Differential Diagnosis for 72-year-old Woman with Throat Pain
- Single most likely diagnosis
- Globus Pharyngeus: This condition is characterized by a sensation of a lump or discomfort in the throat, often radiating to the tongue, without an identifiable cause. The transient relief with lidocaine swish and swallow, lack of systemic symptoms, and unremarkable EGD support this diagnosis. The callus formation on the vocal cords could be related to chronic throat clearing or strain, which is sometimes seen in globus pharyngeus.
- Other Likely diagnoses
- Laryngopharyngeal Reflux (LPR): Despite being on PPI therapy, LPR could still be a contributing factor, especially if the patient has a history of non-compliance or the dosage is inadequate. The symptoms of throat pain and callus formation on the vocal cords could be indicative of LPR.
- Temporomandibular Joint (TMJ) Disorder: TMJ disorders can cause referred pain to the throat and tongue area. The lack of systemic symptoms and the specific location of the pain make this a plausible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Oropharyngeal or Hypopharyngeal Cancer: Although the patient has had an unremarkable EGD, it is crucial to consider the possibility of a malignancy, especially given the patient's age and the presence of persistent throat pain. Further imaging or a repeat ENT evaluation with biopsy may be necessary to rule out this diagnosis.
- Eagle Syndrome: This condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause throat pain radiating to the tongue. Although rare, it is a diagnosis that should not be missed due to the potential for significant morbidity if left untreated.
- Rare diagnoses
- Glossopharyngeal Neuralgia: This is a rare condition characterized by sharp, stabbing pain in the throat and tongue, often triggered by swallowing. The patient's symptoms and response to lidocaine could be consistent with this diagnosis, although it is less likely.
- Stylohyoid Syndrome: Similar to Eagle Syndrome, this condition involves inflammation of the stylohyoid ligament, which can cause throat pain. It is a rare diagnosis but should be considered in the differential due to the patient's specific symptoms.