Globus hystericus is referred to in Chinese medicine as "globus hystericus," with records of similar conditions dating back to the Sui Dynasty. Its symptoms resemble a plum pit obstructing the throat. Clinically, the term "globus hystericus" is often used to describe various abnormal throat sensations other than pain, such as hallucinations, a ball-like obstruction, or a crawling sensation. It is one of the common complaints encountered in clinical practice, particularly in apoplexy involving meridians. Most patients are middle-aged, with a higher prevalence among women. Many seek medical attention due to throat discomfort, suspecting tumors. In the early stages of certain tumors, such as postcricoid carcinoma or upper esophageal cancer, throat foreign body sensations may occur. Lack of vigilance can lead to misdiagnosis. Therefore, diagnosing globus hystericus requires thorough examination to prevent missed or incorrect diagnoses of fistula disease.

bubble_chart Etiology

The pharyngeal nerve supply is extremely rich, with sensory and motor nerves mainly originating from the pharyngeal plexus in the posterior pharyngeal wall, which includes branches of the vagus, glossopharyngeal, accessory nerves, and pre-sympathetic nerves. Additionally, branches such as the second branch of the trigeminal nerve and the glossopharyngeal nerve directly innervate the pharynx, making pharyngeal sensation highly sensitive. Diseases of many organs throughout the body can also cause abnormal sensations in the pharynx through neural reflexes and conduction. Therefore, the mechanism of pharyngeal paresthesia is relatively complex, with numerous {|###|}disease causes{|###|}, some of which are easily identifiable, such as biological factors like bacteria and {|###|}Chinese Taxillus Herb{|###|} parasites, physical factors like temperature extremes, electric currents, and air pressure, as well as mechanical {|###|}injury{|###|} and chemical factors. Additionally, psychological factors can also contribute to this condition, such as emotional fluctuations, prolonged excessive stress, and fatigue, which may lead to functional neurosis. Sometimes, organic diseases coexist with psychological factors, forming complex {|###|}disease causes{|###|}, which can be categorized into local, systemic, and psychological {|###|}constitution{|###|} aspects.

1. Pharyngeal diseases: Such as various types of pharyngitis, chronic tonsillitis, tonsillar stones, {|###|}polyps{|###|}, keratosis, cysts, scars, and abscesses; lingual tonsillitis; elongated uvula; foreign bodies, scars, or tumors in the nasopharynx, oropharynx, or laryngopharynx; varicose veins, cysts, tumors at the base of the tongue; styloid process syndrome; pharyngeal diverticula, etc. These conditions can often be detected through pharyngeal examination. However, early-stage tumors at the base of the tongue or malignant tonsillar tumors may not be easily identified by visual inspection alone; palpation may reveal localized hardening. Small erosions hidden within pharyngeal mucosal folds, openings of pharyngeal bursae at the nasopharyngeal roof, adhesions in the pharyngeal recess, or {|###|}nasopharyngeal carcinoma{|###|} developing beneath the mucosa may be missed if the examination is not thorough, often leading to misdiagnosis as {|###|}fistula disease{|###|}. Occupational-related pharyngitis, such as dust-induced or chemical pharyngitis, is also a {|###|}disease cause{|###|} of pharyngeal paresthesia.

2. Diseases of adjacent organs: Nasal and nasopharyngeal diseases such as sinusitis and nasopharyngitis. Laryngeal diseases such as superior laryngeal neuritis, {|###|}wind-dampness{|###|} cricoarytenoid arthritis, epiglottic cysts, abnormal epiglottic morphology, laryngeal chondromembraneitis, angioneurotic laryngeal {|###|}edema{|###|}, cricopharyngeal and inferior pharyngeal constrictor muscle spasms, etc. Esophageal diseases such as esophageal spasms, diverticula, achalasia, early-stage malignant tumors, traumatic esophagitis, reflux esophagitis, cardia spasms, and hiatal hernias. Neck diseases such as neck masses, fistulas, lymphadenitis, thyroglossal cysts, thyroid inflammation, tumors, as well as dental diseases, {|###|}ear diseases{|###|}, cervical syndrome, glossopharyngeal neuralgia, and cervical {|###|}stirred pulse{|###|} inflammation, etc., can all contribute to this condition. Some believe that hiatal hernia is the most significant adjacent lesion causing pharyngeal obstruction. Malcomson (1968) analyzed 440 patients who underwent upper {|###|}consumptive thirst{|###|} barium meal examinations over seven years, among whom 307 (70%) complained of pharyngeal obstruction. Hiatal hernia was found in 104 cases (34%), and after treatment, the symptoms of pharyngeal obstruction gradually disappeared. Reflux esophagitis can also lead to pharyngeal obstruction due to acidic fluid irritating the esophagus, disrupting its motor function. Symptoms improve or resolve after acid-suppressing therapy. Early-stage upper {|###|}esophagus cancer{|###|} may present with pharyngeal foreign body sensation or obstruction, which worsens during eating, whereas pharyngeal paresthesia is {|###|}antagonistic{|###|} to this, often causing foreign body-like sensations without noticeable symptoms during swallowing.

