Throat Pain: Possible Causes and Concerns After Tonsil Surgery

Throat issues

Hello Doctor, I would like to consult you.
I have been experiencing a sensation of a foreign body and sharp pain in my throat and pharyngeal wall (the area from the uvula down to the deep throat) for the past three months.
Additionally, I have pain on the left side of my jaw and at the base of my left tongue.
The symptoms have been worsening, and although I do not have difficulty swallowing, it does cause sharp pain when I do swallow.
I have been taking medication during this time, but there has been no improvement.
Five months ago, I underwent a bilateral tonsillectomy and uvulopalatoplasty, but the sensation of a foreign body persists.
The left side of my tongue base and throat also experience sharp pain, accompanied by an inflammatory throbbing sensation.
During a previous follow-up, I mentioned this to my doctor, who suspected it might be caused by acid reflux.
I have undergone an endoscopy, and the doctor found that the throat issues were not significant, as there was only very mild gastroesophageal reflux, which should not cause severe sensations of a foreign body in the throat.
I have been taking some gastric medications during this time.
On July 26, I had another follow-up appointment and mentioned that I noticed a protrusion with white spots on the back of my right tongue.
The doctor said that it was a lingual tonsil, which everyone has, but I only have swelling on the right side.
There was no swelling on the left side, but the left base of my tongue has been painful for several months.
The doctor previously indicated that it was inflammation of the tongue base.
On July 26, the doctor only used a tongue depressor to examine the swelling and mentioned that the white spots might be food debris.
However, the swelling and white spots are still present today, which worries me because my throat and pharyngeal wall continue to be very painful, and the sensation of a foreign body is quite pronounced.
It feels like there is inflammation, and I often feel the urge to touch the area to see if there is something stuck.
When I press on the pharyngeal wall, it feels hard in certain areas, and I can also feel a hard protrusion in my throat, which frightens me.
My tongue also has many hard lumps.
These symptoms are very distressing, and I am concerned that I may have developed something serious.
Three months ago, during a follow-up for my surgical wound, an endoscope was used to examine my throat, and it was noted that the area near the vocal cords was swollen, and the left base of my tongue was inflamed.
However, the symptoms have been getting worse, and even when my mouth is still and I am not swallowing, I feel sharp pain in my throat and pharyngeal wall, as if there is a sharp bone stuck inside, along with a throbbing inflammatory sensation.
I am genuinely scared, especially since I experienced sudden left ear tinnitus for 24 hours five months ago (I paid for an MRI of the brain, which showed no significant abnormalities), and I occasionally feel pain deep in my ear, which has become more frequent recently.
I still have not found the cause or received effective treatment.
Now, I would like to ask the doctor if discomfort caused by something serious would lessen after just waking up (within about five minutes).
Additionally, every morning I notice a foul smell in my throat, which becomes more pronounced after a few minutes, and the symptoms become evident throughout the day, including sharp pain when eating.
Sometimes I feel like swallowing saliva has a metallic taste, but there is nothing when I spit it out.
Pressing on certain areas of my neck and throat also causes sharp pain, and even when my mouth is closed, I feel a sensation of a foreign body and pain.
When lying down, if I press down on my throat near the collarbone, the sensation of a foreign body and pain becomes more pronounced.
I have been researching online and found that it might be pharyngitis, but my symptoms seem somewhat different.
I have also read about oral cancers or head and neck cancers and am worried about the possibility of tongue base cancer.
The symptoms described online indicate that the sensation of a foreign body worsens over time, which terrifies me.
Initially, I sought medical attention for tonsil issues, and many doctors thought I had psychological problems.
Now that I have had my tonsils removed, I still have symptoms, and they seem worse than before the surgery.
The area between the palatoglossal arch and the palatopharyngeal arch had previously undergone a biopsy (due to a white lesion), and after treatment, it improved, but I have since experienced abnormal sharp pain in that area.
Now, after the tonsillectomy, that area is no longer visible, but I still feel persistent inflammatory pain.
Even using a cotton swab on that area causes pain.
I am genuinely worried that I may have some form of oral cancer or head and neck cancer.
Since I have already had a bilateral tonsillectomy, I do not understand why I still have these symptoms.
Three months post-surgery, I feel like I have not fully recovered.
I initially decided to have the tonsils removed due to chronic inflammation and persistent sensations of a foreign body, fearing potential cancer development.
Now, the situation seems worse, and I am very concerned about whether I might be facing late-stage issues, especially since cancers in the oropharynx and head and neck are difficult to treat.
I have a child who is not yet three years old, and I am genuinely scared.

