What’s going on in there?
A 19th century etching/lithograph of a human throat dissection during an autopsy.
It was just the right sort of day for a stress-triggered medical problem: moving day. The lump in my throat was like a thick booger I couldn’t swallow. Or a medium-sized pill lodged in my esophagus. Or a finger pressing firmly on my trachea. As moving day wore on, it grew under my Adam’s apple until I noticed I was clearing my throat as often as I swallowed. I kept trying to spit it up, and getting nothing.
It was fucking frustrating. (Mostly I do not swear on this website, but I’m making an exception for this article: it would feel dishonest not to cuss with feeling about this experience!) Painless,1 but deeply unsettling.
This sensation, in the absence of any physical obstruction in the throat, is called globus pharyngeus, or — if you’re in a more judgemental mood — the old-timey term globus hystericus, which bluntly suggests a psychosomatic cause. Globus feels like something in your throat, but it’s all in your head. Apparently.
My initial battle with globus felt like the longest month of my life, peaking with some terrifying swallowing awkwardness that made eating difficult. I then continued to suffer seriously for about eight months, and then occasional milder episodes ever since — another year and counting. For a sensory phantom, globus is a serious bully.
This is an unusually personal article, an exploration of a medical problem that relates to pain indirectly. I’ve rarely used the PainScience.com platform in this way, but globus belongs here: it can hurt, it’s quite musculoskeletal in character, it’s often associated with neck pain, and it involves some truly neat biology and science. I think this article will help some people. There aren’t many detailed articles about globus available, and certainly none like this one.
My globus story has a happy ending (sort of)
My globus was clearly a complication of a larger medical drama. I’d had months of odd throat pain leading up to the onset of globus, and that pain lasted until the middle of summer 2015 … when I finally found and literally removed the cause (after 10 months of serious misery). My globus got much better, but not entirely, and then I suffered erratic episodes for another couple years, slowly winding down to nothing.
You can skip down to the discovery of the weird cause of my throat pain in 2015, or a summary of the slower happy ending by 2018 … or just read through the story as I experienced it and save the good news for last.
My globus story is here to help you, the globus sufferer searching the Internet for clues to the nature of your misery. If this article reassures you, or anything else, please drop me a line and tell me about it. It’s also just pure emotional venting for me. I need to write about this. I’ve been through throat hell, and I just need to talk about it.
Day 1: There’s something growing in there!
By late on moving day — a Saturday — I was starting to really worry. It felt so much like there was something in my throat that I kept shining a flashlight down my gullet. I saw a harmless and irrelevant nodule on my uvula,2 but that’s what I fixated on at first, even though it was much higher in the throat than my globus sensation. This is the problem with trying to diagnose yourself, kids.
Remember, I’d been having months of other odd throat symptoms. So it didn’t take much to get my imagination revved up. Basically, when you have a lump in your throat that won’t go away, most people think cancer. A Wikipedia page on cricopharyngeal spasm (more on this below) says:
These spasms are frequently misunderstood by the patient to be cancer.
I sure as shit did.
Day 2: The least relaxing Sunday ever
I woke up Sunday morning to find the lump gone. Bliss! I felt like cheering. I kept swallowing experimentally and grinning madly. Callooh, callay, it’s gone! Phew! This was also my first helpful hint that it probably wasn’t cancer. As a general rule, tumours don’t
- appear in an afternoon
- leave you alone just because it’s time for breakfast.
Alas, I was also about to be hammered by the discovery that globus typically worsens as the day goes on. By midday, it started to niggle, and within a couple more hours I had to concede that The Lump was back. I found it emotionally impossible to keep in mind that it wasn’t acting much like a tumour. I spent the rest of the day in a state of extreme anxiety and frustration. A couple times, I was squirming on the edge of panic, fighting the impulse to whimper and scream, like I was waking up from a nightmare about swallowing something too large.3
Oddly, my symptoms backed off almost completely later in the evening. As I relaxed. Another clue!
Day 3: This T-shirt is trying to kill me!
On the third day, I got woozy: I had head rushes every other time I stood up all day long, which greatly exacerbated my fear of serious illness. Of course, I was also exhausted and strung out.4 But in my mind, it was all “okay, I guess I’m probably dying now or something.”
