Sore throat is an uncomfortable tickling, scratching, stinging, tingling sensation in the pharynx or larynx. They are often combined with coughing and precede the appearance of pain. Tickling occurs in diseases of the ENT organs, bronchi, lungs, thyroid gland, upper gastrointestinal tract, a number of occupational diseases and allergies. In order to clarify the causes of discomfort in the throat, endoscopic, X-ray, ultrasound, microbiological and serological diagnostic methods are used. To alleviate the condition, steam inhalations, gargling with herbal decoctions, correction of the diet, taking anesthetic lozenges are indicated.
General information
Tickling in the throat is felt as discomfort in the form of tingling, tickling, burning, stinging in the area of the palatine arches, tonsils, the back wall of the pharynx or slightly lower in the larynx. Often the symptom is combined with a slight cough that occurs involuntarily or is taken to get rid of unpleasant sensations. With the progression of symptoms, a painful dry cough may appear. In emotional patients with a low pain threshold, the tickling is quickly replaced by a sore throat of varying intensity.
The symptom is often preceded by contact with infectious patients, staying in an unfavorable epidemiological situation. Less often, tickling develops after irritating substances get on the mucous membrane of the throat or injury while eating. Discomfort in the larynx can become one of the first symptoms of diseases in which the underlying parts of the respiratory system and adjacent organs are involved in the pathological process, a harbinger of infections, including those that are hard to stop – swine and Hong Kong flu, West Nile fever, etc.
Causes of sore throat
The occurrence of the symptom is usually associated with various inflammatory and non-inflammatory processes both in the respiratory tract and in the organs that are located next to the pharynx and larynx. Less often, irritation of the pharyngeal mucosa has a physiological origin and is caused by the use of spicy or too hot food, inhaling frosty air when walking fast, running. The tickling caused by the dryness of the mucous membranes is observed with a decrease in the overall humidity in the room.
Inflammation of the oropharynx
Pathological processes in which the oropharyngeal mucosa is involved are the most common cause of tickling. The development of the symptom is caused by irritation of the nerve endings due to edema and infiltration of the mucosa, the release of inflammatory mediators, vasodilation and peeling of the affected epithelium. Tickling occurs against the background of diseases such as:
- Respiratory viral infections. Most pathogens of ARVI have a high tropicity to epithelial cells of the oropharynx and larynx. After the introduction of influenza viruses, parainfluenza, rhinoviruses, and other viral particles, a local inflammatory reaction is formed, accompanied by tickling, and then pain in the throat. In some diseases, discomfort in the throat precedes the defeat of other systems: the digestive tract (rotavirus infection), lungs (coronaviruses), lymphatic tissue (infectious mononucleosis), parenchymal organs and skin (rubella).
- Bacterial inflammation. Sore throat caused by the persistence of bacteria is often observed in streptococcal infection. Palpable discomfort is noted with angina, acute pharyngitis and chronic tonsillitis. Severe tickling caused by the runoff of mucus from the nose and a spasmodic cough is characteristic of whooping cough. Severe nasopharyngitis with severe intoxication is observed in meningococcal infection. Moderate perspiration in combination with other catarrhal phenomena manifests a flu-like form of ornithosis.
- Catarrhal reaction in other infections. Uncomfortable tickling sensations occur at the initial stage of some acute and chronic infectious diseases that cause systemic damage to the body. Flu-like tickling of the throat mucosa is possible in patients with developing viral hepatitis A, pseudotuberculosis and secondary syphilis. A feature of the symptom in such pathological conditions is a frequent combination with general intoxication, arthralgia, myalgia, skin rashes and other signs of multiple organ disorders.
Severe erosive and ulcerative destruction of the epithelium with intense scratching and sore throat is noted in infectious diseases of the mouth and nasopharynx against a background of decreased immunity (pharyngomycosis, lesions of the ENT organs in HIV-infected people). The symptom is felt more pronounced against the background of ARVI during pregnancy, which is associated with the physiological suppression of the body’s defenses and increased emotionality of pregnant women.
Non-inflammatory pathology of the oropharynx
Irritation with the appearance of characteristic scratchy sensations is observed when non—infectious factors are exposed to the mucous membrane – mechanical injury, pressure of volumetric formations. Sometimes the symptom is provoked by eating (damage to solid foods, fish bone), stress, conflict, experiences. In non-inflammatory diseases, there is often no hyperthermia and other signs of general intoxication, but there may be abundant pathological discharge (mucous, bloody discharge).
