Background
Swallowing disorders are frequent in aged people, but they are underestimated both by patients and physicians, perhaps because their onset is often slow.
Swallowing is a complex motor reflex requiring coordination among the neurologic system, the oropharynx, and the esophagus. A number of disorders, both benign and malignant, can interfere with this process and globus pharyngeus is a common related symptom. It is defined as the feeling of a lump in the throat, it has uncertain origin and constitutes about 4% of all new ENT referrals. According to Deary 6% of his study group of 1158 women complained about globus and Thompson, in a community based study, reported that 45.6% of the general population had experienced globus sensation at some time in their lives. Globus was first described by Purcell in 1707 who coined the term globus hystericus, (globus originating from the Latin meaning "ball" and "hystericus" reflecting the supposed psychological component of the disorder). Traditionally patients presenting with globus symptoms were referred to psychiatrists and a study demonstrated that the these subjects were significantly higher on neuroticism and low on extra-version scales and have significantly elevated levels of psychological distress, including anxiety, low mood, and somatic concern when compared with the control subjects. The disorder was renamed globus pharyngeus in 1968 by Malcomson and more recently it has been defined as a persistent or intermittent sensation of a lump or foreign body in the throat for at least 12 weeks with occurrence of the sensation between meals, absence of dysphagia and odynophagia, absence of pathological gastroesophageal reflux, achalasia, or other motility disorder with a recognized pathological basis (e.g., scleroderma of the oesophagus). Psychological and psychiatric characteristics could be relevant to the experienced discomfort but are unlikely to be etiologically significant. In fact, several potential organic causes for globus pharyngeus were supposed, such as lingual tonsillar hypertrophy, cervical osteophytes, iron deficiency anemia, temporomandibular joint disorder. Laryngopharyngeal reflux, hypertensive upper esophageal sphincter and autoimmune diseases have been considered potential causes. Two recent reviews summarized the main current findings about globus.
The role of thyroid diseases has also been explored. Goiter is often associated with globus like symptoms, but the exact mechanism is poorly understood, particularly in the absence of a significant retrosternal extension. Burns found that one-third of patients with a thyroid mass complained of globus pattern symptoms. Moreover post-thyroidectomy patients may also complain of globus pattern symptoms, although these symptoms frequently settle with time. According to Maung thyroid surgery does not aggravate but rather improves preexisting globus pattern symptoms, while in the study of Wassermann these symptoms increased after surgery. All of these studies relied on the mean value of a score and did not explicitly present data about the rate of asymptomatic patients developing globus pattern symptoms in the post-operative period. The aim of this study is to evaluate the prevalence and severity of globus pattern symptoms in a population of patients three months after thyroidectomy, as a result of reduction or increase of pre-existing symptoms or as the onset of a new set of symptoms.