And then there was the T-shirt. We all know how dangerous they can be.
As the globus set in for the afternoon, it had a more dire quality to it than before. It had merely been irritating and worrisome. When I put on a fresh T-shirt with a fairly high and tight collar, I felt like I was being strangled. I lightly touched my trachea and discovered that even a tiny amount of pressure felt extremely threatening.
That’s it! I thought. To the walk-in clinic! It was dark and raining like movie rain, but I trudged out and walked ten minutes to the clinic in my new neighbourhood … and found they had a minimum one-hour wait.
I wasn’t that scared. I’m a busy man! I went back home. Maybe in the morning.
Days 4, 5, 6 …
As the days marched on, I suffered quite a bit, and learned three main things:
- The walk-in clinic was an absurdly busy place. Spooked as I was, I would be brave-ish and wait for a scheduled appointment with my ENT specialist on Saturday.
- I felt worse every afternoon, but better each late evening — presumably as I relaxed. Indeed, my evenings were unusually relaxing relative to the days that preceded them. It fits. Also, Lorazepam was startlingly helpful.5
- Swallowing saliva was a bit awkward, but food was easy. In fact, it felt good and eased the symptoms for a while. And so I ate quite a bit.
Day 7: Like being force fed a chopstick
“You encouraged me to come back early if I needed to,” I said to the ENT specialist, a big, genial guy with a thick silver chain around his neck. “So I’m back early because I have a new symptom that’s freaking me out. I’ve never wanted anyone to stick a scope down my throat so badly. Please look in there and tell me what you see.”
Avoid throat scopes if you can. Laryngoscopy feels like being force fed a whole chopstick. It’s one of the crappiest experiences I’ve ever had in a doctor’s office. He’d done it once before after spraying the back of my throat with a topical aneasthetic. This time he did it without the numbing, for no apparent reason: just snuck up on me, the bastard. If he ever tries that again, he’s going to end up with a me-shaped hole in his door from my cartoonish exit.
So after a week of having an incredibly distinct sensation of something lodged in my throat, what did he find?
You already know what he found
Nothing. Nothing at all. Just a nice smooth pink tube.
I could go on for paragraphs about the doctor and what we discussed, but blah blah blah. He found nothing, he diagnosed globus. He tried to reassure me that there probably is something “real” going on, but the lump sensation itself … globus. His prescription:
“Calm. The fuck. Down.”
Okay, he didn’t actually swear, but you could tell he wanted to. I more or less accepted his diagnosis.
Day 8: Wikipedia for the win
On the 8th day, I read Wikipedia. Beware of Googling your medical problems. Seriously. Watch this pretty hilarious video about how perilous it is. But I’m an expert — I sort of do this kind of reading for a living — so I dared.
Within minutes I discovered a perfect description of my globus, and I do mean perfect.
Specifically, a sub-type of globus — cricopharyngeal spasm — fit me better than my skin. Some of it was eerily accurate, like “The symptoms can be mimicked by pushing on the cartilage in the neck, just below the Adam’s apple” and “eating, in fact, often makes the tightness go away for a time.” Yeah. That’s me, to a T.
What a strange sensation, to find one’s misery captured precisely in a bulleted list. Strange … but good, because according to Wikipedia, cricopharyngeal spasm is a
harmless, if uncomfortable, self-limiting disorder and will resolve itself over a period of time.
I felt better for the first time in a week. I really did.
Day 9: These eggs are trying to kill me!
On the Monday of the second week, I made myself my favourite breakfast: a nice little omelette, hot and soft. The trick is not to overdo them, mere seconds in the pan, like Julia Child taught me. I had no globus as I prepared them. I wasn’t expecting any trouble.
And then I choked on my eggs.
Swallowing felt distinctly awkward, and I couldn’t get a bite down. I had to cough a bit of it back up.
Betrayed by an omelette! It was emotionally shattering. The most comforting thing I’d learned the day before — “eating often helps” — was destroyed in a few moments. Cancer fear rushed back in like a dark tide. Difficulty swallowing felt like confirmation of my worst fears. If I was struggling to swallow, there had to be something obstructing my throat? Amiright?6
The legacy of the fishbone
Confession: I’ve never been good at swallowing.
