The Etiology of Globus Pharyngeus under Flexible Fiberoptic Nasopharyngoscopy and Laryngoscopy

Abstract

Background: Globus pharyngeus, described as a strange foreign-body sensation in pharyngo-larynx, is a common chief complaint at out-patient department. In this retrospective study, the reports of flexible fiberoptic nasopharyngoscopy and laryngoscopy were reviewed. Methods: One hundred and forty-two patients were enrolled retrospectively at my clinics at 1 regional hospital and 2 local hospitals respectively located in Tao-Yuan county and in Hsin-Chu county during July to December, 2006. Twenty-seven patients with less-than-2-week symptoms and 5 patents with thyroid diseases were excluded. The age of the left 110 patients (62 male, and 48 female) ranged from 23 to 85 (mean, 52.1 years old). The duration of symptom was 2 weeks to even over 2 decades (≤1 years: 66.4 % of the patients). They were examined with flexible fiberoptic nasopharyngoscope and laryngoscope. The results were recorded. All the studying 110 patients were treated with specific therapies, and 65.5% (n=72) received anti-reflux therapy. It was expected that the globus pharyngeus could be cured within 2 months after being treated. Result: The findings were classified into 4 categories, including postnasal drips (PNDs), laryngeal lesions (LLs), oropharyngeal lesions (OLs), and suspected laryngo-pharyngeal acid reflux (R/O LPR). R/O LPR and PNDs both predominated in the only-1-category group (66.4%); PNDs+R/O LPR, in the combined-2-category group (27.3%); PNDs+R/O LPR+OLs, in the combined-3-category group (5.5%). Negative finding was noted in 0.1%. After they were properly treated, 75.4 % (n=83) achieved the therapeutic expectancy and 15.5% (n=17) were lost followed-up. However, 9.1% (n=10) did not achieve the therapeutic expectancy; of them, 4 were followed up at my clinic, and 6 were transferred to other department; then surprisingly, one was diagnosed esophageal malignancy. Conclusions: By this otorhinolaryngologic checking method, R/O LPR and PNDs appear important in globus pharyngeus. More aspects can be checked by flexible fiberoptic nasopharyngoscopy and laryngoscopy than by rigid laryngoscopy, especially for PNDs. The etiology is confirmed with flexible fiberoptic nasopharyngoscopy and laryngoscopy and the following specific therapeutic effect; otherwise, a further examination is recommended. Please keep in mind that esophageal malignancy hides in globus pharynges!