Feeling of something stuck throat (FOSSIT) Globus

For further detail about risk assessment of FOSSIT, please see

Neck Lump and Throat Cancer Risk Assessment.

FOSSIT is a common symptom in general practice. It is usually benign (globus pharyngeus). Typically, it improves with eating and is worse when swallowing saliva. Intermittent FOSSIT, with no other red flag symptoms i.e. neck lump, unexplained otalgia, hoarseness or dysphagia is not indicative of significant pathology and can be managed with simple reassurance.

The Scottish Referral Guidelines for Suspected Cancer outlines that:

• those with 3 or more weeks of constant unilateral throat pain should be referred as an Urgent Suspicion of Cancer (USC) – but not where there is simply a feeling of something stuck in the throat (FOSSIT)
• FOSSIT or globus sensation is unlikely to be head and neck cancer, and in the absence of any other concerning features can be managed in primary care or via non-USC referral
• the upper gastrointestinal cancer guidance emphasises a USC referral to GI where there is persistent or progressive dysphagia (not FOSSIT).

FOSSIT management:

• If dysphagia is present, for solids or liquids, refer as USC to gastroenterology for an oesophagoscopy.
• If unexplained odynophagia (pain on swallowing) is present, and particularly if it is high and radiates as pain to the ear, then refer to ENT for a flexible laryngoscopy.
• If the patient has no true dysphagia or odynophagia but instead has problems with initiating swallowing (a pharyngeal symptom) then ENT referral may need to be considered. The alternative is Speech and Language Therapy if there is already a known (neurological) reason for this.
• If there is no dysphagia or odynophagia and examination of oropharynx and neck is normal, and there are no other red flags, then reassure strongly. Few will return, but they should be advised to if they are in higher risk groups (smoking, over 40)
• If the patient, age > 40, re-presents with FOSSIT and this is increasing, an urgent or urgent suspicion of cancer referral should be made to ENT depending on the symptoms and level of risk.
• Persistent globus without red flags should be referred routinely for an ENT examination.
• Patients may find the leaflet in the resources section helpful.
• Some will present with an irritating cough, and a feeling that this originates in the throat. Please note the respiratory advice about chronic cough, which also advises 2 months of nasal steroids where nasal or sinus symptoms are present.

C.M & A.H. 10-02-26