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Ear, Nose, and Throat Disorders

Throat

03/06/2006

Question:

I have a burning feeling in the back of my throat. It comes and goes. Sometimes I have it for months off and on. I have seen to throat doctors, both could`nt find anything, they looked with one of the flexible scopes. I do get a small tiny bit of clear salty tasting mucous in my throat.I don`t have allergies that I am aware of and am healthy.This is a bothersome problem wondering if you know what it is.

Answer:

Several things come to mind with the symptom of a burning throat. First would be acid reflux. Acid from the stomach commonly spills/refluxes into the esophagus. Most of this is normal; the esophagus has protective mechanisms to tolerate the acid. It can become pathologic if these mechanisms are overwhelmed, and it causes symptoms of esophagitis. If the acid spills higher, past the esophagus, and into the throat (pharynx) and the voice box (larynx), the condition is called laryngopharyngeal reflux. Symptoms include hoarseness, throat clearing, phlegm, cough, problems swallowing, a feeling of a lump in the throat, and a burning sensation in the mouth. Symptoms felt by a patient and signs detected by a doctor on exam do not always correlate, so sometimes empiric treatment with strong anti-acid medications are needed (proton pump inhibitors). Another problem causing burning in the throat would be a neurologic disorder called a neuropathy. Nerves that give sensation to an area of the body become irritated and act as though they are being stimulated and give pain messages with a cause. This can also happen in the throat, mouth, or tongue area. These are difficult to diagnose and are usually diagnosed after other things are ruled-out. The doctor must investigate to find out if there is anything can be found that is irritating the nerve, but many times nothing is found. The neuropathy can be treated with various medications. Relief is not quick and may take weeks to months until the right medication and the right dose is found. Another reason for the burning could be allergies and post nasal drip. Not all allergies are manifest with the more common symptoms of runny nose, itchy nose and eyes, sneezing. Palate itching is also very common. Palatal burning can also be seen. The symptoms may be helped with antihistamines and nasal topical steroid sprays. For severe episodes, a short course of oral, systemic steroids may help. Allergy testing may be needed to further delineate the allergan. This can help with avoidance of the allergan or starting with immunotherapy (allergy shots). I agree with the need to see a throat specialist. Sometimes it takes a prolonged time to find the problem and additional time to treat. Be patient, hang in there.

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Response by:

Michael J Wolfe, MD Michael J Wolfe, MD
Assistant Professor
College of Medicine
University of Cincinnati