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Pain in the throat, neck and voice box (larynx) with associated swallowing difficulties and voice change will affect everyone at some point in their lives.
If this is a daily occurrence and doesn’t seem to be getting better please do get in touch.
Most causes of pain are benign and inflammatory in nature. The commonest cause of inflammation is infection, mostly viral, but sometimes bacterial or fungal. Infection is usually self-limiting with symptoms resolving by 2 weeks.
You can help resolution by drinking plenty of water and taking over-the-counter painkilling and anti-inflammatory medication including throat sprays, for comfort. If you have fever and feel generally unwell, please seek help as you may need urgent antibiotic medication.
Sometimes the inflammation may be localised to a specific area in the throat such as the tonsils or similar type of tissue found at the base of tongue (called lingual tonsils) or at the back of the nose (adenoids). This causes tonsillitis, lingual tonsillitis or adenoiditis respectively.
Laryngitis is the term used for inflammation confined to the voice box.
These focal areas may become repeatedly inflamed in some patients and ultimately become sources of chronic inflammation.
Rarely a patient may have an anatomical variation such as an elongated bone (called the styloid process) at the base of the skull that can impinge on the throat lining or adjacent nerves causing a sharp localised pain (this specific situation is called “Eagles syndrome”).
As well as throat pain, you may suffer with hoarseness, recurrent cough and throat clearing, sudden sensations of choking, difficulty or painful swallowing and a feeling of a foreign body stuck in the throat.
There may be other associated symptoms such as heartburn or nasal block, sneezing, an itchy throat, a runny nose or a feeling of a drip of fluid from the nose running down the back of the throat (post-nasal drip).
When symptoms persist for more than 2 weeks without improvement, I think you should see a specialist. It is vitally important to exclude a head and neck cancer, as it may cause similar symptoms to those described above.
I especially worry if a patient also has:
These symptoms may be indicative of a head and neck cancer.
Smoking and high alcohol consumption are important risk factors for cancer.
Other reasons to get an urgent ENT review include noisy breathing, breathlessness and a prolonged fever.
There may be a number of other irritants or health conditions which if left untreated prevent any inflamed area in the throat and voicebox from healing. These must also be addressed. They include smoking, high caffeine intake, dehydration, gastroesophageal reflux (or GORD), allergy, environmental irritants, nasal and sinus inflammation and some medications.
Rarely, prolonged or recurrent throat and voice box symptoms may be part of a generalized whole-body inflammatory or autoimmune condition.
Dental, jaw joint and spinal pain may cause “referred” poorly localised neck or throat pain. This is a relatively common cause.
When you come to see me, I will perform a comprehensive head and neck examination. This will include the use of a flexible high definition endoscope (camera) providing unparalleled magnified views of the nasal cavity, the back of the nose, the back of the tongue, the upper part of the swallowing apparatus, the voice box with its containing vocal cords and sometimes the upper windpipe.
If there is associated hoarseness, a “video-stroboscopic” assessment with this camera will provide a super slow-motion view of how the vocal cord surfaces vibrate against each other. Without video-stroboscopy, subtle changes on the surface and lumps buried in the vocal cords may be missed.
If swallowing difficulty is an important symptom, the endoscope may be passed into your upper gullet to visualise any suspicious lesions. It will also give us an indication of any tightening of the muscles that circle the upper gullet.
I may recommend specialist blood tests. Allergy tests may either be performed on your skin or via specific blood tests. Bacterial or fungal swabs may be taken from the nose or throat.
If swallowing is affected then a specialist swallow assessment such as functional endoscopic evaluation of the swallow (FEES) and/ or a dynamic X-ray study called a video swallow may be recommended to check how food and fluid passes around your voice box.
I will usually request a CT and/ or MRI scan to exclude any cancerous lesions in the neck and chest. They will also demonstrate dental, jaw or spinal conditions that may cause neck pain. Anatomical problems like Eagle’s syndrome are readily demonstrated by a CT scan.
If there is a strong clinical suspicion of gastric acid reflux you may be referred to a gastroenterology colleague to consider performing a gastric endoscopy and other investigations such as pharyngo-oesophageal pH studies and oesophageal manometry (pressure studies).
As there are likely to be a number of causative or exacerbating conditions following an index triggering event, these will all be sought and treated concurrently. Cigarette smoking should ideally be stopped and alcohol intake reduced. All patients will benefit from plenty of hydration and B, C and D vitamin supplementation. Fish oil may also be helpful.
A period of voice rest, ideally in a “throat soothing” environment created by steam inhalation, humidification and saline nebulisation for example, may be helpful to relieve irritative symptoms such as hoarseness, cough or voice box spasm.
Anti-inflammatory sprays and gargles that you can obtain over the counter may also provide symptom relief.
Caffeine and many medications dehydrate tissues. Other medications (some anti blood pressure agents for example) exacerbate cough and throat inflammation. These should be changed to an alternative if safe to do so.
It’s important for patients who take inhaled steroids to drink some water straight after use, to clear away steroid residue. Prolonged contact with steroids is damaging to the lining of the throat and voice box and may encourage growth of fungal organisms.
Depending on the clinical examination, a prolonged course of antibiotic or antifungal medication may be recommended as well as a prolonged course of anti-acid medication if you have concurrent symptoms of gastric acid reflux.
I will also check for nasal conditions including allergy and chronic sinus inflammation; the treatment of which will help reduce the “post-nasal drip” that delivers inflammatory/ irritative substances into the throat and airway.
Some patients with particularly refractory symptoms may benefit from topical or tablet steroids to reduce inflammation, although their use should be limited and carefully supervised.
You may be referred for a gastroenterology or respiratory consultation if I feel there is an associated problem in your gullet/ stomach or the lungs respectively.
Any suspicious lesion in the throat and neck should be biopsied to exclude cancer.
If clinical and/ or radiological examination demonstrate a focus of chronic inflammation in adenoid, tonsil or lingual tonsil tissue, then surgical removal of these will often be curative. If this is deemed to be beneficial, I will of course detail the exact method of removal I recommend. I am skilled in all techniques including electrocautery, laser and robotic assisted.
If a focal problem in the voice box or upper swallowing apparatus doesn’t respond to medical treatment then I am likely to recommend an examination under general anaesthetic to exclude cancerous or other lesions and/ or to perform specialist treatments. These could include steroid or Botox injection, a stretch of any narrowed section of the upper gullet, laser assisted removal of vocal cord lesions or vocal cord resurfacing.
It’s really important that these procedures are performed by a specialist with experience in these techniques to prevent injury to the surrounding delicate structures and to minimise scar formation.
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