Generalized anxiety causing globus pharyngeus

Abstract

Background: Globus is a feeling of a sensation of a lump in the throat. A variety of explanations (physical and psychological) have been proposed in its etiology, but it is nonspecific nature and high incidence makes a causative association hard to establish or refute. Objective: To associate the role of Anxiety in the etiology of globus pharyngeus. Materials and Methods: A prospective study was conducted in a rural private hospital in South India. One hundred and ninety-three patients with a sensation of lump in the throat were assessed after obtaining consent. A strict inclusion and exclusion criteria meant only 54 made it to the final study. A pan endoscopy was conducted to rule out local lesions. In each patient with absence of a local lesion, Hamilton-A Anxiety (HAM-A) Scale was issued for the levels of anxiety (values between 0 and 56) and the visual analog scale (VAS) for uneasiness experienced (values between 1 and 10) before and after 12-weeks treatment. Management included oral escitalopram and clonazepam. Results: At the end of the study, the average score for HAM-A Scale was 13.96 compared to 26.17 before treatment, an improvement of 46.65%. The average values before and after treatment in the VAS before and after treatment were 7.43 and 3.33, an improvement of 55.18%. Conclusion: In the absence of a local cause, the diagnosis of globus should be looked at from psychological viewpoints. Undiagnosed or untreated anxiety can cause globus and it is more commonly seen in women in the age group of 36–45 years. The P value was significant in this study where we treated anxiety leading to globus (<0.05). Thus, we infer that treatment of anxiety as an entity can help in the management of globus.