Throat pain usually arises from inflammation of the throat mucosa, which in turn can have a variety of causes. Sometimes, however, the complaints are also due to a neuralgia of the glossopharyngeal nerve (tongue-throat-nerve), an epiglottis or a pharyngeal carcinoma (throat cancer).
Throat pain describes symptoms that are limited to the area of the throat or the upper respiratory tract. Usually the colloquially used terms "throat pain" and "sore throat" are used synonymously. At this point, however, throat pain is defined as part of the wide range of sore throats, which includes symptoms that are not related to the throat.
Symptoms of throat pain
Throat pain is characterized by a stinging, burning, sometimes pressure-like pain in the throat area. Typical accompanying symptoms are difficulty swallowing and a generally thick neck, but depending on the possible causes of throat pain, numerous other complaints can also occur. The cause of the pain in the throat also determines the intensity of the symptoms and the timing of the symptoms. Here the spectrum ranges from a relatively sudden onset, quickly disappearing throat pain, for example when swallowing, to permanent pain in the throat area.
Causes of throat pain
Possible causes of throat pain include acute and chronic throat infections, diseases such as an epiglottis, glossopharyngeal neuralgia or throat cancer. Other diseases, such as tonsillitis (tonsillitis) or the rather rare acute inflammation of the thyroid gland (thyroiditis) are known as causes of sore throat, but are not assigned to the triggers of the more narrowly defined term of throat pain here.
Inflammation of the pharynx mucosa
The most common cause of throat pain is acute pharyngitis (inflammation of the throat mucosa). This is usually due to a viral or bacterial infection, whereby the bacterial throat infections are usually associated with far-reaching health risks than the viral infections. The viruses that can cause pharyngitis include, for example, influenza viruses (flu viruses), so-called parainfluenza viruses and human adenoviruses, but also viruses of the genus herpes simplex and special forms of the enterovirus (coxsackie virus) are known to trigger inflammation of the pharynx. Furthermore, viral diseases such as rubella or measles are sometimes accompanied by inflammation of the pharynx mucosa. In addition to the throat pain, flu-like symptoms such as fever, headache and body ache can often be observed in the case of viral throat inflammation. There may also be significantly more serious health problems. For example, an infection with the Coxsackievirus usually initially manifests itself as a cold, with symptoms such as cough, runny nose and hoarseness, but in rare cases it can also lead to life-threatening meningitis or inflammation of the heart muscle.
Throat infections caused by a bacterial infection are significantly less common than viral infections. They cause a similar symptoms, but abdominal pain and nausea are not uncommon, especially in children. Complaints that can also occur with the viral infection, but form a less typical feature there. Bacterial pharyngitis is usually caused by special streptococci, but is also sometimes the result of an infection with Corynebacterium diphtheriae (trigger of diphtheria), Treponema pallidum (syphilis) or other types of bacteria.
Occasionally, the throat inflammation also takes a chronic course, which is often caused by persistent irritation, for example due to tobacco or alcohol consumption. Special environmental toxins and allergies are also possible triggers for the symptoms of chronic inflammation of the pharynx.
Throat pain, especially when swallowing, can be an expression of potentially life-threatening epiglottitis. In most cases, this inflammation of the epiglottis is due to a bacterial infection with Haemophilus influenzae type B. Sufferers feel a lump in their throats, suffer from shortness of breath and produce clearly audible breathing sounds. In the course of the inflammation, the epiglottis can swell to such an extent that the airways are extremely narrowed and, in the worst case, those who die suffocate. Due to the lack of oxygen supply, bluish discoloration of the lips, skin and fingernails can also be observed.
Neuralgia creates sensations and pain in the area of care of the affected nerve pathways. If the neuralgia shows up in the area of the tongue and throat nerve, the patients often suffer from a sudden onset of pain in the throat area, which is particularly common when swallowing, chewing or speaking. The pain can also radiate into the area of the base of the tongue, tonsils or ears. Sometimes the neuralgia of the ninth cranial nerve (glossopharyngeal nerve) also has an influence on the vegetative functions or the vegetative nervous system, which leads to a slowing of the heart rhythm (bradycardia), a drop in blood pressure or even short-term cardiovascular breakdowns (syncope) and life-threatening dropouts of the heartbeat (asystole ) can lead.
Malignant tissue growths in the form of pharyngeal carcinoma can also develop on the pharynx mucosa from a cause that has not yet been fully researched. Depending on the location and size of the ulcer, various symptoms can be observed, which can range from impaired nasal breathing to the feeling of a lump in the throat and discomfort when swallowing, to massive throat pain. More non-specific symptoms such as unpleasant bad breath, repeated nosebleeds or bleeding in the throat are sometimes the result of pharyngeal cancer. The formation of metastases, which often begins relatively early, is particularly dangerous in the case of throat cancer, whereby this usually manifests itself in the cervical lymph nodes.
