Chronic globus sensation is defined as a persistent or intermittent non-painful sensation in the throat, lasting for 3 months. It is derived from the Greek ‘ globus pharyngeus’ which means ball in throat. It is generally unaccompanied by problems swallowing (dysphagia). Chronic globus sensation is a common presenting symptom to primary care, and accounts for 1 in 20 referrals to Ear Nose and Throat clinics.
One cause is the Cervical Inlet patch. This is an area of aberrant stomach lining at the top of the oesophagus in very close proximity to the vocal cords. The stomach lining retains its normal function, to produce acid and mucus, and due to its position this can irritate the back of the throat and cause globus, as well as cough, hoarseness and sore throat. It is estimated that 1 in 10 people are born with an inlet patch, though not all have symptoms. It is thought to affect men and women equally, and typical presentation is between 40-60 years old, though can be younger. Treatments with conventional anti-acid medication can be helpful, although often this has no effect on mucus production and therefore symptoms persist.
HALO Radiofrequency Ablation is a technique that uses an electrode mounted either on a balloon or endoscope, and enables the endoscopist to destroy the lining of the oesophagus by tissue vaporization. Once the abnormal lining is removed, the mucosa that regrows is usually normal squamous lining. This technique has become the first line treatment for a condition called Barrett’s oesophagus, when dysplasia is present, and was introduced to London Bridge Hospital by Dr Dunn last year.
Dr Dunn has recently published the first worldwide study using this technique for inlet patch, with promising results. All ten patients had significant improvement or resolution of the inlet patch, and the majority (80%) had complete symptom resolution. The benefit of the technique is that it is performed under sedation as a day case, and no surgery is involved so there is no scarring. Aside from a sore throat for a few days, no side effects were reported.
A recent BBC documentary has featured Dr Dunn’s follow up study, a randomized control trial of the HALO RFA device. This technique is covered by insurance companies, but not currently available in the NHS outside of a research trial.