Persistent Throat Discomfort: Causes and Solutions

Oral issues

Hello Doctor, I would like to consult you.
I have had a sensation of a foreign body and severe pain in my throat for over three months (it was slightly milder three months ago).
Currently, the symptoms are located at the left base of my tongue and deep in my throat, with signs of inflammation and pulsation in the pharyngeal wall (the sensation is similar to what I experienced previously in the tonsil and tongue base area).
I had a bilateral tonsillectomy five months ago, but my oral and throat discomfort is worse than before the surgery.
When I swallow, it feels like food is stuck, and even swallowing saliva causes a painful foreign body sensation.
There is a subtle pain at the left base of my tongue that radiates to the deep part of my ear.
I have undergone an upper gastrointestinal endoscopy, which showed no abnormalities.
Prior to the surgery, I already had a mild sensation of a foreign body and pain at the base of my tongue, but now, after the surgery, why are the symptoms worse (and it has been several months; why does the base of my tongue still hurt)? Even without swallowing, I feel a sensation (a deep pulsating inflammation at a specific point that feels like the mucosa is painful).
When I speak, I also experience a foreign body sensation and pain in the left base of my tongue and pharyngeal wall.
Last week, I had an endoscopy, which did not reveal any obvious abnormalities, and they arranged for a neck ultrasound.
However, I have to wait until mid-September for an appointment.
I also mentioned to the doctor that there was a lump at the right base of my tongue and throat, and the doctor said it was lymphadenopathy.
Is that lymphatic tissue in the tongue? Why would the lymph nodes in the tongue suddenly swell (I was too nervous at the time to think of many questions)? (Can the endoscopy rule out any malignancies in the oropharynx or hypopharynx, or in the pharyngeal wall?) The most noticeable area of the foreign body sensation on my left side is where I am pressing with two fingers in the picture.
Can the endoscopy also rule out any malignancies at the base of my tongue, or is a physical examination necessary to confirm? (The area where I am pressing with two fingers and the adjacent area in the oral cavity consistently has a foreign body sensation and pulsating inflammation; pressing down makes it more pronounced.) I am really worried that there might be something growing deep inside causing this abnormal sensation, or that there is a pathological change in the oral mucosa, but I cannot visually identify any issues.
Now, when I open my mouth, I also feel a painful foreign body sensation on the left side (as shown in the first image), and swallowing causes a slight pain.
I am truly uncomfortable, scared, and helpless.
In June, I also had a thyroid ultrasound, which showed no obvious abnormalities.
I would like to ask the doctor if my symptoms could indicate an issue at a deeper level? What is the most likely condition that could cause these symptoms? Please help me, as I currently feel a foreign body sensation even when moving my neck, and I have had tinnitus in my left ear for five months, sometimes accompanied by deep ear pain.
The base of my tongue has a slight foreign body sensation and pulsating pain, and the sensation of a foreign body in the pharyngeal wall and deep throat is very pronounced, persisting throughout the day, but I do not currently have difficulty swallowing.
My symptoms are truly distressing, and I do not know how to seek further medical help.
Please assist me, thank you.
If I were to pay for an MRI, would it more definitively determine if there are any abnormalities at a deeper level? Can an MRI check for any growths in the tongue and pharyngeal wall? I have sudden sharp pains on the left side of my neck, but I am not very good at palpating, and I cannot feel anything.
The previous doctors did not help with the examination.
Could this be a complication from the tonsillectomy? Or could it be related to nerve dysfunction? Is there a significant risk of cancer? I apologize if I am being a bother by asking these questions, and I appreciate your understanding.
In the past, the sensation of a foreign body or pain would mostly improve or alleviate with medication, but it has not disappeared over the past few months and seems to have worsened.
I am truly scared, especially since my child is not yet three years old.
I have attached a photo; please advise me on which specialty I should consult for further examination and what tests can rule out any growths.

Miss Lin, 40~49 year old female. Ask Date: 2021/08/18

Dr. Li Jian reply Internal Medicine

For issues related to deep throat, abnormalities in the pharyngeal wall, or oral problems, it is important to follow up with an otolaryngology department at a medical center for further evaluation.

Reply Date: 2021/08/18

More Info

Persistent throat discomfort, particularly the sensation of an obstruction or pain in the throat, can be distressing and may arise from various underlying causes. Given your symptoms, which include a sensation of a foreign body in the throat, pain in the left side of the tongue and throat, and a history of tonsillectomy, it is essential to explore potential reasons for your discomfort and the appropriate steps to address it.

Possible Causes of Your Symptoms
1. Post-Tonsillectomy Complications: After a tonsillectomy, some patients experience ongoing throat discomfort. This can be due to changes in the throat's anatomy, residual inflammation, or scarring. The sensation of a foreign body can also be a result of the healing process, where the tissues may be more sensitive or reactive.

2. Laryngopharyngeal Reflux (LPR): This condition occurs when stomach acid flows back into the throat, leading to irritation and inflammation. Symptoms can include a sensation of a lump in the throat, pain, and discomfort when swallowing.

3. Allergies or Post-Nasal Drip: Allergies can cause inflammation in the throat and lead to a sensation of something being stuck. Post-nasal drip, where mucus drips down the back of the throat, can also cause irritation and discomfort.

4. Neuropathic Pain: Sometimes, nerve damage or irritation in the throat area can lead to persistent pain or discomfort, even in the absence of a physical obstruction.

5. Infections: Chronic infections, such as those caused by bacteria or viruses, can lead to ongoing inflammation and discomfort in the throat.

6. Lymphadenopathy: The enlargement of lymph nodes, which you mentioned, can occur due to various reasons, including infections or other systemic conditions. The lymph nodes in the neck can become palpable and may cause discomfort.

7. Tumors or Growths: While less common, persistent symptoms warrant consideration of the possibility of benign or malignant growths in the throat or tongue area.

Diagnostic Steps
Given the complexity of your symptoms and their persistence, further investigation is warranted. Here are some recommended steps:
1. Consult an Ear, Nose, and Throat (ENT) Specialist: An ENT can perform a thorough examination of your throat and neck. They may use a flexible endoscope to visualize the throat and identify any abnormalities.

2. Imaging Studies: An MRI or CT scan can provide detailed images of the throat and surrounding structures, helping to identify any masses or abnormalities that may not be visible through a standard examination.

3. Allergy Testing: If allergies are suspected, testing can help identify specific triggers that may be contributing to your symptoms.

4. Reflux Evaluation: If LPR is suspected, a referral to a gastroenterologist may be necessary for further evaluation and management.

5. Blood Tests: These can help rule out infections or other systemic conditions that may be contributing to your symptoms.

Management Strategies
1. Medications: Depending on the underlying cause, medications such as antihistamines for allergies, proton pump inhibitors for reflux, or anti-inflammatory medications may be beneficial.

2. Hydration and Humidification: Keeping the throat moist can alleviate discomfort. Drinking plenty of fluids and using a humidifier may help.

3. Avoid Irritants: Smoking, strong odors, and other irritants can exacerbate throat discomfort. Avoiding these can provide relief.

4. Therapeutic Techniques: Speech therapy or throat relaxation techniques may help if your symptoms are related to muscle tension or anxiety.

Conclusion
Your symptoms are complex and warrant a comprehensive evaluation to determine the underlying cause. While the fear of serious conditions like cancer is understandable, many causes of throat discomfort are benign and treatable. It is crucial to follow up with healthcare professionals who can guide you through the diagnostic process and provide appropriate care. Remember, early intervention often leads to better outcomes, so seeking help promptly is essential.

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