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Hemorrhage in globus pallidus — Clinical Guidelines

Overview

Globus pharyngeus is characterized by the persistent sensation of a lump in the throat, often distressing but typically benign, with multiple potential pathophysiologic causes including gastroesophageal reflux disease (GERD) and pharyngoesophageal irritation 1 3.

Diagnosis

Key Diagnostic Criteria: Persistent sensation of a lump in the throat without associated pain 1 3.

Recommended Tests:

- Nasolaryngoscopy: Essential for initial evaluation 3. - Barium Swallow: Not routinely recommended due to low diagnostic yield for malignancies; reserved for specific clinical suspicion 4 5. - Proton Pump Inhibitors (PPIs) Trial: Empirical therapy for suspected GERD 3. - Endoscopy, Multichannel Intraluminal Impedance/pH Monitoring, Manometry: Consider if initial treatments fail 3.

Management

First-Line Treatments:

- Empirical PPI Therapy: High dose for suspected GERD 3. - Reassurance and Education: Important psychological support 6 7.

Adjunctive Treatments:

- Speech and Language Therapy: Techniques targeting laryngeal and pharyngeal tension show promise 6 7. - Cognitive-Behavioral Therapy: For persistent symptoms with psychological underpinnings 3. - Antidepressants: Considered in cases with significant anxiety or depression 3.

Special Populations

Pregnancy: Specific management considerations not detailed in provided abstracts 3.

Pediatrics: Not extensively covered in abstracts 3.

Elderly: Increased prevalence noted; smoking and male gender predict symptom persistence 2.

Comorbidities: Smoking and GERD significantly impact symptom persistence 2 3.

Key Recommendations

Initiate empirical high-dose proton pump inhibitor therapy for globus pharyngeus suspected to be due to GERD (Evidence: Moderate) 3.

Avoid routine use of barium swallow for globus pharyngeus unless there are specific clinical indications (Evidence: Moderate) 4 5.

Consider speech and language therapy for patients with persistent symptoms, particularly those with suspected tension-related factors (Evidence: Moderate) 6 7.

Psychological support, including reassurance and cognitive-behavioral therapy, should be integrated into management plans for persistent globus symptoms (Evidence: Moderate) 3 6.

References

1 Lechien JR, Baudouin R, Hans S, Akst LM. History of Otolaryngology: Globus Pharyngeus as "Globus Hystericus". Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery 2023. link 2 Rasmussen ER, Schnack DT, Ravn AT. A prospective cohort study of 122 adult patients presenting to an otolaryngologist's office with globus pharyngeus. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2018. link 3 Lee BE, Kim GH. Globus pharyngeus: a review of its etiology, diagnosis and treatment. World journal of gastroenterology 2012. link 4 Alaani A, Vengala S, Johnston MN. The role of barium swallow in the management of the globus pharyngeus. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2007. link 5 Caylakli F, Yavuz H, Erkan AN, Ozer C, Ozluoglu LN. Evaluation of patients with globus pharyngeus with barium swallow pharyngoesophagography. The Laryngoscope 2006. link 6 Millichap F, Lee M, Pring T. A lump in the throat: Should speech and language therapists treat globus pharyngeus?. Disability and rehabilitation 2005. link 7 Khalil HS, Bridger MW, Hilton-Pierce M, Vincent J. The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial. Revue de laryngologie - otologie - rhinologie 2003. link 8 Puhakka H, Lehtinen V, Aalto T. Globus hystericus-a psychosomatic disease?. The Journal of laryngology and otology 1976. link

Hemorrhage in globus pallidus