Perspiration is noted with tissue damage by foreign bodies, the presence of amygdala cysts, benign pharyngeal tumors. In case of a fracture of the upper jaw according to the Le Fore 1 type, tickling sensations are associated with a shift of the soft palate tongue downwards and, as a rule, are combined with nausea, obstruction of the upper respiratory tract. In rare cases, the symptom has a functional origin and develops against the background of a hyperesthetic variant of pharyngeal neurosis, accompanied by a feeling of dryness of the mucous membranes and a lump in the throat.
Diseases of the larynx
The occurrence of uncomfortable tickling sensations is associated with the anatomical proximity of the pharynx and upper respiratory tract, the possibility of ascending or descending spread of inflammatory and destructive processes, vascular reactions. At the same time, perspiration is combined with characteristic voice disorders — dysphonia or aphonia. The causes of the symptom are usually:
- Inflammatory diseases. The specific manifestations of tickling for acute or chronic laryngitis are a feeling of dryness of the mucous membrane, burning, tickling, scratching. The discomfort is initially localized in the upper part of the neck, then it can spread to the back wall of the pharynx. In chronic hyperplastic laryngitis, in addition to scratching and hoarseness of the voice, a feeling of a foreign body is often noted. For laryngotracheitis, a combination of a scratchy sensation and a cough is typical. General intoxication is often expressed slightly or moderately.
- Neurotic disorders. Persistent subjective sensation of tickling tickling in the laryngopharyngeal region is a characteristic sign of voice formation disorders in functional laryngeal paresis. The feeling of discomfort is aggravated by pain, a transient change in phonation. There are no visible signs of inflammatory and other pathological processes, the voice remains sufficiently sonorous during laughter, coughing and crying, other neurotic stigmas are revealed: complaints of headache, emotional lability, fatigue, insomnia.
The occurrence of tickling at the larynx level is also possible with the development of benign tumors, cancer of the larynx and larynx. Such uncomfortable sensations are particularly persistent, combined with progressive voice impairment and breathing difficulties. When the neoplasm is localized in the lower part of the pharynx, there is an abundant saliva separation.
Diseases of the thyroid gland
The anatomical location of the organ in the upper part of the trachea, its innervation by the recurrent laryngeal nerve, the fibers of which provide sensitivity and motor skills of the larynx, contributes to the development of tickling sensations when thyroid tissue is affected. Tickling in the middle and lower part of the throat is accompanied by nodes and cysts of the thyroid gland, papillary cancer, and other neoplasms growing in the direction of the respiratory tract. In the later stages of the volumetric process, breathing difficulties and visible neck deformity are also revealed. Signs of hyperthyroidism are possible: emotional lability, irritability, exophthalmos, tachycardia.
Allergy
Various kinds of discomfort in the nasopharynx and oropharynx are typical for acute atopic reactions and chronic allergic diseases. In the first case, tickling occurs suddenly, combined with nasal congestion, lacrimation, sneezing and itching, most often manifests itself with allergies to dust, pets, pollen of plants. As a concomitant symptom, tickling sensations in the larynx and pharynx are noted during paroxysmal cough with difficulty breathing and expiratory shortness of breath in allergic bronchitis. The cause of the development of tickling with allergies is usually irritation of the mucous membrane due to the release of histamine and other inflammatory mediators by mast cells in conditions of sensitization to a certain allergen.
Bronchopulmonary pathology
The causes of uncomfortable sensations in the pharynx, larynx in diseases of the bronchi and lungs are usually irritation of the mucous membrane when expectorated sputum, other pathological discharge and a reaction to a strong cough get on it. With tracheobronchitis, acute bronchitis, tickling is often combined with rhinorrhea or dryness of the nasopharynx, hoarseness of the voice, pain when swallowing. Symptoms of acute respiratory infections with a feeling of tickling sometimes manifest in the initial stages of some types of pneumonia – atypical mycoplasma and caseous pneumonia.
With aspergillosis tracheobronchitis and interstitial pneumonia, the main clinical symptoms are preceded by persistent discomfort in the throat, larynx with hyperthermia and an incessant feeling of bitterness in the mouth. Perspiration and voice changes on the background of persistent cough, inhalation pain, expiratory dyspnea, are noted in secondary infection in patients with osteochondroplastic tracheobronchopathy. Most pathological processes accompanied by hemoptysis also occur with tickling sensations.
Esophageal lesion
The development of the symptom in patients suffering from esophageal pathology is often caused by the abandonment of gastric contents with violations of the closure function of the cardia. When aggressive secretions and digested food get into the esophageal mucosa, irritation spreads to the above-located departments. In addition, when belching occurs, the acidic contents of the stomach directly affect the pharyngeal epithelium, causing a local response.