After a detailed survey of the patients on the occurrence of throat pain, possible accompanying symptoms, previous illnesses and potential risk factors such as smoking or alcohol consumption, an inspection of the mouth and throat area followed with the help of a so-called wooden spatula. The column is used to push the tongue down a little and take a look into the pharynx. Possible inflammations of the pharynx mucosa or the epiglottis can usually be clearly identified in this way. However, if the epiglottis is inflamed, there is a risk that the airways, which are narrowed anyway, will be completely closed by pressure with the wooden spatula, which is why a corresponding examination should only be carried out if the air supply is ensured by a tube inserted into the trachea.
If pain occurs during the examination or when pressure is applied to the area of the tonsils with the spatula and there is no inflammation of the pharynx mucosa, this may indicate a possible presence of glossopharyngeal neuralgia.
If the pharynx is diagnosed, a smear followed by a laboratory test is used to identify the pathogen. Blood tests provide evidence of possible inflammation and can also help in the detection of other diseases such as rubella or measles.
Throat cancer can often already be clearly identified in the throat assessment. The examination using a so-called endoscope, which is inserted into the nasopharynx and allows a look inside the body, is carried out in more difficult cases of diagnosis. A biopsy (taking a tissue sample) can be carried out simultaneously with the endoscope in order to finally confirm the diagnosis. However, not all forms of throat cancer can be recognized with the endoscope. In cases of doubt, modern imaging methods such as ultrasound, computed tomography or magnetic resonance imaging help here to detect the malignant ulcers. However, a tissue sample must be examined in order to finally confirm the diagnosis.
Therapy for throat pain
Once the diagnosis has been made, the cause of the throat pain is treated. For example, viral inflammation of the pharynx mucosa is usually dealt with using various anti-inflammatory and pain-relieving medicines, disinfectant mouthwashes and analgesic and disinfectant lozenges. The application is usually aimed at alleviating the symptoms and avoiding bacterial secondary infections. It is hardly possible to fight the virus with medication, but in most cases it is not necessary either because the viral throat infections can usually be successfully combated by the immune system alone.
If the throat pain is due to bacterial inflammation of the throat, the use of antibiotics promises successful treatment. Special antibiotics are also used against the life-threatening epiglottis, which is caused in most cases by bacteria of the genus Haemophilus influenzae type B. First of all, however, it is important to ensure the air supply. If in doubt, this requires artificial ventilation via a tube. In acute emergency situations with impending suffocation, a so-called tracheal incision can also be made. It is not uncommon to treat the swelling of the epiglottis as part of therapy with cortisone.
In the case of glossopharyngeal neuralgia, drug treatment based on special antiepileptic drugs is usually provided first. However, if this does not show the desired success, the possibility of an operative intervention remains. The microsurgical operation aims at eliminating possible compressions of the nerve pathways, such as are more often present in the form of pulsating vascular loops in glossopharyngeal neuralgia.
If diagnosed early enough, throat cancer can often be completely eliminated in the course of a surgical procedure. Today, so-called transoral laser surgery is often used here, which enables the tumor to be removed with the help of an endoscope and a special CO2 laser. More serious illnesses are usually treated with a combination of radiation therapy and surgery. It is not uncommon for the surrounding tissue structures to be affected at the time the diagnosis is made, so that these are also removed during the operations. This also applies to the cervical lymph nodes, since metastasis often occurs here. If throat cancer is already well advanced, a combination of radiation and chemotherapy is used. In the case of throat cancer with metastasis, the therapy often focuses on palliative care for the patient, since healing is no longer possible.
Naturopathy for throat pain
Naturopathy relies primarily on herbal active ingredients for inflammation of the pharynx and associated throat pain. According to the German Central Association of Homeopathic Doctors (DZVhÄ), preparations made from sage leaves or chamomile flowers, for example, have proven effective against inflammation of the pharynx. Prepared as medicinal tea, after cooling, they are also suitable for gargling several times a day. In addition, mouthwashes with myrrh tinctures from the DZVhÄ are recommended as they have a “disinfectant and mucous membrane tanning effect”. In the case of inflammation of the pharynx mucosa, herbal medicine also relies on the effects of tinctures from the roots of the ratanhia shrub, which are used for gargling.
Numerous homeopathic remedies such as Hepar sulfuris, Mercurius solubilis or Kalium bichromicum are also available to treat inflammation of the pharynx. However, the selection should be based on the symptoms and should only be left to experienced therapists. From the area of the Schüssler salts, the Schüssler Salt No. 9 (sodium phosphoricum) has proven particularly effective against inflammation of the pharynx. (fp)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Dipl. Geogr. Fabian Peters
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