Pharyngeal symptoms are primarily caused by diseases of the pharynx, but they can also arise from disorders in adjacent organs or represent localized manifestations of systemic diseases. The main symptoms include sore throat, abnormal pharyngeal sensations, difficulty swallowing, voice abnormalities, and laryngopharyngeal reflux.
Sore Throat
Sore throat is one of the most common symptoms of pharyngeal diseases. It may result from diseases of the pharynx itself, disorders in neighboring organs, or as a symptom accompanying systemic diseases. It is often described as sharp pain, dull pain, burning pain, aching pain, throbbing pain, or distended pain. The severity of sore throat varies depending on the nature and extent of the disease and the individual's sensitivity to pain.
Clinically, sore throat can present as spontaneous pain or triggered pain. Spontaneous pain occurs at rest without any action in the pharynx and is often localized to a specific area of the pharynx, usually stemming from pharyngeal diseases. Triggered pain occurs during pharyngeal activities such as swallowing, eating, or stimulation from devices like tongue depressors. Pharyngeal pain may accompany infections, trauma, ulcers, foreign bodies, malignant tumors, elongated styloid processes, or systemic conditions such as leukemia. Severe pain is commonly seen in acute inflammation, infections of the retropharyngeal space, and advanced stages of hypopharyngeal cancer, and the pain may radiate to the ipsilateral ear.
Abnormal Pharyngeal Sensations
Patients may experience abnormal sensations in the pharynx, such as a foreign body feeling, obstruction, adhesion, itching, or dryness. These sensations often lead to frequent throat clearing or repeated swallowing in an attempt to alleviate the discomfort. A sensation of a foreign body is more noticeable when swallowing saliva, while it is less pronounced when swallowing food, a condition also known as "globus pharyngeus." Common causes of abnormal pharyngeal sensations include the following:
Organic Lesions in the Pharynx and Surrounding Tissues
These include chronic inflammation, pharyngeal keratosis, tonsillar hypertrophy, elongation of the uvula, pharyngeal tumors, and reflux laryngopharyngitis.
Functional Factors
Abnormal pharyngeal sensations can also be associated with neurosis, often intermittently or persistently present. These cases are frequently linked to psychological factors such as fear of cancer, anxiety, or depression, and may also arise due to endocrine dysfunction.
Difficulty Swallowing
Difficulty swallowing is described as the inability to easily swallow food or liquids. The severity of this symptom depends on the nature and extent of the underlying condition. Mild cases may result in occasional difficulty swallowing solid food, often ameliorated with liquids, while severe cases may cause an inability to swallow even liquids, with drooling of saliva. Causes of difficulty swallowing can be categorized into three main types:
Functional Disorders
Any disease causing throat pain is generally accompanied by varying degrees of swallowing difficulty. The more severe the pain, the greater the difficulty in swallowing.
Obstructive Causes
Narrowing of the pharynx or esophagus due to conditions such as tumors or foreign bodies can impede the downward movement of food. Solid food is particularly difficult to swallow, though liquids may still pass through.
Paralytic Causes
Paralysis of the pharyngeal muscles due to central nervous system disorders or peripheral neuritis can result in difficulty swallowing. This may lead to coughing caused by food or liquid entering the trachea, a problem that becomes more noticeable with liquid ingestion.
Voice Abnormalities
The pharyngeal cavity functions as a resonating chamber for vocalization, while the palate and tongue are essential contributors to the process of sound production. The integrity of the pharyngeal structure and its function are crucial for clarity, timbre, and tone of the voice. Defects or diseases involving the pharynx may lead to indistinct speech (severe articulation difficulties), changes in vocal quality (altered timbre), or abnormal noises during sleep (snoring). These are collectively referred to as voice abnormalities.
Unclear Articulation and Altered Timbre
Defects of the lips, teeth, tongue, or palate can result in difficulty or inability to produce certain sounds, leading to unclear articulation. In conditions such as cleft palate or soft palate paralysis, the inability to close the nasopharynx during speech results in open nasality. On the other hand, hypertrophic adenoids, nasopharyngeal polyps, hypertrophic rhinitis, or nasopharyngeal tumors can obstruct the resonance chamber, leading to obstructive nasality. Space-occupying lesions in the pharyngeal cavity (such as abscesses or tumors) reduce resonance, causing speech to resemble speaking with food in the mouth. Similarly, infants crying with such lesions may produce a duck-like sound.
Snoring
Snoring occurs when soft tissues such as the soft palate, uvula, and base of the tongue vibrate with airflow during sleep, producing rhythmic sounds.