Throat Pain: Essential Tests and Causes Explained

If you have a sore throat, what tests should you undergo?

Hello Dr.
Zheng,
I have been experiencing a sharp pain in the central anterior part of my throat (similar to the location of a male's Adam's apple) since April of last year.
The pain is most noticeable when I first wake up.
I feel as if there is a wound.
I visited an otolaryngologist in April last year, and the doctor used a thin tube inserted through my nostril to examine my throat.
She believed that my symptoms were due to gastroesophageal reflux disease (GERD) and referred me to a gastroenterologist.
After undergoing an upper endoscopy, it was found that there was old scarring from previous inflammation on the stomach wall, but the function of the lower esophageal sphincter was normal, and there were no significant issues.
I was prescribed omeprazole, which I have been taking for nearly a year.
During this time, the sharp pain in my throat has fluctuated.
Since January of this year, the pain has intensified, especially upon waking, and sometimes it persists throughout the day (although I have no difficulty swallowing food).
In February of this year, I returned to the otolaryngologist but was again referred to the gastroenterology department.
The doctor conducted a 24-hour pH monitoring test, and the results showed that my acid levels were normal.
Currently, the issue of acid reflux has been ruled out, and I am waiting for an otolaryngology appointment in a month.
All of these consultations have taken place abroad, where the doctors have been inefficient, merely referring me from one specialist to another.
I am considering returning to Taiwan for treatment during the summer break.

I would like to ask:
1.
Can the examination performed by the otolaryngologist using a thin tube inserted through the nostril accurately determine whether the throat injury is caused by acid reflux or another pathology?
2.
What additional tests should I undergo to help the otolaryngologist identify the cause of my throat pain?
3.
Since last year, I have not experienced any coughing, fever, or other cold symptoms.
Is it possible for a viral infection or other infection to cause throat pain for such an extended period?
Thank you for taking the time to respond.

Fangfang, 30~39 year old female. Ask Date: 2013/05/03

Dr. Zheng Jueyi reply Otolaryngology

Dear Fangfang,
1.
The tube inserted through the nostril for examination is likely a nasopharyngoscope, which allows for a detailed inspection from the nasal cavity, nasopharynx, oropharynx, to the hypopharynx.
Chronic pharyngitis caused by gastric acid can show inflammation and edema of the laryngeal tissue, particularly at the entrance of the esophagus, which may also exhibit signs of inflammation and swelling.
2.
This persistent throat discomfort is commonly referred to as chronic pharyngitis.
The main causes are usually gastroesophageal reflux, postnasal drip, smoking, alcohol consumption, excessive intake of irritating foods, or prolonged speaking due to work.
Common colds or viral infections rarely lead to long-term pain.
It is advisable to carefully evaluate your lifestyle to identify and eliminate potential chronic irritants, as this may lead to gradual improvement.
Wishing you peace and health,
Dr.
Jue-Yi Cheng
Director, Department of Otolaryngology
Taoyuan Hospital, Ministry of Health and Welfare

Reply Date: 2013/05/03

More Info

Hello, thank you for your detailed inquiry regarding your throat pain. It sounds like you have been experiencing persistent discomfort in your throat for quite some time, and I understand how frustrating this can be, especially when you feel like you are being passed around from one specialist to another without a clear resolution. Let’s break down your questions and provide some insights based on medical knowledge.

1. Can the nasal endoscopy accurately determine if the throat pain is due to acid reflux or other lesions?
Nasal endoscopy is a valuable diagnostic tool used by ENT specialists to visualize the throat and nasal passages. It allows the doctor to see any abnormalities, such as swelling, lesions, or signs of inflammation. However, while it can help identify physical changes in the throat, it may not definitively determine the cause of your pain. For example, while it can show signs of irritation that could be due to acid reflux, it may not reveal the underlying cause if there are no visible lesions. Acid reflux can cause inflammation and irritation in the throat, but it can also be caused by other factors such as allergies, post-nasal drip, or even certain medications. Therefore, while nasal endoscopy is helpful, it should be considered as part of a broader diagnostic approach.

2. What additional tests should I consider to help identify the cause of my throat pain?
Since you have already undergone a gastroscopy and 24-hour pH monitoring, it may be beneficial to consider the following additional tests:
- Laryngoscopy: This procedure allows for a more detailed examination of the larynx (voice box) and can help identify any abnormalities that may not have been visible during the nasal endoscopy.

- Allergy Testing: If allergies are suspected, testing can help identify any allergens that may be contributing to your throat discomfort.

- Imaging Studies: In some cases, imaging studies such as a CT scan of the neck may be warranted to rule out structural issues or other underlying conditions.

- Swallowing Studies: If you have any concerns about swallowing, a barium swallow study may help assess the function of your esophagus and throat.

3. Is it possible for a viral infection to cause prolonged throat pain without other symptoms like cough or fever?
Yes, it is possible for certain viral infections to cause throat pain without the classic symptoms of cough or fever. Some viral infections can lead to localized inflammation in the throat, resulting in pain. Additionally, conditions such as chronic pharyngitis or post-nasal drip can cause persistent throat discomfort without other systemic symptoms. However, if the pain persists for an extended period, it is essential to consider other potential causes, including non-infectious factors such as irritants (smoke, pollution), gastroesophageal reflux disease (GERD), or even psychological factors like anxiety, which can manifest as physical symptoms.

In conclusion, your ongoing throat pain warrants further investigation, especially since it has persisted despite treatment. It would be advisable to follow up with an ENT specialist upon your return to Taiwan, where you can discuss the possibility of additional tests and a comprehensive evaluation of your symptoms. Additionally, keeping a symptom diary, noting when the pain occurs, its intensity, and any associated factors (like diet or stress) may provide valuable information for your healthcare provider.

Thank you for reaching out, and I hope you find relief soon!

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