When I was about five, I heard a story about my grandmother getting a fishbone stuck in her throat … and that story stuck in my mind, forever. I hate taking pills, always have. I couldn’t really handle eating fish until I was in my twenties, and I’m still annoyingly cautious with them to this day. I have been known to give up on mouthfuls of perfectly good steak and spit them out, because I just couldn’t get the bolus positioned for a swallow that felt safe. I went through a period about three years ago where I actually felt nervous of swallowing almost anything even slightly difficult, for no apparent reason. I got over it just as it was really getting to be Quite A Thing.
Yeah, I’m a freak. Just something “funny” about me!
All this was like sensory gasoline on the bonfire of my globus. I had a bad moment with swallowing my soft eggs, and it triggered an emotional chain reaction. Everyone has bad moments swallowing, but my moment turned into a 3-day nightmare because of my swallowing idiosyncrazy.
I guess. I’ll never really know. But it’s a good working theory.
Cancer fear redux
Job one on day nine — yeah, we’re still on day nine here — was to get the cancer fear under control. An ENT specialist had looked down my throat 36 hours earlier and seen nothing. It seemed implausible to me that any kind of throat cancer could possibly be missed in a careful throat exam on Saturday, yet cause swallowing trouble on Monday. But I couldn’t confirm this in an hour of furious Googling. I needed to talk to a doctor.
I signed up for an extremely new-fangled online medical consultation service. A doctor friend of mine had invested in the company a year before and encouraged me to give it a try. So I finally did, and soon enough I was video chatting with an amiable 70-year-old physician who appeared to be hanging out at home. He was quite helpful.
“A medical student couldn’t have missed that”
“A medical student couldn’t have missed that,” he said. “The most incompetent non-specialist would have seen something.”
Upper throat cancers (squamous-cell carcinomas) are quite visible to a scope by nature — they mostly grow on the exposed surfaces of the esophagus and trachea — where cells have been abused by smoke or booze for decades, especially the combination. Fit, younger non-smokers and moderate drinkers are nearly immune.7
“Nothing’s impossible, but your risk of a cancer here is absurdly low.”
Thanks, virtual doctor.
“But let me prescribe something a little unconventional for your lump,” he said. And then he prescribed homeopathy. Groan.8 But I already had what I needed. That was more or less the last of the cancer fear.
Days 10, 11, 12: Swallowing my pride
On the flipping of omelettes, Julia Child said something like, “You just have to go for it. You must have the courage of your convictions!”9 So it is with swallowing. Swallowing is not a thing you can think your way through. You must let the reflexes do their work. You have to just go for it.
Easier said than done, when you’re flustered.10
I didn’t have any more difficulty actually getting food down. Nothing got “stuck” again — maybe a little bit once or twice, like a pill going down slowly, something I’ve felt hundreds of times in my life. Acknowledging this now makes it seem like it was all much ado about nothing, but it was scary as hell to live through.
The low point was on day 12, when I was just so strung out and tired that I couldn’t get through a bowl of soup — even though I was quite hungry. But the next night, starving and pissed off, I ate about five pounds of sushi without a hitch.
After I got over the Great Swallowing Terror o’ 2014, the lump as I had known it died down steadily and hasn’t returned in several days.
I doubt it’s the end of my throat story, and it may not even be the end of my globus — apparently it can be intermittent and variable in character for months at a time [already confirmed by the time of publishing this] — but it probably was the end of feeling bullied by it [also confirmed].
Now, about the whole “all in your head business.” I’ve left the most interesting part of the puzzle for last …
All in your head … or not?
Globus is usually considered to be likely psychosomatic in the absence of actual lumps or other physical causes. For example, although “the differential diagnosis is vast” (translation: there are many possibilities!) Finkenbine and Miele (2004) define globus in the absence of a mass as “a form of conversion disorder.”
Conversion disorder, now officially known as functional neurological disorder (FND),11 is psychiatrist-speak for a condition (Mayo Clinic) “in which you show psychological stress in physical ways. The condition was so named to describe a health problem that starts as a mental or emotional crisis — a scary or stressful incident of some kind — and converts to a physical problem.” Specifically, a physical disability — an inability to do something, like walking, seeing, or swallowing.
