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Is there Really a Lump in My Throat? The Incidence and Implication of Vocal fold Abnormalities in Patients Presenting with Globus

      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)
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      REFERENCES

        • Harar RP
        • Kumar S
        • Saeed MA
        • et al.
        Management of globus pharyngeus: review of 699 cases.
        J Laryngol Otol. 2004; 118: 522-527
        • Ortiz AS
        • Lawton A
        • Rives E
        • et al.
        Correlating videofluoroscopic swallow study findings with subjective globus location.
        Laryngoscope. 2019; 129: 335-338
        • Batch AJ
        Globus pharyngeus: (part II), discussion.
        J Laryngol Otol. 1988; 102: 227-230
        • Remacle M
        The diagnosis and management of globus: a perspective from Belgium.
        Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 511-515
        • Hamdan AL
        • Khalifee E
        • Ghanem A
        • et al.
        Predictive value of globus pharyngeus in patients with functional dysphonia versus organic dysphonia.
        Laryngoscope. 2019; 129: 930-934
        • Belafsky PC
        • Postma GN
        • Koufman JA
        Validity and reliability of the reflux symptom index (RSI).
        J Voice. 2002; 16: 274-277
        • Belafsky PC
        • Mouadeb DA
        • Rees CJ
        • et al.
        Validity and reliability of the eating assessment tool (EAT-10).
        Ann Otol Rhinol Laryngol. 2008; 117: 919-924
        • Rosen CA
        • Lee AS
        • Osborne J
        • et al.
        Development and validation of the voice handicap index-10.
        Laryngoscope. 2004; 114: 1549-1556
        • Thompson WG
        • Heaton KW
        Heartburn and globus in apparently healthy people.
        Can Med Assoc J. 1982; 126: 46-48
        • Famokunwa B
        • Walsted ES
        • Hull JH
        Assessing laryngeal function and hypersensitivity.
        Pulm Pharmacol Ther. 2019; 56: 108-115
        • Vertigan AE
        • Gibson PG
        • Theodoros DG
        • et al.
        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
        • Anandasabapathy S
        • Jaffin BW
        Multichannel intraluminal impedance in the evaluation of patients with persistent globus on proton pump inhibitor therapy.
        Ann Otol Rhinol Laryngol. 2006; 115: 563-570
        • Deary IJ
        • Wilson JA
        • Harris MB
        • et al.
        Globus pharyngis: development of a symptom assessment scale.
        J Psychosom Res. 1995; 39: 203-213
        • Khalil HS
        The diagnosis and management of globus: a perspective from the United Kingdom.
        Curr Opin Otolaryngol Head Neck Surg. 2008; 16: 516-520
        • Takwoingi YM
        • Kale US
        • Morgan DW
        Rigid endoscopy in globus pharyngeus: how valuable is it?.
        J Laryngol Otol. 2006; 120: 42-46
        • Patel AK
        • Mildenhall NR
        • Kim W
        • et al.
        Symptom overlap between laryngopharyngeal reflux and glottic insufficiency in vocal fold atrophy patients.
        Ann Otol Rhinol Laryngol. 2014; 123: 265-270
        • Cohen SM
        • Garrett CG
        Hoarseness: is it really laryngopharyngeal reflux?.
        Laryngoscope. 2008; 118: 363-366