The exact cause of primary Globus Pharyngus is unknown but stomach content reflux with or without overt heartburn, is thought to play a significant role.  It has also been found that these symptoms are worse during stress and is more common in certain personality type such as high achievers.  It is also common following cervical spine or thyroid surgery.  In secondary Globus, the lesion may be benign or malignant and can involve any area of the upper aerodigestive tract including thyroid goitre, tonsillitis, sinusitis and even TB of the neck.  In primary disease the pathophysiology is thought to be due to inflammation of the mucosa of the throat and larynx with resultant muscle spasm, incoordination and increased sensitivity.