Silent reflux and globus
Laryngopharyngeal reflux is when stomach juice reaches the voice box or throat. About 60% of people with it have no heartburn at all, which is why it is called silent reflux.
Stomach juice contains acid and enzymes that break down food. The stomach has a lining that resists them. The throat and voice box do not, so the juice can irritate them. The reflux often occurs as a fine mist or gas, after meals or when upright, not just when lying down.
Common symptoms
- Frequent throat clearing, or a lot of mucus in the nose and throat
- A feeling of a lump in the throat that comes and goes
- Hoarseness, often worse during the day, or a tired voice
- A chronic cough or tickle in the throat
- Mild difficulty swallowing saliva, while food goes down normally
Symptoms typically fluctuate over weeks to months, and are often worse with stress, talking a lot, or after rich meals.
What globus is
Globus is the persistent feeling of a lump, ball or tightness in the throat, typically without any actual difficulty swallowing food or drink. Many people notice it most when swallowing saliva, and it often improves while eating. It is very common, and benign in the great majority of cases.
It is thought to arise from a combination of reflux irritation, increased muscle tension in the throat that is often stress-related, and heightened sensitivity of the throat nerves. Once examination is normal, further tests are usually unnecessary.
How it is treated
Diet and lifestyle are the foundation, not an afterthought. Not lying down after eating, leaving about three hours between the last meal and bed, raising the head of the bed rather than stacking pillows, smaller and lower-fat meals, and cutting back on the specific foods and drinks that provoke reflux. A more plant-based, Mediterranean-style diet has been shown to improve symptoms at least as well as acid-suppressing medication.
Medicines that reduce acid are often used alongside. Large trials show they are not effective for everyone with throat symptoms, and current European guidance reserves the strongest of them mainly for people who also have heartburn, at the shortest effective course. Diet and lifestyle changes remain essential either way.
For persistent globus, throat clearing or voice strain, therapy with a speech pathologist has good evidence and is often the most effective treatment. Breaking the throat-clearing habit matters too: clearing scrapes the vocal cords together, creating more irritation and more urge to clear, which is a self-perpetuating cycle.
See a doctor promptly if you have
- Difficulty swallowing food, or food sticking
- Pain on swallowing, or pain in the ear on one side
- Hoarseness lasting more than three weeks
- A lump in the neck, unexplained weight loss, or coughing up blood
Patients under my care receive a detailed handout covering the diet, the medication options and the throat-clearing programme.
This page is general information and does not replace advice about your own case. Reviewed August 2026.