And so — assuming there really is no literal lump — globus is a functional neurological disorder. Which is a sub-type of somatoform disorder, a larger category of physical disorders caused by mental illness. Which is a good-news, bad-news kind of thing. Good news that there’s nothing physically wrong, but …
The worst diseases known to science pale in comparison to the chronic and untreatable nature of somatoform disorders.
Mark Reid, MD, Twitter, @MedicalAxioms, Apr 16, 2015
When globus is not all in your head
Although globus “may ‘simply’ be a local sensory abnormality just like tinnitus,” Kortquee lists several reports “of very subtle changes in anatomy that when rectified have given relief of globus.”12 In other words, globus may be a musculoskeletal problem in nature, quite humdrum, just some little glitch or anatomical abnormality, probably quite subtle — a “harmless” sensory reaction to almost any chronic irritation of the throat. Here are some examples, from Kortequee et al and other sources:
- Gastroesophageal reflux disease (GERD), chronic heartburn basically, which can be amazingly non-obvious
- gastric inlet patches — an area of cells in the esophagus that are behaving like the wall of the stomach (e.g. producing acid)
- Eagle syndrome, styloid process pathology, the elongation/inflammation of a weird little bone in the back of the throat behind the tonsils
- arterial tortuosity, impinged and/or impinging — arteries can be surprisingly hard and kinky
- retroverted epiglottis — an abnormally curled epiglottis tip touching and indenting the tongue base
- corniculate cartilage subluxation — a slight displacement of a tiny cartilaginous structure in the throat
- thyroid nodules — just little lumps that grow on thyroid glands
- cervical osteophyte — arthritic bone calluses on spinal joints in the neck
- prominent greater cornu of the hyoid — overgrowth of a wee bit of throat bone
- hypertonicity of the upper esophageal sphincter — “tight throat,” basically
Some of these, and others, are discussed in more detail below.
Sometimes a lump is just a lump: a cancer example
Sometimes the globus sensation is caused by a real lump of some kind — just one that’s not obvious at first. The medical literature is chock-a-block with examples of globus with sneaky physical causes that dodge diagnosis in the early stages. One chilling paper describes a bone tumour growing on the front of the spine, projecting forward into the throat (Wong 2013). A relatively smooth mass, covered by layers of tissue, such a tumour could grow for a long time in secret, slowly but surely pinching the throat shut.
Yeah, creepy as hell. And I thought a fishbone was bad.
But such a tumour would also be distinctively unrelenting. Bone tumours just don’t back off when you pop a Lorazepam, like my globus does.13 A signature feature of a psychosomatic globus sensation is its sensitivity to emotional state, potentially as unpredictable as the weather. I can imagine some minor symptomatic ups and downs on the road to diagnosing such a cancer, the downward trend would be hard to miss — steadily changing from annoying to downright unpleasant.
It’s a bird! Eagle syndrome
A weirder example is Eagle Syndrome: a seemingly mechanical source of throat trouble that can act pretty strangely, like globus itself.
Eagle Syndrome is an irritation around the tip of an odd little bone at the back of the throat, the styloid bone, which looks like the fang of a sabre-toothed squirrel. The styloid can get too long and start to bother the sensitive anatomy around the tip, nerves and arteries.
Except fairly often people get Eagle Syndrome symptoms — including globus — without having an abnormally long styloid at all. So that’s odd.
Nor does a long styloid necessarily cause any grief! Not even close, in fact.14 As with most musculoskeletal conditions, there seem to be X-factors that make the hazards of long styloid bones less straightforward than they seem. No one knows what those factors are, of course.
Hot tip: the gargle blaster
In the whole globus saga so far, gargling has demonstrated to me best of all that I don’t have a mass in my throat, that the globus sensation is an ephemeral phenomenon — a spasm that can melt away like ice cream on a hot day, in the right circumstances.
Initially, I could only slowly and uncertainly relax my way out of it. I took all evening: a hot bath, a lie down, some deep breathing, sex, an hour of watching The Walking Dead (so peaceful!).
