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Throat pain, near tonsil, accidentally inhaled sodium hydroxide. What could have happened and what can I do?

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Hi

I'm a 27 year old white woman living in Scandinavia.

One cold winter a few years ago, I started experiencing pain in my throat. I would describe the pain as sharp and I could feel it out to my ear. The location of pain is somewhere near the left side of my tonsil. I went to three (3) different doctors but no one could see anything strange nor help me. When winter passed and it became warmer, the pain went away. For some years now, I’ve had this problem returning every cold winter and then again disappear when it gets warmer. Then the following happened this year in May.

3 weeks ago, I opened up a bottle of Mr Muscle cleaner which containes sodium hydroxide (NaOH) and while pouring it out, I accidentally inhaled some of it and immediately started to feel pain in my throat, the same kind of pain I usually feel during cold winters. I tried to wash my mouth/throat using water but it didn't take the pain away.

The pain is specifically located to one area behind/above my left tonsil (marked in red on picture3). As seen in picture1 (which is the same as picture 3 but unedited), there are two holes and I think this is the main area where the pain comes from. If I put a toothstick into the holes (red circles market in picture 3), the pain gets worse. The pain is sharp and also gets worse when I inhale and I can even feel the pain out in my ear. If I talk, the pain gets worse as well. If I lay on my back with my head down looking up, then sometimes the pain goes away but it always comes back again when I stand up again.

In the pictures, the tonsil and the area in which I have pain looks a bit yellow but that's only in the pictures, in real life it does not look like that. To be able to see the area of pain, I have to push a bit with my finger to the right side. Picture 2 shows what my throat looks like when looking into it without touching it. In pictures 1 and 3 (which are the same) I’ve had to use my fingers in order to see the area of pain.

As I mentioned earlier, it’s been three weeks now since I opened the bottle with the cleaner and the pain is still there. Could you please give me some advice on this? What could have happened and what can I do to make the pain go away?

Please note that the type of pain I experience during cold winters and the pain I have now from accidentally inhaling the cleaner is the same kind of pain I feel.

Regards
Posted Sun, 17 Jun 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 7 hours later
Hi,

Thank you for your query.

1. The symptoms that you are describing seem to be related to Glossopharyngeal and partially Trigeminal Neuralgia.

2. The area that you are referring to in the images are the normal tonsillar crypts. The upper one is the largest known as the Crypta Magna. These sensation to these areas are specifically supplied by the Glossopharyngeal Nerve.

3. If your ears are normal on examination, the your ear pain is referred pain. Get a throat examination to rule out Tonsilloliths.

4. Get a Neurologist's opinion. It may also be post herpetic neuralgia.

5. Kindly let me know the results of your investigations. This will help in suggesting further treatment.

I must emphasize that in a vast majority of patients of neuralgias, the cause is never found. However there are further treatment options. The pain killers for neuragias are different from normal painkillers and include amitriptyline, carbamazepine and gabapentin. These should strictly be taken only under medical supervision.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Throat pain, near tonsil, accidentally inhaled sodium hydroxide. What could have happened and what can I do? 7 days later
Hi Doctor, thank you for your opinion.

I have not yet had the time to see a Doctor to rule out the possibilities of Tonsilloliths or herpetic neuralgia. I do however have some follow up questions:

1. Do you have experience from patients who have tonsilloliths and have the symptoms I am describing, i.e. pain gets worse from touching the area, pain gets better when laying down, pain gets worse during winter, pain goes away in the summer? What kind of treatment do you recommend?

2. Do you have experience from patients who have neuralgia and have the symptoms I am describing, i.e. pain gets worse from touching the area, pain gets better when laying down, pain gets worse during winter, pain goes away in the summer?

3. Is there any other treatment for neuralgia which does not involve taking pills or operation?

Regards
 
 
Answered by Dr. Sumit Bhatti 20 hours later
Hi,

Thank you for writing back.

1. I doubt you will be able to figure this out without seeing a doctor.The possibility of Glossopharyngeal neuralgia, chronic tonsillitis, tonsilloliths, post-herpetic neuralgia and temporomandibular joint (TMJ) must be ruled out by your physician.

2. For example, it is difficult to see if the anterior pillar of your tonsils is congested (signifying chronic tonsillitis) or just due to handling and abrasions while clicking the image. Repeat examinatiosn will confirm or rule out this. Anterior pillar congestion is only one of the signs of chronic tonsillitis. Your physician will be able to palpate the lymph node of the tonsil (Jugulo Digastric lymph node) in the neck near the angle of the jaw. The presence or absence of tenderness and pain is also important to elicit.

3. Chronic tonsillitis or Tonsilloliths that do not respond to treatment may require tonsillectomy. Glossopharyngeal neuralgia ma be due to malfunction of the nerve or external causes such as a blood vessel pressing on the nerve as it exits the brainstem.There may be an enlarged styloid process (Eagle's Syndrome). The TM Joint also lies between this area and the ear. If your ear examination is normal, then this will be referred pain.

4. Yes, pain worsening on touch, on lying down and worse in winter are common complaints of patients with neuralgias. Initially many patients neuralgic pain only in certain positions of the head or while swallowing. Without active treatment, some improve and some start experiencing pain without change in position. whether it may improve spontaneously without any treatment depends upon the cause.

5. Kindly let me know the results of your examinations and investigations. This will help in suggesting further treatment.

I hope that I have answered your queries. If you have any further questions, I will be available to answer them.

Regards.
Above answer was peer-reviewed by
 
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