Content area
Full Text
A 58 year old woman presents with a six month history of what she describes as a sensation of a lump in her throat. This has been intermittent in nature and is not worsening, but is causing great concern. She also complains of producing excessive amounts of phlegm. She has not lost weight and has no pain on swallowing. She is a non-smoker and has otherwise been well.
What you should cover
A feeling of a lump in the throat or an abnormal sensation is a subjective feeling, and there may not be an identifiable physical cause for the symptom.
Ask about
How long the feeling of a lump has been present. Ask the patient to describe this feeling. Try to distinguish from a pain (which may be a more significant pathology). Globus is often described as a feeling that is central and suprasternal.
Is it getting worse, and do the symptoms come and go? Persisting symptoms would raise more concern.
Difficulties swallowing (dysphagia). If so, then ask specifically about dysphagia to liquids or solids, or both. Ask about symptoms of regurgitation, which may indicate the possibility of a pharyngeal pouch.
Pain on swallowing (odynophagia). Is the pain central or does it lateralise? Pain would not be expected with globus pharyngeus.
Does the feeling improve on swallowing solids or liquids? Globus pharyngeus is typically worse when swallowing saliva (dry swallow) and is often less noticeable on swallowing food and drink.
Change in voice or hoarseness. If so, is this intermittent or progressive (with the latter possibly being of more concern, especially if no history of voice overuse)?
Dyspepsia. If so, ask about relevant risk factors such as eating late at night, spicy foods, etc.
Symptoms of otalgia. This may represent a referred pain, especially if the symptoms are unilateral. There may be an underlying pathology in the oral cavity (trigeminal nerve); the oropharynx or tonsils (glossopharyngeal nerve); or from the laryngopharynx (vagus nerve).
Any cough. This can irritate the larynx.
Presence of systemic symptoms (also known as B symptoms). These include fever, weight loss, and night sweats that may be associated with lymphoma. These may be relevant in the presence of neck lumps or asymmetrical tonsils...