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.)

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 such as 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? How was it treated? 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 and the nasopharynx. 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. 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, throat pain 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.

Avian influenza.Throat pain, muscle aches, cough, and fever are common early symptoms of avian influenza. The most virulent of these viruses, avian influenza A (H5N1), may also cause pneumonia, acute respiratory distress, and other life-threatening complications.

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 characterized by incapacitating fatigue. Associated findings include throat pain, myalgia, and cognitive dysfunction.

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.

Gastroesophageal reflux disease (GERD).With GERD, an incompetent gastroesophageal sphincter allows gastric juices to enter the hypopharynx and irritate the larynx, causing chronic throat pain 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 throat pain, 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, cough, enlarged cervical lymph nodes, and pain that radiates to the ear.

Monkeypox.Early symptoms of this rare viral disease include throat pain, fever, lymphadenopathy, chills, myalgia, and rash. The virus exhibits some similarities to smallpox, but its symptoms tend to be milder.

Mononucleosis (infectious).Throat pain 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 1018 to 1028 F (38.38 to 38.98 C). Splenomegaly and hepatomegaly may also develop.

Necrotizing ulcerative gingivitis (acute).Also known as trench mouth, necrotizing ulcerative gingivitis usually begins abruptly with throat pain 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 throat pain and localized erythema and edema. Bacterial pharyngitis begins abruptly with a unilateral throat pain. 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 throat pain—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 throat pain, 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 throat pain 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.Throat pain 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 throat pain 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 throat pain, 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.

Upper respiratory infection (URI).With a URI, throat pain may accompany coughing, sneezing, nasal congestion, rhinorrhea, fatigue, headache, myalgia, and arthralgia.

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

Foreign body aspiration.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.

Treatments.Endotracheal intubation and local surgery, such as tonsillectomy and adenoidectomy, commonly cause throat pain.

Nursing considerations

▪ Provide analgesic sprays or lozenges to relieve throat pain.

▪ Prepare the patient for throat culture, complete blood count, and a Monospot test.

Patient teaching

▪ Explain the underlying disorder and treatment plan.

▪ Explain the importance of taking the full course of antibiotics, as ordered.

▪ Discuss ways to soothe the throat.

Pictures

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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