Persistent Throat Pain: Is It a Neurological Issue?

Is there a problem with the nervous system?

Hello Doctor, I have been experiencing a sensation of a foreign body and sharp pain in my oral and pharyngeal walls, which becomes particularly pronounced when swallowing saliva.
There is also sharp pain and a foreign body sensation near the left base of my tongue and the posterior mucosa.
Additionally, I have been experiencing inflammatory symptoms with intermittent pain for over six months.
Despite undergoing numerous examinations, no definitive cause has been identified.
It has been suggested that this may be related to the bilateral tonsillectomy I had in April or possibly emotional factors.
However, since my symptoms have not improved or resolved, I have continued to seek answers.

In May, a nasopharyngoscopy showed no abnormalities; in June, a thyroid ultrasound revealed no significant issues; in July, a gastroscopy at a clinic showed no abnormalities in the esophagus; in August, another nasopharyngoscopy showed no significant findings, but there was lymphadenopathy at the right base of the tongue.
In mid-August, I paid out of pocket for a contrast-enhanced MRI of the head and neck, which revealed specific lymph nodes on both sides of the neck and lymphadenopathy at the right base of the tongue.
In September, another thyroid ultrasound showed no significant abnormalities, and in October, a PET scan indicated a focal uptake at the posterior base of the tongue.

Since no cause has been found for my throat discomfort, the sharp pain and foreign body sensation at the left base of my tongue, and the discomfort in the pharyngeal walls, I opted for a PET scan.
The report indicated that there may be a lesion in the area behind the base of the tongue and epiglottis, but the doctor could not confirm the presence of cancer cells, suggesting it might be physiological changes, though malignancy cannot be ruled out.

I found some information online regarding SUV values, and the report indicated an SUVmax of 4.9, which is concerning as values above 2.5 are more likely to indicate cancer.
I am extremely fearful and worried.
On the other hand, if there is an issue, I hope to address it as soon as possible to prolong my life, especially since I have a 3-year-old child at home.
I am truly scared and feel helpless.

I have attached the report and hope you can provide some advice on what I should do next.
Thank you.
I previously visited an ENT specialist at a health checkup hospital, but the doctor reviewed the report and said it was a physiological change and that I would not have any issues.
However, my symptoms persist, and I constantly feel discomfort and pain.
I consulted another hospital, and the doctor mentioned that the entire epiglottis appears bright on the report.
To confirm, they would need to excise the entire area, which is a major surgery, or they could take a biopsy of the brightest spot, but there is no guarantee that areas not biopsied are free of issues.

I am truly at a loss as to how to determine whether there is a pathological change or cancer cells.
The report states an SUVmax value of 4.9, which makes me very anxious.
Although there are no obvious signs from the endoscopy, the doctor only noted that the lymph nodes are somewhat enlarged, yet I endure constant pain and a foreign body sensation 24 hours a day, which is excruciating.

1.
Is it possible to experience pain radiating from the left uvula down to the base of the tongue and a sensation of a foreign body in the throat after undergoing tonsillectomy and uvulopalatopharyngoplasty? Could there be nerve damage involved? Additionally, I have been experiencing 24-hour tinnitus in my left ear accompanied by sudden deep ear pain.

I hope you can provide more suggestions and help analyze how to proceed with this situation.
I truly do not know how to move forward.
Currently, I am taking medication for acid reflux and esophagitis, as well as medication for post-nasal drip and nasal anti-inflammatory sprays, but there has been no relief or improvement.

2.
Even with my mouth closed, I have persistent inflammatory pain in a specific area of my mouth accompanied by a sensation of a foreign body, which is extremely uncomfortable.
Could this be a nerve issue? Or could it be related to autonomic nervous system dysfunction or an autoimmune disease? Should I pursue further examinations to investigate potential issues? Which specialty should I consult?
I apologize for the multitude of questions, but I truly do not know how to proceed.
I am concerned there may be a neurological issue.
Thank you for your understanding and assistance.

