An Approach to Globus Sensation: Clinical Pearls for Clinicians.

Globus sensation is a common presenting symptom encountered by primary care physicians, otolaryngologists, and gastroenterologists. Although common, it can have a significant impact on quality of life and is often difficult to treat, given lack of a standardized approach to diagnosis and management. In this concise review, we outline the various causes that may contribute to globus sensation, encompassing sinonasal processes such as post-nasal drip, esophageal conditions including laryngopharyngeal and gastroesophageal reflux, and psychological factors as well as structural abnormalities, among others. We also provide a framework on how to approach diagnosis and management of this symptom, which frequently requires multidisciplinary care between otolaryngologists and gastroenterologists. Patients with globus sensation and typical sinonasal symptoms may be empirically trialed on topical nasal sprays. Similarly, in patients with globus sensation and heartburn or regurgitation, a trial of acid suppression medications may be considered. In patients with globus sensation and alarm symptoms, urgent nasolaryngoscopy and endoscopy should be pursued. In patients with isolated globus sensation, work-up often entails nasolaryngoscopy followed by endoscopy. In these patients with a negative initial work-up, we highlight important considerations for when to consider empirical therapy vs when to pursue additional diagnostic testing, which is guided by the clinical context, severity of the patient's symptoms and impact on quality of life, and shared decision-making.