Throat pain
Throat pain — commonly 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 commonly accompanied by ear pain because cranial nerves IX and X innervate the pharynx as well as the middle and external ear. (See Anatomy of the throat, page 590.)
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 and physical examination
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.
Next, 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, it 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.
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 and cognitive dysfunction.
Common cold
Sore throat may accompany cough, sneezing, nasal congestion, rhinorrhea, fatigue, headache, myalgia, and arthralgia.
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 (GERD)
With GERD, an incompetent gastroesophageal sphincter allows gastric juices to enter the hypopharynx and irritate the larynx, causing chronic sore throat and hoarseness. The arytenoids may also appear red and swollen, resulting in a sensation of a lump in the throat.
Influenza
Patients with the flu commonly complain of sore throat, fever with chills, headache, weakness, malaise, muscle aches, cough and, occasionally, hoarseness and rhinorrhea.
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, the chief symptom is 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.
Mononucleosis (infectious)
Sore throat is one of the three classic findings in this infection. 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, this 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.
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.
Sinusitis (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 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 may 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.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Mouth infections
Read excerpts from these other book chapters related to Mouth infections:
Medical Books Excerpts
- Mouth lesions
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Throat pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Throat pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Sore Throat
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Mouth infections
» Next page: Stomatitis and other oral infections (Professional Guide to Diseases (Eighth Edition))
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