The symptoms of sore throat and swallowing difficulty frequently overlap because of the proximity of the neck structures. The mouth opens into the throat, which leads to the voice box for air and the esophagus for food. The throat, voice box and esophagus contain nerves that communicate pressure and pain, although precise localization often proves challenging. The many causes of sore throat or swallowing difficulties necessitate a careful evaluation to arrive at an accurate diagnosis and appropriate treatment strategy.
Throat, Tonsil and Epiglottis Infections
Bacterial infections of the throat, tonsils or epiglottis--the tissue flap that covers the airway during swallowing--can cause significant throat pain and difficulty swallowing. Associated symptoms may include fever, white patches in the throat and swollen, tender lymph nodes. Common causes of bacterial infections of the throat and associated tissues include group A streptococcus, Haemophilus influenzae type b and Streptococcus pneumoniae. Tissue swelling associated with epiglottitis may partially obstruct the airway, causing breathing difficulty. This condition requires emergency medical treatment.
Gastroesophageal Reflux Disease
Gastroesophageal reflux disease is a disorder characterized by the backflow of stomach acid and food contents into the esophagus due to malfunction of the lower esophageal sphincter. This tissue is a muscular ring between the esophagus and stomach that constricts to keep gastric contents contained. Severe gastroesophageal reflux can cause backflow of stomach acid into the throat and mouth. With longstanding disease, stomach acid can irritate the lining of the esophagus and throat, potentially causing pain and difficulty swallowing. Esophageal ulcers and scarring may also occur, adding to the likelihood of throat pain and swallowing difficulties. Medication to reduce stomach acid production along with lifestyle measures are the cornerstones of treatment for this disease.
Tumors in or near the throat and esophagus can cause swallowing difficulties and throat discomfort. Many types of noncancerous and cancerous tumors can arise in the throat region, including pharyngeal or laryngeal cancer, lymphoma, thyroid cancer, parathyroid cancer, tonsil cancer, neck muscle tumors, branchial cleft cysts, blood vessel-derived tumors and esophageal cancer. A biopsy typically proves essential in diagnosing a neck tumor. This test involves taking a small sample of the tumor tissue and examining it under the microscope. Treatment depends on the source of the tumor, whether the tissue is cancerous, and the involvement of other structures in the disease process.
- American Academy of Otolaryngology--Head and Neck Surgery: Sore Throats
- “Harrison’s Principles of Internal Medicine, 16th Edition”; Dennis L. Kasper, M.D., et al., Editors; 2004
- American Academy of Otolaryngology--Head and Neck Surgery: Tonsillitis
- American Academy of Otolaryngology--Head and Neck Surgery: Swallowing Trouble
- “Clinical Oncology, Third Edition”; Martin D. Abeloff, M.D., et al., Editors; 2004