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.
- Musculoskeletal Pain: The patient's symptoms could be related to musculoskeletal issues, such as temporomandibular joint (TMJ) disorder or cervical spine disease, which can refer pain to the throat and tongue.
- 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 evaluation, such as a thorough head and neck examination, imaging studies, or a repeat biopsy, may be necessary to rule out cancer.
- Eosinophilic Esophagitis: This condition can cause throat pain and dysphagia, and although the EGD was unremarkable, it may not have been performed with the specific intent of diagnosing eosinophilic esophagitis. This diagnosis should be considered, especially if the patient has a history of atopy or asthma.
- Rare diagnoses
- Nutcracker Esophagus: This rare condition is characterized by high-amplitude peristaltic waves in the esophagus, which can cause chest pain and dysphagia. Although it is unlikely, it could be considered if other diagnoses are ruled out.
- Glossopharyngeal Neuralgia: This rare condition is characterized by sharp, stabbing pain in the throat, tongue, and ear, often triggered by swallowing. It is usually related to compression of the glossopharyngeal nerve and is a diagnosis of exclusion.