Globus pharyngeus is a common benign condition frequently encountered in ENT practice. Laryngopharyngeal reflux and psychological stressors are often considered to be contributory factors, but globus symptoms do not always respond to antacid medications. Such medications can also be limited by side effects, with PPIs in particular not representing an ideal long-term treatment option. Transcutaneous auricular vagus nerve stimulation (taVNS) has recently emerged as a non-invasive neuromodulation tool. Efficacy has apparently been shown in addressing disorders such as depression, anxiety and chronic pain. This paper reports the results from a single-arm prospective pilot trial examining the efficacy of taVNS for treating globus. The treatment was given once daily for 30 minutes over a two-week period. Thirty-five patients completed the trial. Eighty percent of patients were female with a median age of 51 years. No serious adverse effects were noted. A significant reduction in globus symptom severity (as measured by pre- and post-treatment LUMP questionnaire scores) was noted. Mean anxiety and depression scores also decreased. As the authors acknowledge, the absence of a control arm is clearly a significant limiting factor in establishing whether taVNS is more effective than a placebo in-ear device. Nevertheless, the reported efficacy and absence of any adverse effects does mean that this is an intriguing new therapeutic option for patients with persistent globus symptoms and potentially worth exploring further through prospective, double-blind randomised controlled trials.
An otological cure for globus?
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