult patients presenting to an otolaryngologist's office with globus pharyngeus

“…The main fear both in the patient, but also in the physician, is to overlook malignant disease; however, this is very rare in patients with monosymptomatic globus . No cases of malignant disease were discovered in our cohort.…”

“…Järvenpää et al had a similar response rate and gender distribution in their questionnaire‐based follow‐up study but found a lower rate of persisting symptoms (62%) at 3‐year follow‐up, probably due to a longer study period …”

“…Today patients often worry about cancer, but globus is rarely the only symptom of malignant disease . None the less, globus can cause anxiety, and patients might repeatedly seek medical advice to find a reason for the symptom …”

Authors’ response to Commentary on “Role of barium swallow pharyngoesophagography in the management of globus pharyngeus”

“…Although benign findings in barium swallow may be seen in globus patients, the causal relationship of these findings is questionable and hard to analyze in retrospective settings that the author mentioned [2,3]. Globus pharyngeus is a general symptom; it is usually intermittent, eating or drinking often helps and it has a great probability of resolving spontaneously, although the symptom recurs in some patients [4]. However, the before-mentioned findings in barium swallow are chronic conditions, such as osteophytes or Zenker's diverticulum, which may induce dysphagia symptoms rather than typical globus.…”

“…Based on many studies, a typical globus pharyngeus without any alarming signs, such as progressive dysphagia, or findings in ear, nose, and throat examination, is not a sign of a malignancy [4,5]. To perform further investigations just to ensure the patient about the globus symptom's benign nature is not, however, justified.…”