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Die Globussensation

Eine klinische Übersichtsarbeit

Globus sensation

A clinical review

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Zusammenfassung

Eine Globussensation ist eine median im Rachen lokalisierte Missempfindung i. S. eines Kloßes. Sie kann symptomatisch mit verschiedenen Krankheiten assoziiert sein, monosymptomatisch als somatoforme Störung oder als sekundäres somatoformes Krankheitsverhalten kontinuierlich wie auch intermittierend auftreten. Eine interdisziplinäre Diagnostik ist ratsam, denn der Globus kann auch Symptom von Angst-, depressiven oder Persönlichkeitsstörungen sein. Zuerst findet eine gründliche otorhinolaryngologische Untersuchung (einschließlich sorgfältiger Anamnese) statt, evtl. in Kooperation mit anderen Facharztrichtungen. Die sich ggf. anschließende psychosomatische und klinisch-psychologische Testdiagnostik kann aufgrund von Wechselwirkungen zwischen somatischer Vulnerabiliät und psychosozialer Störungsverarbeitung ein zeitaufwendiges Unterfangen sein. Manchmal wird ein komorbides Krankheitsbild diagnostiziert und die primäre Erkrankung therapiert, doch mitunter ist die Aufdeckung multipler ätiologischer Wirkmechanismen gar nicht möglich. Sofern dem Patienten die Akzeptanz seiner benignen monosymptomatischer Globussensation als somatoforme Störung (ICD-10; F45.8) nicht gelingt, ist eine Kombination von pharmakologischer Therapie und kognitiv-behavioraler Intervention als integrativer Behandlungsansatz zu empfehlen. Das Symptom hat eine hohe Tendenz zur Remission. Kontrollierte Therapiestudien sind bisher selten, sodass es noch an evidenzbasierten Konzepten zur Therapie fehlt.

Abstract

Globus sensation is a medially felt lump in the throat. It can be associated with a number of different diseases, but this symptom may also occur monosymptomatically as a somatoform disorder or as a secondary somatoform illness behavior. Globus sensation may be persistent or intermittent. Diagnosis requires close interdisciplinary cooperation, since the globus may be a symptom of anxiety, depression or personality disorders. Firstly, patients should undergo a thorough otolaryngological examination (including careful medical history taking), possibly in cooperation with other medical specialists. Subsequent psychosomatic and clinical tests – if necessary – may be time-consuming due to complex interrelations between somatic vulnerability and psychosocial coping strategies. Sometimes a comorbid disorder is diagnosed and the primary disease treated; however, the identification of multiple etiologically effective mechanisms is impossible. If the patient is unable to accept his benign monosymptomatic globus as a somatoform disorder (ICD-10; F45.8), a combination of pharmacologic intervention and cognitive-behavioral intervention as an integrated treatment approach is recommended. However, the symptom has a strong tendency to recur. Since controlled therapy studies are scant to date, evidence-based treatment concepts are currently not available.

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    C. Kiese-Himmel Dipl.-Psych.

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Kiese-Himmel, C. Die Globussensation. HNO 58, 586–594 (2010). https://doi.org/10.1007/s00106-009-2065-2

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