Can pain in the back of throat and difficulty in swallowing be signs of tendinitis?
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Good day The irony is: I am a GP myself and have a preal problem. Horrible pain in the back of my throat since 8 weeks. Started with pain left in throat, radiating to left ear, almost only while swallowing. No fever. It came while being treated with ciproxin for an urinary tract infection. Pain became gradually worse, no hoarseness. I referred myself to an ENT who did a nasal flexible laryngoscopy: no abnormalities, maybe a few red 'herpetian spots'. A few weeks later still havy swallowing pain > CT contrast of the neck region > no abnormalities. Laryngoscopy repeated: no abnormalities. Recently been to an academic centre ENT who looked with a nonflexible scope in the farynx: no abnormalities. His conclusion: some kind of 'tendinitis' from the muscles of the voicebox. Ibuprofen 3d600 for a month and then return to him. I am gradually becoming crazy of the swallowing pain. I notice that when I 'support' my adam's XXXXXXX in going upwars while swallowing that it is a bit less painful. Speaking hurts, swallowing hurts, and pushing my adam's XXXXXXX hurts. Ibuprofen in high dose reduces the pain with 50-60 percent but last for only three hours. I cannot find anything on the internet that resembles my problem. Am I the only patient with this? Myself being a GP (Holland) and not getting better after 8 weeks now makes me exhausted and without any hope, which is totally not my style... Any suggestion?
Posted Tue, 11 Feb 2014 in Ear, Nose and Throat Problems
Answered by Dr. Prahlad Duggal 2 hours later
Brief Answer: Descriptive Detailed Answer: Hi, Thanks for the query. I share your concern and the frustration being yourself a doctor. Your symptoms and examination findings are not suggestive of a routine diagnosis. In my opinion, you may be suffering from some inflammation involving the cartilages of the larynx. The reason, I can not define but your description goes in favour of chondritis as tendinitis does not explain things and as such tendinitis of muscles of voice box is not heard of and if supposedly true still does not explain all your pain. The above statement is my personal opinion and a literature reference/evidence for isolated chondritis of larynx will be difficult to find. Please do steam inhalation, antiseptic with local anaesthetic gargles and proton pump inhibitors. If this does not give you relief, I would suggest a short course of steroids with antibiotic cover, empirically. I am again reiterating that this treatment I am suggesting empirically. Feel free to ask another query. Regards
Follow-up: Can pain in the back of throat and difficulty in swallowing be signs of tendinitis? 23 hours later
Hello Collegue, thanks for your reply. I have a few questions. 1) Could there be an infection while a laryngoscopy is 'normal'. In other words: does it make sense to try an antibiotic, while the ENT says 'there is no logic in that because the lining of the throat is not inflammated' and 'totally normal'.? 2) The pain started slowly while taking a 3 weeks coarse of ciproxin for u UTI. Does that relate to having a superinfection of one sort or another, see also 1)? 3) Yawning, sneezing and snouting with pressure gives a terrible pain in the larynx which radiates to the back of my head. Swallowingpain is worsened immediately after yawning, sneezing etc, and then lessens a bit. 4) swallowing food gives more pain than saliva. Food passes well. Pain does radiate to back of head. 2d500mg naproxen makes the pain a lot better, which I do since yesterday. 5) Fysiotherapist says that all muscles of the larynx, sternocleido etc. are 'hard'. What I'm surprised of that this seems to be a unique diagnosis (I find nothing on the internet on the subject of 'strained muscles larynx' or something like it, certainly not as far as swallow pain is concerned, while it seems to me to be a potentially 'popular' diagnosis. 6) how does the steroid/ab regimen look like? Thanks!
Answered by Dr. Prahlad Duggal 1 hour later
Brief Answer: Descriptive Detailed Answer: Dear, There antibiotic I advised is to prevent any superadded infection while you are taking steroids. Otherwise also the inflamed mucosal lining of the larynx is usually a laryngitis like condition which I am not suspecting. I meant perichondritis and there is no question of the laryngeal lining being hyperemic in perichondritis. Laryngoscopy in any case will be normal in this. But again to mention, I am suspecting perichondritis just on history and there is no other evidence. Point 3 in your query can not be explained by tendinitis of laryngeal muscles. Sternocleidomastoid is not a laryngeal muscle and is not attached to the larynx. Spasm of the neck muscles does not cause such severe pain as you are describing. I can try explaining pain on food swallowing by saying that food bolus will pass through the cricopharynx and larynx moves upwards during swallowing and can lead to pain. But a caveat is that during fluid intake also the larynx moves upwards. Difference can be that bolus will put more pressure on the larynx. There no muscles of larynx which can become tense as the intrinsic muscles spasm produces different symptoms and extrinsic muscle spasm is not a known entity. Sternocleidomastoid spasm produces pain on neck movements but can produce some pain on swallowing but character of that pain is not that severe. Steroid regimen I would suggest: Tablet Prednisolone 30mg or equivalent for three days, then 20mg for three days and then 10mg for three days. Antibiotic like Amoxycillin plus clavulinic acid for the entire period along with analgesics. Still I am suggesting entirely on empirical basis and a trial of this treatment will give a clearer picture. Feel free to ask another query. Regards