From the Guidelines
The initial workup for chronic throat pain should include a thorough history and physical examination, focusing on duration, aggravating factors, associated symptoms, and medical history, as recommended by the American Society of Clinical Oncology 1. An oropharyngeal examination and flexible laryngoscopy are essential to visualize the throat structures. Laboratory tests may include complete blood count, erythrocyte sedimentation rate, and thyroid function tests. For treatment, start with lifestyle modifications such as avoiding irritants (tobacco, alcohol, spicy foods), maintaining adequate hydration, and using a humidifier. First-line medication typically includes proton pump inhibitors like omeprazole 20mg once daily for 4-8 weeks if laryngopharyngeal reflux is suspected, as suggested by the AGA clinical practice update on the diagnosis and management of extraesophageal gastroesophageal reflux disease 1. For pain management, acetaminophen 500-1000mg every 6 hours or ibuprofen 400-600mg every 6-8 hours can be used. Throat lozenges containing benzocaine or menthol may provide temporary relief. If allergy is suspected, try cetirizine 10mg daily or fluticasone nasal spray 1-2 sprays per nostril daily. Persistent symptoms beyond 2-4 weeks warrant referral to an otolaryngologist for further evaluation, which might include imaging studies or endoscopy to rule out serious conditions like malignancy, chronic infection, or neurological disorders, as recommended by the ACCP evidence-based clinical practice guidelines for chronic cough due to gastroesophageal reflux disease 1. This approach addresses the most common causes of chronic throat pain while ensuring serious pathologies aren't missed. Some key points to consider in the workup and treatment of chronic throat pain include:
- Conducting an initial comprehensive pain assessment, including an in-depth interview to explore the multidimensional nature of the pain 1
- Considering the potential manifestations of extraesophageal gastroesophageal reflux disease, such as laryngeal/ENT symptoms, pulmonary symptoms, and dentition symptoms 1
- Using a multidisciplinary approach, including collaboration with otolaryngology, gastroenterology, allergy/immunology, and speech pathology, to evaluate and manage patients with suspected extraesophageal gastroesophageal reflux disease 1
- Assessing the response to empiric treatment and considering further evaluation, including objective investigation for GERD, if symptoms persist 1
From the Research
Initial Workup for Chronic Throat Pain
The initial workup for a patient with chronic throat pain involves a thorough history and physical examination to identify potential causes. According to 2, common causes of chronic sore throat include chronic tonsillopharyngitis, gastroesophageal reflux disorder, submandibular sialadenitis, and laryngopharyngeal reflux disorder.
Diagnostic Tests
Diagnostic tests such as throat culture and rapid antigen detection testing can be used to diagnose streptococcal pharyngitis, as mentioned in 3. The modified Centor score can be used to help physicians decide which patients need no testing, throat culture/rapid antigen detection testing, or empiric antibiotic therapy.
Clinical Guidelines
Clinical guidelines, such as those developed by the American and European professional associations, can help medical professionals choose among available techniques to diagnose strep throat, as discussed in 4. However, guidelines for diagnosing GABHS vary significantly, and there is substantial evidence that most physicians do not follow any published guidelines.
Treatment Options
Treatment for chronic throat pain depends on the underlying cause. For streptococcal pharyngitis, antibiotics such as penicillin and amoxicillin are first-line treatments, as recommended in 3 and 5. However, the use of antibiotics for GABHS remains a controversial question, and there is no clearly superior management strategy for strep throat, as mentioned in 4.
Key Considerations
Key considerations in the workup and treatment of chronic throat pain include:
- Taking a thorough history and physical examination to identify potential causes
- Using diagnostic tests such as throat culture and rapid antigen detection testing to diagnose streptococcal pharyngitis
- Following clinical guidelines to choose among available techniques to diagnose strep throat
- Considering the use of antibiotics for GABHS, while minimizing the unnecessary use of antibiotics
- Evaluating patients with worsening symptoms after appropriate antibiotic initiation or with symptoms lasting 5 days after the start of treatment, as recommended in 5