Miss Lin, 40~49 year old female. Ask Date: 2021/11/17

Dr. Jiang Junyi reply Neurology

Dear Miss Lin,
Regarding the "medication for post-nasal drip" you mentioned, it may cause discomfort such as dry mouth.
Additionally, it is important to consider female hormones and autoimmune issues.
Since your symptoms are atypical and you have sought multiple medical opinions, I recommend the following principle for seeking care: find a nearby hospital with an emergency department to consolidate your medical information in one place.
I suggest starting with interventions for gastroesophageal reflux disease (GERD).
This should involve not only medication but also lifestyle adjustments.
Avoid foods that contain spices, fats, chocolate, coffee, cocoa, tea, mint, glutinous rice, bananas, citrus fruits, tomatoes, pineapples, sodas, and cola, and refrain from smoking and alcohol.
Avoid consuming excessively hot or cold foods.
It is advisable to adopt a low-fat, high-protein diet.
Eat smaller portions (about 70% full) and have multiple meals (4 to 6 meals) throughout the day, as overeating can lead to excessive gastric acid secretion and increased intra-abdominal pressure.
Chew your food thoroughly and swallow slowly, and only drink a moderate amount of liquid during meals to assist food passage.
Do not lie down within 2 hours after eating, and avoid eating within 3 hours before bedtime.
Elevate the head of your bed by 10 to 15 centimeters or at a 30-degree angle after meals or when sleeping.
It is recommended to sleep on your left side to utilize gravity to keep stomach acid in the stomach.
Maintain a positive mood and manage stress appropriately.
Avoid wearing tight clothing and bending over while working.
Thank you for your inquiry.
If you have further related questions, feel free to discuss them!
Wishing you good health and happiness,
Dr.
Jiang Junyi, Taoyuan Hospital

Reply Date: 2021/11/17

More Info

Persistent throat pain, particularly when accompanied by sensations of foreign body presence and sharp pain, can be a complex issue that may involve multiple factors, including neurological, psychological, and physiological components. Given your detailed history and the extensive investigations you've undergone, it's understandable that you're feeling anxious and uncertain about your condition.

Firstly, it is important to acknowledge that post-operative complications, such as those following tonsillectomy and uvulopalatopharyngoplasty, can lead to persistent throat pain. Surgical interventions in the throat area can sometimes result in nerve damage or irritation, which may manifest as chronic pain or altered sensations in the throat, tongue, and surrounding areas. This could explain the persistent pain and foreign body sensation you are experiencing.

The symptoms you describe, including the sharp pain when swallowing and the sensation of something being stuck in your throat, could indeed be related to nerve involvement. The throat is richly innervated, and any trauma or surgical manipulation can lead to neuropathic pain, which is often characterized by sensations such as burning, tingling, or a feeling of pressure. This type of pain can be challenging to treat, as it may not respond well to conventional pain management strategies.

In addition to potential nerve damage, psychological factors such as anxiety and stress can exacerbate the perception of pain. The mind-body connection is powerful, and chronic pain can lead to increased anxiety, which in turn can heighten the experience of pain. It's not uncommon for individuals with chronic pain to develop heightened sensitivity to pain stimuli, a phenomenon known as central sensitization.

Regarding the findings from your imaging studies, an SUVmax of 4.9 is indeed concerning, as values above 2.5 can suggest increased metabolic activity, which may be indicative of malignancy. However, it is crucial to interpret these findings in the context of your overall clinical picture. The fact that previous endoscopic examinations did not reveal any overt lesions is reassuring, but it does not entirely rule out the possibility of a pathological process. The recommendation from some physicians to consider a biopsy or further investigation is prudent, especially given your persistent symptoms.

In terms of next steps, it would be advisable to consult with an Ear, Nose, and Throat (ENT) specialist who has experience with post-operative complications and chronic throat pain. They may recommend further diagnostic procedures, such as a biopsy of the suspicious area, to definitively rule out malignancy. Additionally, a neurologist could assess for any underlying neurological issues that might be contributing to your symptoms.

You mentioned the possibility of autonomic nervous system dysfunction or autoimmune disease. While these conditions can manifest with a variety of symptoms, including pain and discomfort in the throat, they are typically accompanied by other systemic signs. A thorough evaluation by a rheumatologist or a specialist in autonomic disorders may be warranted if your symptoms persist without a clear diagnosis.

In the meantime, managing your anxiety and stress levels is crucial. Consider exploring cognitive-behavioral therapy (CBT) or other psychological support options to help cope with the emotional toll of chronic pain. Additionally, medications for neuropathic pain, such as gabapentin or pregabalin, may be beneficial if nerve involvement is confirmed.

In summary, your persistent throat pain could be multifactorial, involving surgical consequences, potential nerve damage, and psychological factors. A multidisciplinary approach involving ENT specialists, neurologists, and mental health professionals may provide the best pathway toward relief and clarity regarding your condition. It is essential to advocate for yourself and seek further evaluations until you find a satisfactory explanation and treatment for your symptoms.

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