Objectives: To assess the pattern and severity of globus-type symptoms, as measured by the Glasgow Edinburgh throat scale, in individuals who had never sought health care for a feeling of something in the throat, in order to generate the first useful normative dataset for the Glasgow Edinburgh throat scale.

Methods: One hundred and seventy-four participants recruited from non-ENT clinics completed the Glasgow Edinburgh throat scale. They were distributed among three age groups (21–45, 46–65 and >65 years).

Results: The commonest throat symptoms reported were ‘coughing to clear the throat’, followed by ‘catarrh down the throat’ and ‘discomfort/irritation in the throat’.

Conclusions: The results of the study – a normative dataset for the Glasgow Edinburgh throat scale – may form the basis for: (a) the use of the Glasgow Edinburgh throat scale in primary care to identify patients for whom referral to secondary care may be appropriate; (b) monitoring the natural history of globus sensation; and (c) assessing response to intervention, in terms of resolution to baseline population levels of symptom severity.

We describe a series of four patients who presented with ‘high globus pharyngeus’, who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of ‘curling epiglottis’, as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent.

Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms.

We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an ‘empty swallow’. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric ‘inlet patch’. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.

Introduction: The globus sensation is a constant feeling of a lump in the throat and may be associated with thyroid enlargement. A two year prospective study was set up to ascertain the relationship between thyroid pathology and globus symptoms.

Materials and methods: All patients undergoing thyroid surgery over a two year period were included. Patients were questioned pre- and post-operatively. Globus symptom scores were recorded using a visual analogue scale. The size, weight and histological features of the removed specimens were correlated and statistical analysis performed.

Results: Two hundred patients were included in the study; 58 were symptomatic for globus pharyngeus pre-operatively, and 80 per cent of these patients' symptoms resolved post-operatively (p≤0.0001). Patients with histological features of inflammation showed the greatest improvement (p≤0.0001).

Conclusion: As many as one-third of patients with a thyroid mass will complain of a globus-like symptom. Patients undergoing thyroid surgery, who are symptomatic for globus pharyngeus, can expect that their symptoms will improve following surgery.

We present a series of four patients presenting with symptoms leading to a provisional diagnosis of globus pharyngeus. On further investigation, they were all found to have small areas of abnormal mucosa in either their hypopharynx or proximal oesophagus, which on biopsy were reported as containing gastric-type mucosa. Following anti-reflux treatment, all patients eventually reported a cessation of symptoms. All but one patient was followed up with repeat endoscopies. We highlight the fact that biopsies reporting gastric epithelium at this anatomical site are in keeping with the diagnosis of heterotopic gastric mucosa. We review the literature and report the high incidence and natural history of this condition.

Heterotopic gastric mucosa can only be diagnosed on endoscopy and is easily missed, even during such an investigation. We raise the question of whether this condition may be one of a number of factors in the aetiology of globus pharyngeus.

The aim of this study was to assess the value of rigid endoscopy in patients presenting with globus symptoms. We conducted a retrospective analysis of 250 patients who underwent rigid endoscopy for globus symptoms over a 12-month period. In 217 patients (86.8 per cent) the examination of the larynx, pharynx and upper oesophagus was entirely normal. Abnormal findings included cricopharyngeal spasm in 12 patients (4.8 per cent), reflux in 11 (4.4 per cent), pharyngitis in two (0.8 per cent), web in two (0.8 per cent), and retention cyst in three (1.2 per cent). The 95 per cent confidence interval (CI) for the mean number of persons with malignancy based on the Poisson distribution is 0 and 3.7 (0 and 14.8 as rates per 1000). The relationship between the clinical diagnosis and endoscopic findings was examined using the chi-square test, with a p value of 0.0001. These results suggest that patients presenting with globus sensation are unlikely to harbour neoplastic lesions and therefore rigid endoscopy may well be an inappropriate investigation in this group. The risks, costs and discomfort associated with this intervention can often be avoided.