What is the basic treatment for a 25-year-old male with a stable condition, presenting with an 8-day history of throat discomfort characterized by a tingling sensation, dysphagia, and no fever, without enlarged tonsils and normal vitals?

Management of Throat Discomfort in a Young Adult

For a 25-year-old male with 8-day history of throat discomfort characterized by tingling sensation and dysphagia without fever or enlarged tonsils, empiric treatment with a short course of anti-inflammatory medication and symptomatic relief is recommended as first-line management.

Initial Assessment Considerations

When evaluating this patient, several key factors should be noted:

• 8-day duration of symptoms (subacute)
• Normal vital signs
• No fever
• No tonsil enlargement
• Discomfort while eating (dysphagia)
• Tingling sensation in throat
• Cost sensitivity

Recommended Treatment Plan

First-line Treatment (Without Investigations)

1. Anti-inflammatory therapy:

   • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen 400mg three times daily for 5-7 days to reduce inflammation and discomfort

2. Symptomatic relief:

   • Salt water gargles (1/2 teaspoon salt in warm water) 3-4 times daily
   • Throat lozenges containing benzocaine or menthol for local anesthesia
   • Adequate hydration with warm fluids

3. Dietary modifications:

   • Soft, non-irritating foods
   • Avoid spicy, acidic, or very hot foods
   • Avoid alcohol and smoking

Follow-up Plan

• Review after 1 week as planned
• If symptoms persist or worsen, proceed with targeted investigations

Differential Diagnosis to Consider

1. Viral pharyngitis: Most common cause of throat discomfort without fever or significant physical findings 1

2. Gastroesophageal reflux disease (GERD): Can present with throat discomfort and dysphagia 2

   • Consider adding a proton pump inhibitor (e.g., omeprazole 20mg once daily) if reflux symptoms are present

3. Globus pharyngeus: Sensation of a lump in the throat without actual obstruction 3

4. Functional dysphagia: More common in young adults with normal physical examination 1

5. Early eosinophilic esophagitis: Can present with dysphagia and throat discomfort 2

When to Consider Further Evaluation

If symptoms persist beyond the 1-week follow-up, consider:

1. Endoscopic evaluation: To assess for structural abnormalities, especially if dysphagia worsens 2

2. Barium swallow study: If structural abnormalities are suspected 2

3. pH monitoring: If GERD is suspected as the underlying cause 1

Important Caveats

• Watch for red flags: Development of fever, severe pain, inability to swallow, drooling, or respiratory symptoms requires immediate evaluation 2

• Foreign body sensation: While this can be functional, it occasionally represents pathology requiring intervention 4

• Cost-effective approach: The recommended initial management is appropriate for cost-sensitive situations, as it addresses the most common causes without expensive investigations 5

This approach balances the need for appropriate treatment with cost considerations while ensuring patient safety through planned follow-up and clear guidance on when further evaluation is necessary.