EpistemisSensation of pharyngeal globe
Specialty: Otolaryngology.
Why it occurs
- Hypertonia of the upper esophageal sphincter mediated by emotional stress or anxiety disorders
- Laryngopharyngeal reflux disease with chronic acid irritation of the interarytenoid mucosa
- Hypertrophy of the lingual tonsil that mechanically rubs against the epiglottis when swallowing
- Cricopharyngeal dysfunction or localized muscle spasm not coordinated with swallowing
Initial workup
Detailed flexible nasofibrolaryngoscopy paying special attention to the base of the tongue, valleculae, pyriform sinuses and retrocricoid area, upper gastrointestinal endoscopy if accompanied by esophageal symptoms, and 24-hour pH-metry and impedanciometry if there is suspicion of refractory acid or non-acid reflux.
red flags
Presence of real progressive dysphagia to solids and liquids, localized painful odynophagia, unintentional weight loss, persistent dysphonia lasting more than 3 weeks, palpable suspicious cervical lymphadenopathy, or recurrent food aspiration with coughing spells.
Standard management
- Proton pump inhibitors in double doses such as esomeprazole — 40 mg orally every 12 hours taken 30 minutes before breakfast and dinner for a trial period of 8-12 weeks if laryngopharyngeal reflux is suspected
- Prokinetics such as cinitapride — 1 mg every 8 hours before meals
- Anxiolytics in low doses if the psychological or stress component is the predominant triggering factor.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Otolaryngology
- Listed causes
- 4
- Treatment options
- 3