For further detail about risk assessment of FOSSIT, please see
Neck Lump and Throat Cancer Risk Assessment opens a new window.
FOSSIT Feeling Of Something Stuck in Throat – Globus
This 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.
Please use the risk calculator for unexplained throat symptoms: this has been reliably validated using Scottish evidence: http://www.orlhealth.com/risk-calculator-2.html opens a new window and includes all the red flags mentioned in the Scottish Referral Guidelines for Suspected Cancer opens a new window. It will shortly be incorporated into SCI Gateway.
FOSSIT management:
- If dysphagia (is present, for solids or liquids, refer urgently as suspicion of cancer to gastroenterology-that patient will need an oesophagoscopy. Note that the Scottish Referral Guidelines for Suspected Cancer define dysphagia opens a new window as “interference of the swallowing mechanism that occurs within five seconds of the swallowing process”
- 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 referral or urgent suspicion of cancer referral should be made to ENT depending on the symptoms and level of risk. The risk calculator opens a new window should help in determining the level of urgency.
- 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 opens a new window, which also advises 2 months of nasal steroids where nasal or sinus symptoms are present.
C.M & I.N 25-03-25
