Globus Pharyngeus: A Comprehensive Review from Pathophysiology to Management

Abstract Globus pharyngeus is a common functional pharyngeal and esophageal disorder characterized by the persistent or intermittent, painless sensation of a lump or foreign body in the throat. Historically known as a hysterical symptom, it is now recognized as a complex, multifactorial disorder of gut-brain interaction under the Rome IV classification. A comprehensive narrative review of the literature was conducted to synthesize current evidence regarding the pathophysiology, diagnosis, and management of globus pharyngeus. The pathophysiology encompasses gastroesophageal and laryngopharyngeal reflux, upper esophageal sphincter (UES) dysfunction, esophageal dysmotility, laryngeal hypersensitivity, autonomic nervous system dysregulation, psychological and affective factors, and structural or anatomical anomalies. Dehydration and habitual cough or throat clearing perpetuate mucosal irritation and represent underrecognized modifiable risk factors. When laryngeal hypersensitivity syndrome (LHS) is the dominant mechanism, an in-office superior laryngeal nerve (SLN) block with local anesthetic and corticosteroid has emerged as an effective adjunctive intervention. Understanding the heterogeneous nature of globus pharyngeus is essential for guiding individualized diagnostic workup and targeted therapy. This review provides structured diagnostic and therapeutic algorithms and outlines a rational, mechanism-directed approach to clinical management.