Throat pain
Throat pain: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
Throat pain — also known as a sore throat — refers to discomfort in any part of the pharynx: the nasopharynx, the oropharynx, or the hypopharynx. This common symptom ranges from a sensation of scratchiness to severe pain. It’s typically accompanied by ear pain because cranial nerves IX and X innervate the pharynx as well as the middle and external ear.
Throat pain may result from infection, trauma, allergy, cancer, or a systemic disorder. It may also follow surgery and endotracheal intubation. Nonpathologic causes include dry mucous membranes associated with mouth breathing and laryngeal irritation associated with alcohol consumption, inhaling smoke or chemicals like ammonia, and vocal strain.
History
Ask the patient when he first noticed the pain and have him describe it. Has he had throat pain before? Is it accompanied by fever, ear pain, or dysphagia? Review the patient’s medical history for throat problems, allergies, and systemic disorders.
Physical assessment
Carefully examine the pharynx, noting redness, exudate, or swelling. Examine the oropharynx, using a warmed metal spatula or tongue blade, and the nasopharynx, using a warmed laryngeal mirror or a fiber-optic nasopharyngoscope. Laryngoscopic examination of the hypopharynx may be required. (If necessary, spray the soft palate and pharyngeal wall with a local anesthetic to prevent gagging.) Observe the tonsils for redness, swelling, or exudate. Obtain an exudate specimen for culture. Then examine the nose, using a nasal speculum. Also, check the patient’s ears, especially if he reports ear pain. Finally, palpate the neck and oropharynx for nodules or lymph node enlargement.
Medical causes
Agranulocytosis
With agranulocytosis, sore throat may accompany other signs and symptoms of infection, such as fever, chills, and headache. Typically, sore throat follows progressive fatigue and weakness. Other findings include nausea and vomiting, anorexia, and bleeding tendencies. Rough-edged ulcers with gray or black membranes may appear on the gums, palate, or perianal area.
Allergic rhinitis
Occurring seasonally or year-round, allergic rhinitis may produce sore throat as well as nasal congestion with a thin nasal discharge, postnasal drip, paroxysmal sneezing, decreased sense of smell, frontal or temporal headache, and itchy eyes, nose, and throat. Examination reveals pale and glistening nasal mucosa with edematous nasal turbinates, watery eyes, reddened conjunctiva and eyelids and, possibly, swollen lids.
Bronchitis (acute)
Acute bronchitis may produce lower throat pain associated with fever, chills, cough, and muscle and back pain. Auscultation reveals rhonchi, wheezing and, at times, crackles.
Chronic fatigue syndrome
Chronic fatigue syndrome is a nonspecific symptom complex that’s characterized by incapacitating fatigue. Associated findings besides sore throat include myalgia, lymphadenopathy, and cognitive dysfunction.
Common cold
With the common cold, sore throat may accompany cough, sneezing, nasal congestion, mouth breathing, rhinorrhea, fatigue, headache, myalgia, and arthralgia. The patient may also have a transient loss of taste and smell.
Contact ulcers
Common in men with stressful jobs, contact ulcers appear symmetrically on the posterior vocal cords, resulting in sore throat. The pain is aggravated by talking and may be accompanied by referred ear pain and, occasionally, hemoptysis. Typically, the patient also has a history of chronic throat clearing or acid reflux.
Foreign body
A foreign body lodged in the palatine or lingual tonsil and pyriform sinus may produce localized throat pain. The pain may persist after the foreign body is dislodged until mucosal irritation resolves.
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) may cause chronic sore throat and hoarseness. The arytenoids may also appear red and swollen, resulting in a sensation of a lump in the throat. Pyrosis, usually severe, is the most common symptom of this disorder.
Glossopharyngeal neuralgia
Triggered by a specific pharyngeal movement, such as yawning, chewing or swallowing, glossopharyngeal neuralgia causes unilateral, knifelike throat pain in the tonsillar fossa that may radiate to the ear. Eating spicy foods may also trigger this pain.
Herpes simplex virus
Sore throat in those infected with the herpes simplex virus may result from lesions on the oral mucosa, especially the tongue, gingivae, and cheeks. After causing brief prodromal discomfort, lesions erupt into erythematous vesicles that eventually rupture and leave a painful ulcer, followed by a yellowish crust. In generalized infection, the vesicles accompany submaxillary lymphadenopathy, halitosis, increased salivation, anorexia, and fever of up to 105° F (40.6° C).
Influenza
Patients with influenza commonly complain of sore throat, fever with chills, headache, weakness, malaise, muscle aches, cough and, occasionally, hoarseness and rhinorrhea. Chills generally subside after the first few days, but intermittent fever, weakness, and cough may persist for up to 1 week.
Laryngeal cancer
With extrinsic laryngeal cancer, the chief symptom is pain or burning in the throat when drinking citrus juice or hot liquids, or a lump in the throat; with intrinsic laryngeal cancer, it’s hoarseness that persists for longer than 3 weeks. Later signs and symptoms of metastasis include dysphagia, dyspnea, a cough, enlarged cervical lymph nodes, and pain that radiates to the ear.
