Summary
Objective
To identify the prevalence of vocal fold abnormalities in patients with a primary
complaint of globus sensation. Secondly, to determine the relationship between globus,
vocal fold abnormality, and patient-reported quality of life questionnaire score.
Study Design
Retrospective chart review.
Methods
A retrospective chart review was performed to identify all new patients evaluated
at a tertiary academic care laryngology practice between January 2018 and December
2018 presenting with a chief complaint of globus. Variables of interest include age,
gender, laryngeal symptoms, self-reported quality-of-life questionnaire results, and
laryngostroboscopy findings. Questionnaires selected for this investigation include
the reflux symptom index (RSI), eating assessment tool-10 (EAT-10), and voice handicap
index-10 (VHI-10).
Results
Two hundred twenty-eight subjects with an average age of 54 ±17 years, were categorized
based on one of three laryngostroboscopic findings: absence of vocal fold abnormality,
vocal fold paresis/paralysis (motion abnormality), or a vocal fold mass lesion. Fifty
percent of patients reporting globus had a normal laryngeal exam, and 50% had a mass
lesion or motion abnormality. Twenty five percent had vocal fold motion abnormality
(paresis, paralysis, or supraglottic squeeze); 19% had a mass lesion; and 3% had both
a lesion and motion abnormality. The average self-reported survey scores were compared
among the three groups. Patients with dysphonia had a significantly higher VHI-10
(P = 0.00), and a significantly higher RSI (P = 0.00) than those without dysphonia. Those patients with dysphagia had significantly
higher EAT-10 (P = 0.00) and RSI (P = 0.02) scores than those who did not have dysphagia. Patients with vocal fold motion
abnormality had significantly higher VHI-10 than those with normal vocal fold mobility
(P = 0.02)
Conclusions
Identifying the etiology of globus presents a significant challenge to laryngologists.
Data presented here suggest that vocal fold abnormalities may contribute to the sensation
of globus and should therefore be considered in the differential when managing these
patients.
Key Words
Abbreviations:
VHI-10 (Voice Handicap Index-10), RSI (Reflux symptom index), EAT-10 (Eating assessment tool-10), IRB (Institutional Review Board), GERD (gastroesophageal reflux disease), LPR/GERD (laryngopharyngeal reflux/gastroesophageal reflux), LPR (laryngopharyngeal reflux), SLP (speech and language pathologist), GI (glottic insufficiency), MTD (muscle tension dysphonia), PPIs (proton pump inhibitors), TVF (true vocal fold)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Management of globus pharyngeus: review of 699 cases.J Laryngol Otol. 2004; 118: 522-527
- Correlating videofluoroscopic swallow study findings with subjective globus location.Laryngoscope. 2019; 129: 335-338
- Globus pharyngeus: (part II), discussion.J Laryngol Otol. 1988; 102: 227-230
- The diagnosis and management of globus: a perspective from Belgium.Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 511-515
- Predictive value of globus pharyngeus in patients with functional dysphonia versus organic dysphonia.Laryngoscope. 2019; 129: 930-934
- Validity and reliability of the reflux symptom index (RSI).J Voice. 2002; 16: 274-277
- Validity and reliability of the eating assessment tool (EAT-10).Ann Otol Rhinol Laryngol. 2008; 117: 919-924
- Development and validation of the voice handicap index-10.Laryngoscope. 2004; 114: 1549-1556
- Heartburn and globus in apparently healthy people.Can Med Assoc J. 1982; 126: 46-48
- Assessing laryngeal function and hypersensitivity.Pulm Pharmacol Ther. 2019; 56: 108-115
- The role of sensory dysfunction in the development of voice disorders, chronic cough and paradoxical vocal fold movement.Int J Speech Lang Pathol. 2008; 10: 231-244
- Multichannel intraluminal impedance in the evaluation of patients with persistent globus on proton pump inhibitor therapy.Ann Otol Rhinol Laryngol. 2006; 115: 563-570
- Globus pharyngis: development of a symptom assessment scale.J Psychosom Res. 1995; 39: 203-213
- The diagnosis and management of globus: a perspective from the United Kingdom.Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 516-520
- Rigid endoscopy in globus pharyngeus: how valuable is it?.J Laryngol Otol. 2006; 120: 42-46
- Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.Ann Otol Rhinol Laryngol. 2014; 123: 265-270
- Hoarseness: is it really laryngopharyngeal reflux?.Laryngoscope. 2008; 118: 363-366
Article info
Publication history
Published online: July 03, 2022
Accepted:
May 12,
2022
Publication stage
In Press Corrected ProofFootnotes
Presented as a poster presentation at the Fall Voice Virtual Conference October 23-24, 2020.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
