UNUSUAL CAUSES OF A SORE THROAT
MANY OF US ARE FAMILIAR WITH – AND HAVE PROBABLY EXPERIENCED – THE common causes of a sore throat. These include viral infections which lead to an inflamed throat often accompanied by fever and phlegm; acute tonsil infections which cause a sore throat and a hoarse voice; sinus infections where mucus falls back into the throat. There are, however, lesser known causes of a sore throat that one should be aware of as they are fairly common and may lead to further problems if left untreated.

Unusual causes of a sore throat include:
  • An abscess on the tonsils: This could cause a sore throat on either the left or right side of your throat and the sore throat is usually accompanied by difficulty in opening the mouth. Another possible reason for this one-sided sore throat is an ulcer.
  • A change in voice: It is quite common to have a hoarse voice temporarily when you have a sore throat. However, if your voice does not return to normal, this may suggest that there is a growth that has spread from your throat to your larynx (voice box). There may be nodules on your vocal cords or the change in voice may be due to gastric reflux.
  • Difficulty in swallowing: A sore throat that lasts several weeks or longer and is accompanied by swallowing difficulties could be indicative of a tumour.
  • Pain in the ears: The throat and the ear share the same nerve, so it is possible to have an ulcer in the throat causing both a sore throat and pain in the ears. It is also possible for one to have pain in the ears without a sore throat.
  • Blood-stained saliva: This could be due to an ulcer in the throat. One would first have to exclude that the ulcer is not causing pain, difficulty in swallowing or a voice change. Once these are excluded, the ulcer should be tested for cancer.
The treatment for a sore throat will depend on the diagnosis. Treating the common causes is a straightforward process; topical medications will be given to the patient to treat the symptoms and sometimes, a dose of antibiotics is necessary. For the unusual causes, the treatment is more varied. For instance, a patient with an abscess on the tonsils will need a dose of antibiotics and may need to get the abscess drained and removed. For a change in voice, swallowing problems, pain in the ears and blood-stained saliva, an endoscopy is needed to confirm the diagnosis. If an ulcer is present, a biopsy will be done, and if it is malignant, it will be removed via surgery and the patient will undergo radio or chemotherapy thereafter. Pain in the ears may also be due to a granuloma (a small area of inflammation in the tissue) which is caused by reflux. Treating the reflux would in turn treat the granuloma. Do note that any ulcer that has been present for three weeks or longer should be tested for cancer.
There is one more cause of a sore throat called globus pharyngeus. Someone with this condition would feel as though there is a lump in his/her throat though the throat itself would not feel terribly sore. Globus pharyngeus in turn is caused by stress or reflux. To be diagnosed with this condition, a patient would have to be excluded of all the causes of a sore throat first (both common and uncommon). The treatment for this condition would be that for reflux, which includes dietary changes such as reducing the intake of caffeine and acidic fruits as well as medication. If you have any of the signs and symptoms discussed above, seek the advice of a medical professional.
A/PROF LUKE K S TAN
Ear Nose & Throat Surgeon

MBBS FRCS (England) MMEDS ci FAMS (ORL)
Head & Neck Surgery (Texas, USA)
Luke Tan ENT - Head & Neck Cancer and
Thyroid Surgery Centre
3 Mount Elizabeth #14-17 Mount Elizabeth Medical Centre. Tel: 6474 6116
www.thyroidsurgery.com.sg