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1. Diseases distant from the organs, such as gastritis and duodenitis or ulcer, stomach cancer, pylorospasm, cholelithiasis, left ventricular enlargement, hypertensive heart disease, pericarditis with effusion, aortic aneurysm, refractive errors, etc. For these conditions, ENT doctors often pay less attention or fail to recognize their relationship with pharyngeal paresthesia. Malcomson (1968) conducted detailed X-ray gastrointestinal barium meal examinations on 307 patients with "globus hystericus," finding positive findings in 242 cases (79%). Among these, more than half were due to diseases distant from the organs, including 104 cases diagnosed with hiatal hernia, 39 cases with gastric and duodenal ulcers, and the rest with pylorospasm, hypertensive heart disease, esophageal deviation, achalasia, etc. Effective treatment of the primary diseases often led to the disappearance of the original globus symptoms.

2. Systemic Diseases Metabolic and endocrine disorders are more common, such as vitamin deficiencies, iron-deficiency anemia, thyroid diseases like hyperthyroidism or hypothyroidism, menopausal syndrome, myasthenia gravis, cervical osteoarthritis, joint stiffness, and intestinal parasites like Chinese Taxillus Herb. Iron-deficiency anemia is closely related to globus pharyngeus, with many patients showing lower serum iron levels and higher unsaturated iron-binding capacity. For those with vitamin deficiencies, supplementation with riboflavin and nicotinamide has proven effective in treating stubborn cases.

3. Psychological Factors

Changes in mental state and emotions have a significant impact on the onset and progression of globus pharyngeus, such as neurasthenia, neurosis Guanneng , schizophrenia, cancer phobia, hysteria, and states of anxiety or depression.

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Traditional Chinese medicine emphasizes the role of emotional factors in disease, attributing "globus hystericus" to the stagnation of seven emotions, phlegm obstruction in the throat, or liver-stomach disharmony. "Like a plum pit stuck in the throat—unable to swallow or spit out—worsening with melancholy and easing with joy." This fully illustrates the influence of psychological factors on the condition.

bubble_chart Clinical Manifestations

Patients can often indicate that the foreign body sensation is located between the oropharynx and the suprasternal fossa, most commonly in the laryngopharynx. They may experience sensations such as a foreign body, crawling, burning, tightness, suffocation, or narrowing in the throat. Some patients feel as if there are leaves, hair strands, threads, masses, or sticky phlegm in their throat, while others feel neck tightness and avoid buttoning their collars. These sensations are more noticeable when the patient performs an empty swallowing action but lessen or disappear during eating. There is usually no pain or only grade I pharyngeal pain. The symptoms often fluctuate with the patient's emotions, and the abnormal sensations may change frequently.

In patients with pharyngeal paresthesia, local lesions are often不明显 or mild. For patients whose symptoms do not match the signs, it is necessary to rule out symptoms caused by various organic sexually transmitted diseases in the throat. A thorough examination should be conducted to check the nasopharynx, oropharynx, laryngopharynx, and neck for signs such as粘 membrane congestion, swelling, hyperplasia, dryness, atrophy, scarring, deformities, or lymph node enlargement.

bubble_chart Diagnosis

The etiology of this disease is relatively complex. It is essential to carefully listen to the chief complaints and thoroughly understand the course of onset, living and working environments, as well as potential triggers. Generally, abnormal sensations caused by organic sexually transmitted diseases often have fixed locations, whereas those with uncertain foreign body sensations are not always due to psychological factors. For patients with adjacent lesions, X-ray imaging and esophageal barium meal examinations may be performed. A diagnosis of pharyngeal paresthesia can only be made after a detailed analysis of the complete medical history, symptoms, and examination findings, ruling out organic sexually transmitted disease lesions hidden in the pharynx, neck, upper respiratory tract, or upper digestive tract.

bubble_chart Treatment Measures

Focus on treating the disease cause. For patients without obvious organic sexually transmitted disease changes, provide patient explanations to help them understand their condition, eliminate unnecessary concerns, and cooperate with medication or suggestive therapy. Quit smoking and alcohol, and use Chinese medicine Chinese medicinals, such as soothing liver and relieving depression, moving qi and removing food stagnation, or drugs that dissipate nodules and eliminate phlegm. Alternatively, use acupuncture, acupoint block therapy, and other treatments. Medication may include sedatives, vitamins, and antipyretic analgesics.