But then I discovered that gargling could usually put a stop to it almost immediately. Gargling seems to relax the throat by stretching and vibrating it at the same time. A warm gargle may be even more soothing. And for bonus points, do a “singing” gargle, too: that is, don’t just blow air, but engage your vocal cords.
It is a very unusual sensory experience. After gargling for 1-2 minutes — that’s quite a lot, try it sometime — I can get nearly complete relief from the globus sensation for at least a half hour, often much more (hours). Not bad. And quite informative about the nature of the beast.
Over time, as I improved, I found that I could get more benefit from less gargling.
More exercise? Might as well give your throat some more exercise while you’re at it: easy strength training for the anterior neck muscles. Lie on your bed face up with your head off the edge and just raise and lower your headed several times, enough to challenge the neck muscle a bit. Don’t overdo it — that’s the last thing you need! — but enough to “stimulate.”
Maybe muscle pain? The relationship of globus pharyngeus and trigger points
How does a somatoform disorder cause pain anyway? How do you go from a mental state to a physical pain? There are several possible mechanisms, but one of the most likely is the formation of so-called “trigger points” — mysterious patches of oversensitive soft tissue, particularly muscle. They are a well-described but poorly understood phenomenon, and crop up in all kinds of other chronic pain problems. Muscle is everywhere, so it can be the delivery system for an incredible array of miseries.
Like painful globus pharyngeus, I imagine — though I have no evidence of it, only my personal experience and expertise. I’ve written a large and heavily referenced book about trigger points, so I’m familiar with the science.
Globus pharyngeus mostly just feels odd and “uncomfortable,” but it can also be outright painful. I’ve experienced plenty of that. What began for me as “just” a weird lump sensation eventually progressed to a constant parade of deep aches and pains throughout the area — like a headache in my throat. On numerous occasions I was able to get temporary relief from these pains simply by gently massaging my neck and throat muscles (eg15)
It’s even possible that trigger points are involved in non-painful globus. Trigger points exist in a “latent” state where they are sensitive only if provoked. They don’t cause pain in this state, but they might cause subtle muscular malfunction and sensory weirdness — which we are probably quite sensitive to in the throat. The same trouble in the back might barely register with us, or only as a “stiff back,” but even the slightest interference with the sensation of swallowing may be much more of a problem.
Is it possible to tell if it’s in your head or your throat?
No, not really: it’s virtually impossible to rule out a physical lump with high confidence at first. There are too many ways that a physical problem could defy confirmation. As time goes on without any true lump being found, your confidence could go up fairly high … but it can’t reach 100%. Probably not even 90%.
Nor can globus as a functional neurological disorder be confirmed in most cases — not even if you are lucky enough to experience a rapid and complete recovery.
The only way to be nearly certain that it’s not a functional neurological disorder is to confirm a mass. And nobody wants that. That’s mostly only possible with worst-case-scenario diagnoses.
If you suspect globus, treat it like globus as best you can, and see how it goes.
2015 UPDATE: Big news! A tonsil stone emerges
After ten months of intermittent globus pharyngeus symptoms, mostly mild but often awful, something big changed on August 5. I felt a sharp catch in the back of my throat, like I’d swallowed a burr or a scrap of rough sandpaper. I rushed to the bathroom and flushed my tonsil with a syringe full of salty water, and …
A stone came out! A hard, dark, jagged little rock popped out of my tonsil onto my tongue. I saw it happen. I scooped it out of my mouth with a Q-tip. And I have it in an envelope now.
Yeah, smaller than a Q-tip head. But sharp as a burr, hard & stuck in a fleshy crack. You do not want this.
It is not an imposing size, but you would not want this thing in your eye, your tonsil, or any delicate crevice. It’s removal spelled immediate relief. Three of my non-globus throat symptoms vanished that day — acute, maddening symptoms I’d had constantly for a year.
Imagine finally scratching the worst itch of your life.
Imagine the end of Chinese water torture.
Imagine something stuck between your teeth for a year, finally pried loose.
