How to cure a sore throat that is exaggerated while talking?

Question

Hello doctor,

I have been having a sore throat that comes and goes for probably around three months now. If I talk a little bit more than usual, my throat will hurt for hours. Sometimes my left ear hurts too. It feels dry and painful, and I cannot talk much as my voice fades. Then it comes back to normal after a few hours. This keeps happening, and today I decided to take pictures to figure out if there was something visibly wrong, and I found the arch behind my uvula looks swollen or bumpy. It does not look like other people’s throats. Also, the roof of my mouth is yellowish. I have had chronic gastritis, IBS, and also chronic sinusitis for years now. Could that be the cause? Are these cancer symptoms? I have attached pictures. My throat looks very pale overall. I do not smoke or drink. Please help.

Answer 1

Hello,

Welcome to icliniq.com.

Based on your clinical history and the photographs you shared (attachments removed to protect the patient's identity), let me assure you that these are not cancer symptoms. The clinical history and findings are consistent with recurrent gastroesophageal reflux disease or laryngopharyngeal reflux disease causing a recurrent sore throat. Let me clarify further. Your throat gets inflamed due to the acid from your stomach coming up when you lie down. Chronic sinusitis (that you mentioned) would also contribute to throat inflammation. The side of the throat inflammation may depend on the side to which you lie down at night. The ear ache that you mentioned has two possible mechanisms: 1) It is generally referred pain (meaning pain referred to the ear due to the same nerve supply). 2) It is due to inflammation of the eustachian tube (the tube connecting the back of your nose to the ear). Generally, the voice also changes due to the swelling caused by throat inflammation. Conservative line of management would include giving three hours gap between dinner and sleeping at night. Avoid spicy and oily foods at night. Medical management generally does start on a six weeks regimen of Nexium (Esomeprazole) with Domperidone. However, I suggest you start on oral suspension of Gaviscon (Aluminium hydroxide and Magnesium trisilicate) 10 mL at night after dinner, just before you go to bed, for at least 14 days. Few clarifications that I would need: 1) Has anyone at home observed you snoring? 2) Does your throat get dry at night, needing to wake up to drink water? 3) Do you wake up several times during a night's sleep? 4) Do you feel tired, or do you feel fresh after a night's sleep? Any feedback on the status of your chronic sinusitis would be helpful. I will suggest you do a flexible nasopharyngolaryngoscopy and review after two weeks.

Answer 2

Hi,

Welcome back to icliniq.com.

Yes, your clinical history suggests chronic rhinosinusitis (CRS). The fact that you have a reduced sense of smell could be attributed to chronic inflammation and the possibility of nasal polyps. Generally, people with nasal allergies have pale nasal mucosa. The yellowish color on the roof of your mouth that you mentioned is not of particular significance. If you do not have symptoms of nasal allergy: 1) recurrent bouts of sneezing in the mornings, 2) running nose, 3) itchy eyes or nose or throat, then other causes for CRS need to be ruled out. Occasionally there may be fungal elements associated. Again a CT (computed tomography) scan of the paranasal sinuses has to be taken after taking maximal medical therapy. It is usually a combination of oral antibiotics, topical nasal steroid sprays (Fluticasone Furoate), and sometimes steroid Budecort nasal alkaline douches. So the question is, have you ever had your Chronic sinusitis assessed by a local ENT (ear, nose, throat) doctor? Have they done a nasal endoscopy or been assessed radiologically (CT scan of the paranasal sinuses)? Have you taken treatment for the management of CRS?