Perspiration is observed in gastroesophageal reflux disease, especially against the background of GERD during pregnancy, when there is a higher discharge of liquid gastric chyme. Such scratchy sensations with burning in the larynx, dysphagia, coughing up a large volume of mucus and dysphonia are caused by laryngopharyngeal reflux. Scratching of the pharynx, dry cough, copious saliva, “lump in the throat” are characteristic of esophageal diverticulosis with the formation of pharyngoesophageal sac-like protrusions (Cenker’s diverticulum).
Occupational pathology
Irritation of the laryngopharyngeal mucosa associated with the performance of work duties is observed when inhaling toxic substances and high vocal load. Occupational diseases, in the clinical picture of which a symptom of sore throat is possible, can occur both acutely and chronically. Patients often have voice changes, signs of bronchial and lung lesions. The causes of tickling sensations in the larynx and oropharynx can be:
- Acute poisoning. Acute berylliosis, foundry fever and toxic pulmonary edema begin with a feeling of dryness of the mucous membranes, tickling of the larynx and pharynx, an unusual taste in the mouth, sometimes lacrimation. Subsequently, the clinic is rapidly aggravated by hyperthermia, myalgia, paroxysmal cough, chest pain, and aggravation of the general condition.
- Chronic intoxication. Changes from the laryngopharyngeal mucosa, manifested by perspiration, are possible with pneumoconiosis, respiratory allergies. In patients suffering from occupational bronchial asthma and byssinosis, the symptom is often combined with difficulty inhaling and exhaling, coughing, shortness of breath, and then respiratory failure.
- Defeat of the vocal folds. In specialists whose activities are associated with an overload of the vocal apparatus, perspiration is caused by local hyperplasia of connective tissue. When nodules of the vocal cords appear, in addition to laryngopharyngeal discomfort and burning, the voice becomes hoarse, its fatigue is noted, and an unproductive cough occurs.
Diagnostics
The diagnostic search is aimed at establishing the underlying disease, manifested by a sore throat. The primary examination is usually prescribed by an otorhinolaryngologist (ENT doctor). Specialized examination includes pharyngoscopy, laryngoscopy and rhinoscopy, during which the mucous membrane of the pharynx, larynx, vocal cords and nasal passages are examined to identify possible pathology. If necessary, additional research methods are prescribed to assess the condition of the ENT and other organs, with diseases of which tickling may occur:
- Endoscopic ENT procedures. More detailed information about the degree of possible damage to the mucous membranes can be obtained by endoscopy of the larynx and nasal cavity. If doubtful pathological foci are detected, an endoscopic biopsy of ENT organs is performed, followed by histology of the biopsy.
- Diagnosis of infections. To confirm the infectious genesis of the disease, a smear is seeded from the pharynx to the microflora. Streptatest is used as an express method for detecting beta-hemolytic streptococcus of group A. PCR and IFA have a high diagnostic value.
- X-ray examinations. Fast methods for determining bronchopulmonary pathology are fluorography and chest radiography. In complex diagnostic cases, tomographic examinations (thoracic CT, MRI), lung scintigraphy, bronchoscopy are recommended.
- Ultrasound examination of the thyroid gland. The method is used as a screening, since the occurrence of tickling may be associated with volumetric formations of thyroid tissue. During ultrasound of the thyroid gland, the structure of the organ, its size, diffuse or focal changes are evaluated.
- Endoscopy of the esophagus and stomach. To exclude gastroenterological prerequisites for the appearance of a sore throat and larynx, gastroscopy and esophagoscopy are performed. Visual examination with possible biopsy of suspicious tissues is the fastest and most accurate method of detecting gastroesophageal pathology.
Treatment
Short-term sore throat caused by food errors, inhalation of cold or dry air, and other non-pathological causes usually resolves on their own. To alleviate discomfort, steam inhalations of essential oils using a nebulizer, sprays or lozenges with antiseptic and local painkillers can be used. Before normalization of the condition, it is recommended to limit the use of spicy, hot, sour and salty food, cold and highly carbonated drinks.
With a combination of perspiration and signs of possible infection (sore throat, lacrimation, runny nose, high fever), it is necessary to contact an otorhinolaryngologist or a district therapist (pediatrician), and with a rapid aggravation of the condition, call an ambulance. Before the examination of a specialist, inhalations, gargling with anti-inflammatory herbal decoctions, the use of local painkillers (lozenges, sprays) are allowed. It is important to take care of humidifying the air in the room. Self-medication with antibiotics is strictly prohibited.
