For further detail about risk assessment of FOSSIT, please see the RefHelp page on:
Neck Lump and Throat Cancer Risk Assessment.
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.
We now advocate the use of a risk calculator for unexplained throat symptoms: this has been reliably validated using Scottish evidence: http://www.orlhealth.com/risk-calculator-2.html and includes all the red flags mentioned in the Scottish Referral Guidelines for Suspected Cancer. It will shortly be incorporated into SCI Gateway.
In terms of FOSSIT in particular:
- 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 this 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 (or 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 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. They may be helped by a chronic cough leaflet (LINK TO FOLLOW) and please also note the respiratory advice respiratory advice about chronic cough, which also advises 2 months of nasal steroids where nasal or sinus symptoms are present.
Who to refer
- FOSSIT is not an indication for USOC (Urgent Suspicion of Cancer) referral but if accompanied by red flag symptoms please refer according the validated risk calculator http://www.orlhealth.com/risk-calculator-2.html is incorporated into SCI Gateway. The calculator is in keeping with the Scottish Referral Guidelines for Suspected Cancer.
- Patients over 40 who present again with increasing or persistent FOSSIT symptoms, or where indicated by the risk calculator – URGENT or URGENT SUSPICION OF CANCER
- Persistent globus with no red flags – ROUTINE.
Who not to refer
- REFER TO GASTROENTEROLOGY AS URGENT SUSPICIOUS OF CANCER all those with dysphagia or odynophagia
- FOSSIT with no red flags settling with reassurance.
- Globus with no red flags which settles with reassurance.
How to refer
SCI Gateway Lauriston / St John’s ENT Throat
C.M & I.N 02 -06-20
The following is a guide and will allow you to safely reassure most patients, but we recognise that some are bothered by their symptoms to such a degree that they need secondary care management.
Globus Syndrome: Information for patients in primary care
What is globus?
Globus syndrome is a feeling of something in the throat where we can’t find anything wrong. It is a very real feeling, it is not something you are “making up”. You may feel it as a lump, a ledge, catarrh or simply an area of discomfort; different people have different ways of describing it. It is commonly soothed by eating.
It is common?
Yes, it is. At one time or other approximately 50% of the population will experience it. It was first described by Hippocrates over 2000 years ago!
What is the cause?
The simple answer to this is we don’t know. Acid coming from the stomach may be responsible in some patients and if you suffer from heartburn or waterbrash (acid coming up into your mouth) it should be treated; unfortunately the throat feeling doesn’t always respond to such treatment but your heartburn should. Stress does seem to play a part in globus syndrome in about two thirds of patients so often a change of lifestyle or relaxation exercises help. Many patients worry that their globus symptom is a sign of throat cancer and find that after they’ve been checked out they spontaneously get better.
Is there a cure?
There is no specific treatment for globus syndrome at present. If you can, try to ignore it because the more you think about it the worse it seems to get. Excessive swallowing or throat clearing simply irritates the throat making the sensation worse, and you can get in to a vicious cycle, so try to consciously stop yourself from doing this. If your globus is particularly bad, having a drink or sucking a sweet should help by keeping the throat moist.
Does having globus mean I’m likely to get throat cancer?
NO. In fact, most globus sufferers are non-smokers and are therefore very unlikely to get throat cancer.
Will it ever go away?
Probably, but if there is no improvement in 6 weeks please make another appointment at the clinic.
