Persistent Throat Pain: Symptoms and Seeking Solutions

Throat issues

Hello Doctor, I would like to consult you.
I have been experiencing sharp pain on the left side of my throat wall extending to the base of my tongue for six months, accompanied by a sensation of a foreign body.
The symptoms persist throughout the day; swallowing saliva causes pain, and even when my mouth is still, I feel the foreign body sensation.
It feels like the throat wall and the left base of my tongue are inflamed and throbbing.
Pressing on the left side of my jaw and the base of my tongue intensifies the pain.
Certain head movements also exacerbate the discomfort, and lowering my head towards my collarbone makes the foreign body sensation more pronounced.

Over the past six months, I have undergone several examinations.
An MRI of my head and neck in August did not reveal any issues, and a nasopharyngoscopy also showed nothing significant.
A neck ultrasound was normal, and an endoscopy only indicated mild esophagitis.
At the end of September, I had a PET scan that suggested a possible lesion in the epiglottis area.
Although it could be a physiological change, the possibility of a malignant tumor cannot be ruled out, with an SUVMAX of 4.9, which is slightly elevated.

I would like to ask if the PET scan and MRI can rule out the possibility of a tumor at the base of my tongue.
The epiglottis appears bright on the X-ray; does this indicate a higher likelihood of something serious? The endoscopy has been performed three times without any visible ulcers, only noting that the left base of my tongue is somewhat swollen, and the right tonsil has been enlarged.
Eight months ago, I underwent a bilateral tonsillectomy and uvulopalatopharyngoplasty.
Could this be the cause of my current pain and foreign body sensation?
Regarding the PET report, I have consulted several doctors, some of whom say I have no issues.
However, in the last three months, my symptoms have worsened.
When I examine the base of my tongue, it feels somewhat hard.
In November, I visited another doctor who also noted that it felt a bit hard.
The doctor suggested removing the entire area for biopsy, but it would cost 200,000 NTD for the Da Vinci system, which I cannot afford.
My symptoms persist, causing significant discomfort and distress.
I have a three-year-old child and do not want to act rashly, but I am also afraid that I might have early-stage cancer or oropharyngeal cancer symptoms that have been overlooked by doctors.
During this time, I have been taking gastric medication and anti-inflammatory sprays, but there has been no improvement.
I am very troubled and unsure where the problem lies.
Do you have any recommendations for treatment or advice on how I should proceed with my medical care? Please help me as much as possible, as I am at a loss for what to do.
Thank you.
Attached is the report for your analysis: https://1drv.ms/f/s!AjPJXu4grsOPgghlZnmGkKuCZsRm

Ms. Lin, 40~49 year old female. Ask Date: 2021/12/11

Dr. Zheng Jueyi reply Otolaryngology

Hello, based on the description, all necessary examinations have been conducted, and the relevant clinical physicians have provided clinical recommendations.
Online consultations cannot replace in-person medical visits.
It is advised that any concerns should still be addressed through medical examination and evaluation by the appropriate specialists.
Wishing you safety and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2021/12/11

More Info

Persistent throat pain, especially when accompanied by a sensation of a foreign body and sharp pain, can be distressing and may significantly impact your quality of life. Based on your description, it seems you have been experiencing these symptoms for an extended period, and despite undergoing various diagnostic tests, the underlying cause remains elusive.
From a medical standpoint, persistent throat pain can arise from several conditions, including but not limited to infections, inflammation, gastroesophageal reflux disease (GERD), or even more serious conditions such as tumors. Given that you have undergone an MRI, endoscopy, and other imaging studies without definitive findings, it is understandable to feel frustrated and anxious about your symptoms.

Understanding Your Symptoms
1. Inflammation and Irritation: Chronic inflammation of the throat can lead to persistent pain and a sensation of something being stuck. This could be due to allergies, irritants, or even chronic sinusitis that drains into the throat.

2. Gastroesophageal Reflux Disease (GERD): GERD can cause acid to irritate the throat, leading to pain and a sensation of a lump. You mentioned mild esophagitis, which could suggest that reflux might be contributing to your symptoms.

3. Muscle Tension: Sometimes, muscle tension in the neck and throat can lead to referred pain, which may explain the pain worsening with certain movements or pressure.

4. Psychological Factors: Anxiety and stress can exacerbate the perception of pain. Given your concerns about potential malignancy, it’s understandable that anxiety could be contributing to your discomfort.

5. Tumor Concerns: While your imaging studies have not shown any definitive tumors, the concern about a possible malignancy is valid, especially with the PET scan findings. However, a high SUVmax can sometimes indicate inflammation rather than malignancy. It’s crucial to discuss these findings with an oncologist or an ENT specialist who can provide a more nuanced interpretation.

Recommendations for Further Action
1. Consult an ENT Specialist: Since you have already seen multiple specialists, it may be beneficial to seek a second opinion from an ENT who specializes in head and neck disorders. They may consider more advanced imaging or diagnostic techniques.

2. Consider a Gastroenterologist: If GERD is suspected, a gastroenterologist can help manage this condition effectively, possibly through dietary changes, medications, or further testing.

3. Pain Management: A pain management specialist may provide strategies to cope with chronic pain, including medications, physical therapy, or alternative therapies such as acupuncture.

4. Psychological Support: Given the emotional toll of chronic pain, it might be helpful to speak with a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly effective in managing chronic pain and anxiety.

5. Lifestyle Modifications: Consider lifestyle changes that may alleviate symptoms, such as avoiding irritants (smoke, strong odors), staying hydrated, and practicing relaxation techniques.

6. Follow-Up on Imaging: If your symptoms worsen or new symptoms develop, it’s essential to follow up with your healthcare provider. They may recommend repeat imaging or a biopsy if there are concerning changes.

Conclusion
Your symptoms are complex and multifactorial, and it’s crucial to approach them holistically. While the fear of serious conditions like cancer is understandable, it’s essential to focus on managing your symptoms and improving your quality of life. Collaborating with a multidisciplinary team of healthcare providers can help you navigate this challenging situation. Remember, you are not alone in this, and there are resources and support available to help you through it.

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