What causes a persistent red throat with normal test results?

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

You have been experiencing chronic, recurring redness in your throat for the past eight months. Despite normal blood tests and no issues with pharyngeal function or swallowing, the situation is complex due to your medical history, which includes a gastrostomy, esophagogastric junction (OGJ) incompetence, a 3 cm hiatal hernia, significant use of proton pump inhibitors (PPIs), and chronic use of nasal steroid sprays.

Persistent throat redness often indicates underlying chronic irritation rather than infection, and several factors may be contributing to your symptoms:

Hiatal hernia and OGJ incompetence: These conditions can lead to acid reflux, particularly at night. This can silently irritate the throat via laryngopharyngeal reflux, even in the absence of pain during swallowing. Chronic exposure to acid, even without classic GERD (gastroesophageal reflux disease) symptoms, can result in ongoing redness and inflammation in the throat or voice box.

Proton pump inhibitors (PPIs): While PPIs help to reduce stomach acid, research indicates that they do not consistently alleviate throat symptoms linked to reflux. Recent studies show that throat redness and discomfort may persist despite aggressive PPI therapy, suggesting that non-acidic causes or ongoing reflux may be at play.

Nasal steroids: These medications may sometimes lead to localized dryness and mild mucosal changes, though they are generally considered safe. Occasionally, they can contribute to throat dryness or irritation, particularly if runoff from the spray reaches the back of the throat.

Environmental and allergic influences: Chronic pharyngitis, or throat inflammation, can result from

environmental factors like air pollutants, smoke, allergens, or chronic rhinosinusitis, even in the absence of pain or swallowing issues. Such irritants are common in urban settings and can lead to throat redness.

Postnasal drip: The use of nasal sprays and underlying sinus or allergy problems could be causing mucus to drain down the back of your throat, leading to chronic redness without significant other symptoms.

Using PPIs alone may not resolve throat redness related to reflux. Non-acidic pepsin reflux, mechanical irritation, or associated allergies and sinusitis may also contribute to the condition, making a multidisciplinary approach appropriate.

To manage these issues:

1. Address any nasal dryness through saline sprays, humidification, and optimizing your technique for using steroid sprays.

2. Avoid irritants such as smoke, dust, and pollution, and consider reviewing your allergy management.

3. For your hiatal hernia and reflux, lifestyle modifications such as adjusting sleep position, managing weight, changing meal timing, and identifying dietary triggers can be discussed with your gastroenterologist. In severe cases, surgical options may also be considered.

Overall, your symptoms are likely due to chronic reflux and irritation from your hiatal hernia, possibly worsened by nasal sprays and environmental or allergic triggers, rather than an infection or systemic illness.

I hope this answers your query. Feel free to reach out anytime.

Thank you.