Laryngitis (acute)
Acute laryngitis produces sore throat. Its cardinal sign, however, is mild to severe hoarseness, perhaps with temporary loss of voice. Other findings are malaise, low-grade fever, dysphagia, dry cough, and tender, enlarged cervical lymph nodes.
Mononucleosis (infectious)
Sore throat is one of the three classic findings in mononucleosis. The other two classic signs are cervical lymphadenopathy and fluctuating temperature with an evening peak of 101° to 102° F (38.3° to 38.9° C). Splenomegaly and hepatomegaly may also develop.
Necrotizing ulcerative gingivitis (acute)
Also known as trench mouth, necrotizing ulcerative gingivitis usually begins abruptly with sore throat and tender gums that ulcerate and bleed. A gray exudate may cover the gums and pharyngeal tonsils. Related signs and symptoms include a foul taste in the mouth, halitosis, cervical lymphadenopathy, headache, malaise, and fever.
Peritonsillar abscess
A complication of bacterial tonsillitis, peritonsillar abscess typically causes severe throat pain that radiates to the ear. Accompanying the pain may be dysphagia, drooling, dysarthria, halitosis, fever with chills, malaise, and nausea. The patient usually tilts his head toward the side of the abscess. Examination may also reveal a deviated uvula, trismus, and tender cervical lymphadenopathy.
Pharyngeal burns
First- or second-degree burns of the posterior pharynx may cause throat pain and dysphagia. Laryngeal edema, bronchospasm, and stridor may occur if the larynx is involved in the burn.
Pharyngitis
Whether bacterial, fungal, or viral, pharyngitis may cause sore throat and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral sore throat. Associated signs and symptoms include dysphagia, fever, malaise, headache, abdominal pain, myalgia, and arthralgia. Inspection reveals an exudate on the tonsil or tonsillar fossae, uvular edema, soft palate erythema, and tender cervical lymph nodes.
Also known as thrush, fungal pharyngitis causes diffuse sore throat — commonly described as a burning sensation — accompanied by pharyngeal erythema and edema. White plaques mark the pharynx, tonsil, tonsillar pillars, base of the tongue, and oral mucosa; scraping these plaques uncovers a hemorrhagic base.
With viral pharyngitis, findings include diffuse sore throat, malaise, fever, and mild erythema and edema of the posterior oropharyngeal wall. Tonsillary enlargement may be present along with anterior cervical lymphadenopathy.
Pharyngomaxillary space abscess
A complication of untreated pharyngeal or tonsillar infection or tooth extraction, pharyngomaxillary space abscess causes mild throat pain. Inspection reveals a bulge in the medial wall of the pharynx accompanied by swelling of the neck and at the jaw angle on the affected side. Other signs and symptoms include fever, dysphagia, trismus and, possibly, signs of respiratory distress or toxemia.
Sinusitis (acute)
Acute sinusitis may cause sore throat with purulent nasal discharge and postnasal drip, resulting in halitosis. Other effects include headache, malaise, cough, fever, and facial pain and swelling associated with nasal congestion.
Tongue cancer
With tongue cancer, the patient experiences localized throat pain that may occur around a raised white lesion or ulcer. The pain may radiate to the ear and be accompanied by dysphagia.
Tonsillar cancer
Sore throat is the presenting symptom in tonsillar cancer. Unfortunately, the cancer is usually quite advanced before the appearance of this symptom. The pain may radiate to the ear and is accompanied by a superficial ulcer on the tonsil or one that extends to the base of the tongue.
Tonsillitis
With acute tonsillitis, mild to severe sore throat is usually the first symptom. The pain may radiate to the ears and be accompanied by dysphagia and headache. Related findings include malaise, fever with chills, halitosis, myalgia, arthralgia, and tender cervical lymphadenopathy. Examination reveals edematous, reddened tonsils with a purulent exudate.
Chronic tonsillitis causes mild sore throat, malaise, and tender cervical lymph nodes. The tonsils appear smooth, pink and, possibly, enlarged, with a purulent debris in the crypts. Halitosis and a foul taste in the mouth are other common findings.
Unilateral or bilateral throat pain just above the hyoid bone occurs with lingual tonsillitis. The lingual tonsils appear red and swollen and are covered with exudate. Other findings include a muffled voice, dysphagia, and tender cervical lymphadenopathy on the affected side.
Uvulitis
Uvulitis is an inflammation that can cause throat pain or a sensation of something in the throat. The uvula is usually swollen and red but, in allergic uvulitis, it’s pale.
Other causes
Treatments
Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause sore throat.
Special considerations
Provide analgesic sprays or lozenges to relieve throat pain. Also, prepare the patient for throat culture, complete blood count, and a Monospot test.
Pediatric pointers
Sore throat is a common complaint in children and may result from many of the same disorders that affect adults. Other pediatric causes of sore throat include acute epiglottiditis, herpangina, scarlet fever, acute follicular tonsillitis, and retropharyngeal abscess.
Patient counseling
If the patient is taking antibiotics, stress the importance of completing the full course of treatment, even if symptoms improve after only a few days. Tell the patient that he’s presumed noninfectious after 24 hours of antibiotic coverage. Suggest gargling with salt water to soothe the throat.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
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- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Sore Throat (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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