title: Endoscopic investigation and evaluation of anxiety for the management of globus sensation.
abstract: OBJECTIVE
  To verify whether the severity of globus sensation would be affected by the results of investigations on possible underlying serious pathology in the head, neck and esophagus.
  
  
  METHODS
  Thirty-six patients with globus sensation were enrolled in this study. All the patients suffered relatively persistent globus sensation which remained after conventional laryngoscopy at their family doctors. These patients were investigated for possible underlying oropharyngeal and esophageal lesions using fiberoptic endoscopy. The severity of globus was evaluated by the visual analog scales (VAS), and the degree of anxiety was evaluated by the state section of State Trait Anxiety Inventory (STAI-s). The questionnaires were administered at their first visits, and 9.6±3.2 months after endoscopy. The follow-up data obtained from 22 patients were incorporated in the further evaluations. Multiple regression analysis was used to evaluate the relationship between the improvement of VAS scores and that of STAI-s scores. Afterwards, Pearson product-moment correlation coefficient was measured. The recorded images of fiberoptic endoscopy were retrospectively verified by an expert of upper gastrointestinal endoscopy.
  
  
  RESULTS
  No malignancies were observed in the endoscopic examination. Despite no treatment administered during the follow-up period, significant improvement of VAS scores was observed from the initial scores (40±21) to follow-up scores (27±27, p=0.014) in the patients examined in this study. The multiple linear regression analysis proved that the improvement of STAI-s scores was the only factor significantly affected the improvement of VAS scores (p=0.029) among the dependent valuables. The retrospective evaluation of the recorded images revealed comorbid esophagitis in 10 out of the 22 patients. When patients were stratified with the presence of comorbid esophagitis, significant improvement of VAS scores was observed only in the group without comorbid esophagitis at their follow up (17±20, p=0.026) compared with their initial scores (36±17). The multiple linear regression analysis proved that the improvement of VAS scores was significantly affected by the improvement of STAI-s scores (p=0.047) in this group. Moreover, significant positive relationship between the improvement of VAS scores and that of STAI-s scores was observed only in the group without comorbid esophagitis (r=0.61, p=0.047).
  
  
  CONCLUSIONS
  Proper investigation to prove no underlying serious pathology may lead to the improvement of globus sensation in the patients without comorbid esophagitis through the reduction of their anxiety even when their symptoms are relatively persistent. Our results also indicated that some treatments against esophagitis may be helpful for the improvement of globus sensation in the patients with this comorbid disease.
authors: Department of Otolaryngology - Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.
authors: Naoki
authors: N
authors: Oishi
authors: Koichiro
authors: K
authors: Saito
authors: Yutaka
authors: Y
authors: Isogai
authors: Haruna
authors: H
authors: Yabe
authors: Koji
authors: K
authors: Inagaki
authors: Hideki
authors: H
authors: Naganishi
authors: Hiroyuki
authors: H
authors: Kimura
authors: Kaoru
authors: K
authors: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000523:psychology*; D004941:Esophagitis / Q000175:diagnosis / Q000523:psychology*; D004945:Esophagoscopy / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000523:psychology; D006801:Humans; D057045:Laryngopharyngeal Reflux / Q000523:psychology*; D007828:Laryngoscopy / Q000523:psychology; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011379:Prognosis; D012189:Retrospective Studies; D014741:Video Recording