Throat Pain

Throat pain is one of the most common reasons for visits to the doctor.  Throat pain may start suddenly and be very painful or start gradually and persist for several months.  ENT providers are specialists who can help identify the cause of your throat pain.

Signs and Symptoms

There are several signs and symptoms that can accompany throat pain including:

fevers

 dysphagia (difficulty swallowing)

cough

globus (sensation of something stuck in the throat)

hoarseness or voice change

dyspnea (difficulty breathing)

History and Exam

A thorough history is an important part of evaluating your throat pain.  The length of time you have been experiencing throat pain can help to determine the cause.  Throat pain which has been present for a few days may indicate an acute infection, whereas throat pain lasting several months may be a symptom of acid reflux or possibly a mass.  Smoking history is also important to identify, as it may help determine your risk for cancer.  In addition to the general ear, nose and throat exam we may also look inside your throat using a flexible camera called a laryngoscope.  This allows us to directly visualize the deeper areas of the throat including the vocal cords.

Common causes and treatment of throat pain

Infection

Infections are the most common cause of sudden onset of throat pain.  There are three primary categories of throat infection: viral, bacterial and fungal.

Viral Infections

Sore throats are most commonly caused by viral infections.  Acute viral pharyngitis, or viral infection of the throat, is the cause of approximately 80% of acute sore throats.  Viral throat infections can occur with URIs/upper respiratory infections or the common cold.  In addition to a sore throat, patients will often have a runny nose or rhinitis, nasal congestion and cough.  Viral sore throats can last 4-5 days.  Treatment for viral sore throats include supportive measures to control the pain and discomfort while the infection resolves. These measures can include throat lozenges, analgesic throat sprays, and analgesic oral medications like acetaminophen or ibuprofen. Antibiotics do not help to cure viral throat infections.  During an acute viral infection, rest is important along with increasing fluid intake. Salt water gargles may help soothe the throat.

Infectious mononucleosis, also known as mono, is a specific viral infection that can cause significant throat pain.  During a mono infection, tonsils can become severely swollen making it painful to swallow. If tonsils are extremely swollen you may be prescribed a short course of oral steroids. Lymph nodes in the neck can also become swollen and tender as well. Diagnosis may be confirmed with a blood test. Symptoms related to mononucleosis can last longer than other types of viral infections.

Bacterial Infections

Bacterial infections of the throat may include the tonsils which can cause swelling, redness and white spots to appear on them.  The most common bacterial throat infection is caused by a type of bacteria known as GABHS (group A beta-hemolytic streptococcus).  GABHS is the cause of approximately 5-15% of acute sore throats in adults.  Common symptoms are fever, sore throat and swollen lymph nodes in the neck. Bacterial throat infections are usually treated with a course of antibiotics.  A throat culture or strep test may be performed before treatment.

Sinus infections are other bacterial infections that can cause throat pain. Post-nasal drip from the sinuses can irritate the throat causing pain with globus sensation. If evidence of a bacterial sinus infection is found on exam or nasal endoscopy, the appropriate antibiotics will be prescribed.

Fungal Infections

Less commonly, sore throats can be caused by fungal infections. This type of infection is more common in immunocompromised patients, patients on long-term antibiotics or asthma patients using inhaled corticosteroids. The most common fungal throat infection is candidiasis. Candidiasis can results in white patches to grow in the mouth and on the back of the tongue. Sometimes, candidiasis is only present in the larynx causing throat pain and discomfort. This type of candidiasis may only be visualized on laryngoscopy. Treatment usually consists of a course of antifungal medication.

More serious throat infections may need emergency evaluation. Abscesses may form as a complication of throat and neck infections. Epiglottitis is a potentially life threatening acute infection that causes swelling in the larynx, which can cause breathing difficulty and airway closure.

Acid Reflux

Acid reflux should be suspected as a source of throat pain when symptoms have been present for several weeks to months and there is no evidence of infection. Symptoms related to acid reflux may include a sour taste in the mouth, burning sensation in the throat/chest after eating, or feeling like something is stuck in the throat (also known as globus). When stomach acid reaches the throat, it is called laryngopharyngeal reflux or LPR. We may see evidence of LPR on laryngoscopy. Sometimes LPR can occur without symptoms or only cause throat pain/discomfort. Diet changs may be recommended. Limiting acid producing food and drinks such as coffee, alcohol, red meat, and tomatoes can help improve symptoms. One of the most important diet changes is to avoid eating at least 2 hours before going to bed. An acid reducing medication may also be prescribed.

Allergies

Allergies can be a potential cause of throat pain. Chronic allergies may cause irritation of the throat and itchiness. Allergic throat pain can happen if you are having frequent exposure to allergy triggers such as dogs or cats or during the seasons when your allergies are at their worst, like the springtime when pollen is high. If you have year-round allergies to molds or dust mites, allergies may be more difficult to avoid. Keeping a clean home can minimize dust mites along with special allergy covers for your pillows and mattress. Daily saline rinses can help improve symptoms. You can learn more in our blog post: http://www.manhattanentdoctor.com/blog/to-netpot-or-not Allergy medications may be an option for your throat pain as well.

Voice Overuse/Straining

Throat pain and irritation may happen with voice overuse. If you talk frequently or loudly at work or in your daily life, you may be straining your vocal chords. Hoarseness or voice change can develop as well.  We will look with laryngoscopy at your vocal chords to see if there is any change noted related to voice overuse such as swelling, also known as vocal cord edema, or small bumps, known as vocal cord polyps.  Depending on history and exam with laryngoscopy findings we may recommend further testing.  Stroboscopy involves a more in-depth examination of the vocal cords and speech.  Based on stroboscopy results, speech therapy may be offered to help you speak in a way that puts less strain on the vocal cords.  Voice rest is important to allow recovery of the vocal cords. Increased water intake may also be recommended.

Other causes of throat pain

Nasal Congestion/ Open Mouth Breathing

Throat irritation may also occur because of chronic congestion.  Frequent mouth breathing may lead to throat pain over time.  Mouth breathing prevents the necessary humidification of air in the nose, thus leading to a dry and irritated throat.  Evaluation of the nose can help determine causes of congestion and possible treatment.  Dry environments can also cause throat pain.  Heating systems during the winter can contribute to extremely dry conditions in homes and apartments.  Using a humidifier can help reduce dryness.

Tumor/Mass

Sometimes throat pain may be caused by a tumor or mass.  Related symptoms may include voice change or hoarseness, coughing up blood or difficulty swallowing.  A laryngoscope is used to visualize the mouth and throat region, including the back of the tongue, throat and vocal cord regions.  Based on exam and laryngoscopy findings, we may obtain further imaging, such as a CT scan or MRI of the neck.

Environmental Irritants/Smoke

Exposure to environmental irritants can lead to throat pain.  Irritants may include pollutants or chemicals in the air we breathe.  Smoke is one of the most common environmental irritants.  Smoking or being exposed to second-hand smoke is a likely factor in your throat pain and also detrimental to your health.  It is important for you or your household member to stop smoking as soon as possible in order to improve your throat pain.

Evaluation of your throat pain by an ENT specialist can help to determine the cause and available treatments for your symptoms.  Sometimes there are several factors contributing to your pain.  Making an appointment is the first step to finding out more about your pain and options for relief.