Tonsil stones, it turns out, are a thing. Like kidneys and gall bladders, tonsils can form nasty little calcifications. They are usually just disgusting, not painful, but sometimes they can get unpleasant — like a thorn in the lion’s paw. In this case, it was a thorn I couldn’t see or touch, just a maddening irritation deep in my throat.
What a perfect way to provoke a nice case of globus pharyngeus!
2018 UPDATE: The fate of the globus after the stone came out
My globus and pharyngeal freakout did wind down dramatically after the stone came out, just as you’d expect. Hallelujah! But I didn’t finish recovering for a long time. The globus was actually gone for a while, but my pharyngeal muscles still often felt spastic, tugging and twinging and give me the impression that my throat might never be quite the same ever again. And then … I had another episode of globus, as bad as anything I’d experienced before the stone came out.
I remember that first globus relapse as being even more upsetting the original.
For two more years I had several more wrestling matches with globus, generally easier and briefer as time went on. More intimidating too, because the tonsil stone was gone, so why was it still happening?
Probably my tonsil was still somewhat irritated, maybe by a little more “gravel,” which made recovery from the orginal insult slower and more erratic. I worried about that for almost two years, and continued to mull over the possibility of a tonsilectomy.
After all, globus can happen without any physical provocation at all!
As I write this update in early August 2018 (just about exactly three years after the stone came out) it has been about six months since the last trace of globus, and that last episode was pretty tame. My old globus nightmare is over. If it ever comes back, it’ll be a new nightmare.
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About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter.
Appendix: Another story about a very physical lump in the throat
This is a true reader story about the difference between feeling like there’s something stuck in your throat (globus sensation) and actually having something stuck in your throat. It’s another you’re-not-paranoid-if-they’re-really-after-you story, much like my own. Bill was definitely in the “actual lump” category! If I were him, I would have stopped trying to eat poultry …
I had this thing where food, especially of the meat variety, would get stuck halfway down if it wasn’t well chewed. This went on for a long time — about fifteen years — before an emergency surgery finally put a stop to it.
My first notable incident was a Thanksgiving dinner and some turkey was the culprit. I went outside and behind the barn at my parents’ place, where my disgusting noises would not be heard. I don’t remember how long it took to dislodge, but it probably was a good half-hour or more.
I went on to have some seriously ugly episodes with it, sometimes taking a couple hours to clear my throat. I would have to do some pretty gross things to try to get the food down, such as sticking my fingers down my throat. It also would cause some serious pressure and pain and accompanied by ugly sounding heaving. It happened one time on a date. She was very forgiving (and worried).
The final reckoning was caused by some grilled chicken. My very first bite got through virtually un-chewed and immediately got stuck. This one wasn’t going to budge. I was able to get the discomfort to stay relatively tolerable for the evening. It was still there the next day and all the way into the early evening. I would have episodes of severe suffering with the pain and pressure and also occasionally coughing up globs of phlegm. I had to pull over at one point while driving to deal with phlegm coughing/dry heaving/pain episode. It was hell.
I ended up going to the emergency room that evening, twenty-four hours after it got lodged. They put me under and pushed the chunk of chicken down.
They also expanded my esophagus while they were at it. I still have the before and after pics somewhere. Apparently I had a narrow esophagus all of that time. I had an aunt who had the procedure done several times, so I guess it might be inherited. I’ve not gone back to have another expansion. I don’t think it’s narrowed all the way back and I also just make sure to chew meat very well. Only minor episodes since.
If you can get any comfort out of the “other people have bigger problems” trick, that story should do the trick!
Interestingly, Bill never suffered from any fearful swallowing awkwardness, and he never had a phantom lump — just poultry lumps! My experience was a mirror image of Bill: a relatively minor provocation created a huge sensation of throat blockage.
People are different! Bill, for instance, seems quite a lot more stoic and badass than I am. Also more stubborn. Why didn’t you talk to a doctor sooner, Bill, why?!
Appendix B: That time when a doctor told me I didn’t have tonsil stones while he was looking right at direct evidence of a huge crop of tonsil stones
The doctor who scoped me too aggressively early in the globus drama had another amazing bad-doctor moment with me a couple months later. I’d gotten a CT scan of my head and neck, but he’d already previously made it clear that he thought tonsil stones were never clinically significant.
