An Otolaryngologic Quandary: Diagnosis and Treatment of Pain Syndromes of the Head and Neck

It is important not to throw antibiotics at every inflammatory condition in the oropharynx just in case the cause may be bacterial, he said.

Trauma can also cause oropharyngeal pain, either by ingesting foreign bodies such as fish bones or by a blunt or penetrating (eg, knife or gunshot wound) trauma to the neck. Because a foreign body like a fish bone can scratch the pharyngeal muscosa long after the bone leaves the body, scanning is needed to show persistence or absence of the bone, said Dr. Donald.

click for large version

Table 2. Syndromes Causing Oropharyngeal Pain

Oropharyngeal pain that arises from cancer of the oropharynx will cause pain, especially when the cancer becomes ulcerated. Often the only symptom of cancer in this region will be ear pain arising from the Arnold’s and Jacobsen’s nerves.

Table 2 lists the various syndromes causing oropharyngeal pain and their distinguishing features.

One final syndrome that, according to Dr. Donald, has pretty much gone out of fashion, is Eagle’s Syndrome. A type of glossopharyngeal neuralgia, pain associated with this condition is often initiated by touching a trigger point, usually at the base of the tongue or in the lateral pharynx. Patients describe the pain as stabbing initially followed by burning sensation. Treatment can include topical application of cocaine to the pharynx or injection of xylocaine, or surgical treatment.

Dr. Donald no longer treats this syndrome surgically because of lack of long-term pain relief, and recommends psychological counseling for possible underlying anxiety or depression.

©2009 The Triological Society