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, which can radiate to the tongue. The patient's symptoms of long-standing throat pain, lack of systemic symptoms, and transient relief with lidocaine swish and swallow support this diagnosis. The callus formation on the vocal cords may be related to chronic throat clearing or strain.
- Other Likely diagnoses
- Laryngopharyngeal reflux (LPR): Although the patient is on PPI therapy, LPR can be resistant to treatment, and the symptoms of throat pain and callus formation on the vocal cords are consistent with this diagnosis.
- Temporomandibular joint (TMJ) disorder: TMJ disorders can cause referred pain to the throat and tongue, and the patient's symptoms of transient relief with lidocaine swish and swallow may suggest a musculoskeletal component.
- Oral or pharyngeal dysphagia: The patient's symptoms of throat pain and difficulty swallowing may be related to a swallowing disorder, which can be caused by a variety of factors, including neurological or muscular conditions.
- Do Not Miss diagnoses
- Oropharyngeal or hypopharyngeal cancer: Although the patient has no systemic symptoms and an unremarkable EGD, it is essential to rule out cancer, particularly in an older adult with persistent throat pain.
- Thyroid or parathyroid disease: Thyroid or parathyroid disorders can cause throat pain and should be considered, especially if the patient has a history of thyroid disease or abnormal calcium levels.
- Eagle syndrome: This rare condition is caused by an elongated styloid process and can cause throat pain, dysphagia, and other symptoms.
- Rare diagnoses
- Sjögren's syndrome: This autoimmune disorder can cause dry mouth, throat pain, and other symptoms, but it is less likely given the patient's lack of other systemic symptoms.
- Glossopharyngeal neuralgia: This rare condition is characterized by sharp, stabbing pain in the throat and tongue, but it is typically more episodic and severe than the patient's symptoms.
- Pharyngeal or esophageal diverticulum: These conditions can cause throat pain and dysphagia, but they are less likely given the patient's unremarkable EGD and lack of other symptoms.