Could you please help me analyze this? Is it possible that I have a neurological issue? Thank you.
I am also afraid to seek medical help again, as I have previously experienced being misunderstood and treated poorly, which was very distressing.
Now, I am unsure how to proceed with seeking medical care.
Currently, when my mouth is closed and I move my tongue, I feel a sensation of a foreign body on the left side of my jaw, and occasionally I experience sudden sharp pains.
It feels like there is ongoing inflammation inside, and swallowing saliva clearly brings a sensation of a foreign body with some pain.
The left base of my tongue also feels like it is throbbing with inflammation, and speaking causes sharp pain.
Turning my neck to one side makes the sensation of a foreign body more pronounced.
Even when my mouth is closed, I sometimes feel sudden sharp pain on the left side.
I am genuinely worried that there might be an underlying issue.

As of early July, I had an endoscopy that showed no abnormalities, only very mild gastroesophageal reflux.
In early August, I underwent a nasopharyngoscopy, which also showed no significant abnormalities.
Regarding the mentioned swelling on the right side of my tongue, the doctor said it was lymphoid hyperplasia.
Could the tonsillectomy have caused these aftereffects? Or could there be a neurological issue? I am truly feeling lost, and I would appreciate your help in analyzing this.
Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2021/08/17

Dr. Zhang Junwei reply Neurosurgery

This is not a neurology issue; you should seek assistance from another otolaryngologist.

Reply Date: 2021/08/17

More Info

After undergoing tonsillectomy, it is not uncommon for patients to experience lingering symptoms such as throat pain, a sensation of a foreign body, and discomfort in the throat and surrounding areas. Your description of persistent pain, especially in the left side of your throat and the sensation of something being stuck, raises several important considerations.

Firstly, it is essential to understand that tonsillectomy can lead to various postoperative complications, including inflammation, scarring, and changes in the throat's anatomy. The sensation of a foreign body or pain in the throat may be attributed to residual inflammation or irritation of the surrounding tissues. The fact that you have been experiencing these symptoms for three months post-surgery suggests that there may be an underlying issue that needs to be addressed.

One potential cause of your symptoms could be gastroesophageal reflux disease (GERD), which can lead to acid reflux irritating the throat and causing pain or a sensation of something being stuck. Although your gastroenterologist indicated that your reflux is mild, even minor reflux can cause significant discomfort in some individuals, especially after surgery when the throat may be more sensitive.

Additionally, the presence of a lump or swelling on the right side of your tongue, as noted by your doctor, could be related to lymphoid tissue or a reactive process following surgery. It is not uncommon for lymphoid tissue to become enlarged in response to irritation or inflammation. However, the persistence of this lump, especially if it is associated with pain, warrants further investigation to rule out any serious conditions.

Your concerns about the possibility of cancer, particularly given your symptoms and history, are understandable. While it is essential to be vigilant about any changes in your health, it is also crucial to approach this situation with a balanced perspective. The likelihood of developing head and neck cancer shortly after a tonsillectomy is relatively low, especially if you have had negative results from previous examinations, including endoscopy and imaging studies.

The symptoms you describe, such as the sensation of a foreign body, pain upon swallowing, and discomfort in the throat, could also be related to nerve irritation or neuropathic pain, which can occur after surgical procedures. This type of pain may not respond well to standard pain management strategies and may require a different approach, such as nerve blocks or medications specifically targeting nerve pain.

In terms of management, here are some recommendations:
1. Follow-Up with Your ENT Specialist: It is crucial to have a thorough follow-up with your ENT specialist. They may consider performing additional imaging studies or a laryngoscopy to assess the throat's condition more closely.

2. Consider Gastroenterology Consultation: If GERD is suspected, a consultation with a gastroenterologist may be beneficial. They can evaluate your reflux symptoms and recommend appropriate treatment, which may include lifestyle modifications, dietary changes, or medications.

3. Pain Management: If your pain is neuropathic in nature, medications such as gabapentin or pregabalin may be considered. These medications can help manage nerve pain and may provide relief from your symptoms.

4. Physical Therapy: Some patients benefit from physical therapy focused on the neck and throat area. This can help alleviate tension and improve function.

5. Psychological Support: Given the anxiety and fear surrounding your symptoms, consider seeking support from a mental health professional. They can help you cope with the emotional aspects of your condition and provide strategies to manage anxiety.

6. Avoid Self-Diagnosis: While it is natural to search for answers online, it is essential to avoid self-diagnosing based on internet research. Instead, rely on your healthcare providers for accurate information and guidance.

In conclusion, while your symptoms are concerning and warrant further investigation, it is essential to approach this situation with a comprehensive plan involving your healthcare team. Open communication with your doctors, adherence to follow-up appointments, and a proactive approach to managing your symptoms will be key to finding relief and understanding the underlying causes of your discomfort.

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