Persistent Throat Pain: Causes and When to Seek Help

Throat issues

Hello Doctor, I would like to consult you.
I have been experiencing a sensation of foreign body and pain in my throat and pharyngeal wall for the past three months.
The symptoms seem to be getting more painful and severe.
I have been taking medication during this period, but there has been no improvement.
Five months ago, I underwent a tonsillectomy, but the sensation of a foreign body still persists.
Additionally, I have sharp pain at the base of my left tongue and throat.
During a previous follow-up, I mentioned to my doctor that this was caused by acid reflux.
I have undergone an esophagogastroduodenoscopy, and the doctor believes that the throat issues are not significant, as there is only very mild gastroesophageal reflux.
On July 26, I had a follow-up appointment and informed the doctor that I noticed a raised area with a white spot on the back of my right tongue.
The doctor said that this is a lingual tonsil, which everyone has, but I only have swelling on the right side, while the left side is normal, although the base of my tongue is painful.
The doctor only used a tongue depressor for examination and mentioned that the white spot might be food debris.
However, the swelling and white spot still persist, which worries me because my throat and pharyngeal wall are very painful, and the sensation of a foreign body is quite strong.
I keep touching the area to see if there is something there, and I can feel a protrusion in the area of my throat, which frightens me.
These symptoms are very uncomfortable, and I am concerned that there might be something wrong.
Two months ago, during a follow-up for my surgical wound, my throat was examined, and it was noted that the area near my vocal cords was swollen.
Now, the symptoms feel increasingly severe; even when I am not moving my mouth or swallowing, I experience sharp pain in my throat and pharyngeal wall, as if there is a sharp bone stuck inside.
I also feel a throbbing inflammatory sensation, which is very frightening.
Now, I would like to ask the doctor: if the discomfort is caused by something serious, would the symptoms lessen after just waking up? After a few minutes, they become significantly noticeable throughout the day, including pain while eating.
Pressing on certain areas of my throat causes sharp pain, and even when my mouth is closed, I feel pain and a sensation of a foreign body.
When lying down, if I apply slight pressure to the area around my collarbone, the sensation of a foreign body and pain becomes more pronounced.
I have been researching online and found that it could be pharyngitis, but my symptoms seem somewhat different.
I also read that early symptoms of pharyngeal or laryngeal cancer include a sensation of a foreign body, which then worsens.
I am truly scared.
Please help me analyze this situation.
Which direction should I take for medical consultation or examination? Thank you.
If a repeat laryngoscopy shows no significant abnormalities, can I be reassured that it is not something serious? If I plan to pay out of pocket for an MRI, will it provide a thorough examination? Is it also necessary to perform a neck ultrasound?

Miss Lin, 40~49 year old female. Ask Date: 2021/08/05

Dr. Zheng Jueyi reply Otolaryngology

Hello, if you are concerned, you may return for a follow-up appointment for a physician's examination.
If the otolaryngological examination or laryngoscopy shows no significant abnormalities, a tumor can be temporarily ruled out.
If you still have concerns, you may consider self-paid health screenings, such as blood tests, self-paid MRI, or self-paid PET scans.
For details on self-paid health screenings, please consult the health screening center at various hospitals.
Wishing you peace and good health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/08/05

More Info

Persistent throat pain, especially when accompanied by a sensation of a foreign body and sharp pain, can be distressing and warrants careful evaluation. Given your symptoms have persisted for three months, it is essential to consider various potential causes and the appropriate steps to take.

Possible Causes of Persistent Throat Pain
1. Gastroesophageal Reflux Disease (GERD): You mentioned that your doctor suggested that acid reflux might be contributing to your throat discomfort. GERD can cause inflammation in the throat, leading to symptoms such as pain, a sensation of a lump, and irritation. Even mild reflux can cause significant symptoms in some individuals.

2. Post-Surgical Changes: Since you had a tonsillectomy five months ago, it is possible that the surgical site is still healing or that there are residual effects from the surgery. Sometimes, scar tissue can form, leading to discomfort or a sensation of tightness.

3. Infections or Inflammation: Conditions such as pharyngitis or laryngitis can cause persistent pain and discomfort. Even if you have been evaluated for infections, some viral infections can linger and cause ongoing symptoms.

4. Allergies or Irritants: Allergies to environmental factors, such as pollen, dust, or smoke, can lead to throat irritation. Additionally, exposure to irritants such as strong odors or chemicals can exacerbate throat pain.

5. Neoplasms: While it is understandable to be concerned about the possibility of cancer, particularly with the presence of a lump and persistent pain, it is important to note that many benign conditions can present similarly. However, any new growth or persistent symptoms should be evaluated thoroughly.

When to Seek Help
Given the duration and severity of your symptoms, it is advisable to seek further medical evaluation. Here are some steps you can take:
1. Follow-Up with an ENT Specialist: If you haven't already, consider seeing an Ear, Nose, and Throat (ENT) specialist. They can perform a thorough examination, including a laryngoscopy, to visualize the throat and identify any abnormalities.

2. Imaging Studies: If your symptoms persist despite normal examinations, imaging studies such as an MRI or a neck ultrasound may be warranted. These can help assess for any structural abnormalities or masses that may not be visible during a standard examination.

3. Consider a Second Opinion: If you feel that your concerns are not being adequately addressed, seeking a second opinion from another healthcare provider can provide additional insights and options for treatment.

4. Symptom Management: In the meantime, consider using over-the-counter pain relievers, such as ibuprofen or acetaminophen, to manage pain. Gargling with warm salt water or using throat lozenges may also provide temporary relief.

Conclusion
While it is natural to worry about serious conditions such as cancer, many causes of throat pain are benign and treatable. If your symptoms are worsening or not improving, it is crucial to pursue further evaluation. A thorough examination by an ENT specialist, along with appropriate imaging if necessary, will help clarify the cause of your symptoms and guide you toward effective treatment. Remember, early intervention is key to managing any health condition effectively.

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