When I went to see him to review the results of a CT scan, he brought it up on his screen just out of my view, appeared to read for a moment, and then looked back at me and said, “Well, you don’t have tonsil stones.”
Ok. I was surprised, but I accepted it. We proceeded with the appointment based on that information.
But then, a couple weeks later, I got the images and the report myself. The first line of the report reads:
“Multiple prominent palatine and lingual tonsilloliths.”
And indeed they showed up on the scan like a handful of radioactive gravel had been thrown in the back of my throat. So what the doctor really meant, of course, was not that I didn't have tonsil stones but that he didn’t think it mattered!
Lesson: read imaging reports yourself; do (just) not have a doctor paraphrase it for you. It can of course be extremely difficult and even dangerous (risk of a serious nocebo16) for laypeople to read radiology reports. But this was really straightforward, and that ENT basically lied to me about what the report said. Or he was wearing confirmation bias goggles so thick that it was impossible for him to read something that wasn’t what he expected to see. Good grief.
I do a lot of doctor defending, but #%[email protected]& they make it difficult sometimes.
What’s new in this article?
Eleven updates have been logged for this article since publication (2014). All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. more
When’s the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are “fine print,” but more meaningful than most of the comments that most Internet pages waste pixels on.
I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.
See the What’s New? page for updates to all recent site updates.
2019 — Clarified gargling self-treatment tip and added another: gentle strength training for the neck/throat.
2019 — Added story and information about tonsil stones showing up on CT scans.
2018 — Probably the final status updates to the article. I’ve received several inquiries lately from people wanting to know how am doing with the globus these days. That question is now answered in the final section.
2016 — Added more updates about to the story about on-going episodes of globus, more integration of the implications of my updates, miscellaneous minor editing, and a new list of possible musculoskeletal causes (from sources like Kortequee). Also added a mobile-only article summary.
2016 — Updated my last update: status report on globus recovery one full year “Post Stone.”
2016 — Added “Appendix: A story about a real lump in the throat.”
2015 — Good news: added another update on my own story, reporting on the successful resolution of my globus.
2015 — Added a section “Maybe muscle pain?” and a good photograph of my bizarre tonsil stone.
2015 — Added a major update: the discovery of a very likely organic cause for my globus.
2014 — Added a brief epilogue, and clarification of several of the all-in-your-head concepts.
2014 — Added information about Eagle syndrome and gargling.
2014 — Publication.
- Only painless at first. Later on, it became painful. I’ll return to that later in the article.
- Probably just a little papilloma, very common, basically a throat wart — “A benign papillomatous tumor derived from epithelium” (Wikipedia). “These benign lesions rarely cause symptoms” (Goodstein 2012). But they can get big! A 1930 case report describes one on the uvula “so long he could hold the tip between his lips. It caused him annoyance by entering the larynx and giving rise to coughing and spasm.” (Neville 1930) Yes, that would be annoying!
- I’ve actually had those nightmares. In particular, I’ve had clogging nightmares, where my plumbing fills with thick mucus, and I’m trying to pull it out of myself like rotting rope.
- The globus marched on, but my head rushes stopped. If I had continued to feel that way, concern might have been justified — although even then I’m not sure how I would have known it wasn’t just more exhaustion. Context is everything. I’ve had many days in the past when I had head rushes for no apparent reason — not even stress or lost sleep — days when I just randomly felt oogy, and it never amounted to anything. How are we to judge whether such symptoms are signs of something more serious, or just biological noise? We probably can’t.
- I had a small Lorazepam prescription for help with insomnia. I am a champion insomniac, and have experimented with essentially all treatment options over the years. I have occasionally dabbled in the benzos, in small precisely timed doses, and found them to be extremely useful and effective when used in moderation. I dipped into my meagre supply for the globus in desperation, and was astonished by the effect: the globus went poof. It didn’t just “help” — it nuked it for the remainder of the day. But warning: benzo addiction is incredibly dangerous. Never take benzos for long: only take small doses, consistently for short periods. If you take them longer, be extremely vigilant about signs of developing tolerance, and never go “cold turkey” — always reduce benzo dosage slowly. Many doctors are ignorant of the risks and best practices for withdrawal.
