Adam Rubin, MD, co-director of the Lakeshore Professional Voice Center, part of the Lakeshore Ear, Nose and Throat Center in St. Clair Shores, Mich., believes that neuralgia is a close second in etiology.
Dr. Rubin recently served as senior author for a study on the use of gabapentin in patients with globus (Ann Otol Rhinol Laryngol. 2013;122:492-495). He and his colleagues looked at 87 patients who presented with globus pharyngeus between 2006 to 2011 at Lakeshore Ear, Nose and Throat Center and were given a trial of proton pump inhibitor therapy for at least two months and/or a trial of gabapentin for at least two weeks, with at least one follow-up visit.
After treatment, 77% of all patients showed improvement, 67% showed a complete or partial response to aggressive reflux management, and 66% of patients who had a trial of gabapentin reported improvement. In addition, eight of 14 patients who did not improve with aggressive reflux management improved with gabapentin. Dr. Rubin believes that these results point to neuralgia being a more common cause of globus than previously thought. “I believe that many neurogenic cases go undiagnosed,” he said.