- I am not right. My logic was flawed. More on this below.
- This was more or less confirmed by the National Cancer Institute: “Most head and neck cancers begin in the squamous cells that line the moist surfaces inside the head and neck. Tobacco use, alcohol use, and human papillomavirus infection are important risk factors for head and neck cancers.”
- He unwittingly prescribed this to the assistant editor of ScienceBasedMedicine.org… probably the most authoritative source of homeopathy criticism and skepticism on the Internet. I politely and briefly told him what I think of homeopathy. Short of keeping my mouth shut, I was as amiable about it as possible. The inevitable lame defensive answer? “Well, I’ve been doing this 30 years … ” Experience is not how these things are determined. If it was, we’d still be bleeding people.
- I do a great Julia Child impression. Seriously. If this was radio, I’d demonstrate.
- A physician friend, Dr. Rob of One-Minute Medical School tells me that this sort of thing can get pretty bad. This is also noted in medical papers: “The sensation may lead to difficulty swallowing or breathing and may become severe or life threatening” (Finkenbine 2004). People can get so psyched out about swallowing that they do choke, and it becomes a downward spiral of fear and failure and more fear and more failure, and next thing you know, bam, feeding tube. It happens. I believe it, after this experience.
- Espay AJ, Aybek S, Carson A, et al. Current Concepts in Diagnosis and Treatment of Functional Neurological Disorders. JAMA Neurol. 2018 09;75(9):1132–1141. PubMed #29868890 ❐
- Kortequee S, Karkos PD, Atkinson H, et al. Management of globus pharyngeus. Int J Otolaryngol. 2013;2013:946780. PubMed #23935629 ❐ PainSci #53674 ❐
- I’ve wondered about this carefully. Could good drugs make you temporarily much more tolerant of the annoying sensation of a tumour in its early stages? How would that be any different than simply feeling better for a little while? A growing mass is definitely going to keep getting worse, and it’s only going to be so helpful for so long. There will be a clear trend. But at first, I think relaxation by any means could easily cause misleading remission: feeling better without actually being better. This is the sort of thing that makes it so incredibly hard to tell what’s in your head or not.
- Most people with elongated styloids are fine. So what’s the difference in those who do get symptoms? “Type I (elongated) was the most frequent type on both sides (42/59); and the most frequent patterns of calcification were partially calcified on the left side (18/59) and completely calcified on the right side (16/59). Only two patients were symptomatic.” (Ilgüy 2005)
- There was one particularly memorable occasion. I was being kept awake by a pain that felt like it was at the back of my throat, above the larynx. It didn’t seem like something that would yield to massage, because it seemed well out of the reach of anything but a laryngoscope. And yet in desperation I was fiddling with the muscles on the surface of my throat, over the Adam’s apple, and by chance I struck upon a classic example of “reproduction” and “referral” — that is, the vivid sensation that pressure on a trigger point is (a) equisitively sensitive and (b) feels the same as a pain in another location. That is, even though I was touching superficial throat muscles, the pain “referred” right to the deep spot that was driving me bonkers. Having been prone to trigger points all my life (which is a major reason I wrote a book about them), I’ve had hundreds of experiences with this kind of sensation, but this was definitely in the top five Most Holy Shit Worthy. I rubbed the spot gently for a couple minutes … and that particular deep throat pain, one of the worst complications in the whole story, went away and stayed away for weeks. I had to repeat the treatment about three more times over the months, and it worked equally well each time.
“Nocebo” is roughly the opposite of placebo: harm powered by belief, instead of relief.
Latin for “I shall harm” (which I think would make a great supervillain slogan). It refers to the harmful effect of … nothing but the belief in or fear of a harmful effect. Give someone a sugar pill and then convince them you actually just fed them a deadly poison, and you will probably witness a robust nocebo effect. A common funny-if-it’s-not-you nocebo in general medicine is the terror of “beets in the toilet”: people eat beets, and then think there’s blood in the toilet, and call 911. Nocebo is a real thing, and not to be messed with. It is one of the chief hazards of excessive X-raying and MRI scanning, for instance: showing people hard evidence of problems that often aren’t actually a problem.