Q. What can be the causes of pain below Adam's apple?
Hello doctor,
I am a 32 year old male with a history of some tonsil problem. About seven years ago, I had both a peritonsillar abscess and mononucleosis around the same time. After that, I began seeing an ENT for some fatigue and for lymph nodes on my neck that were both large and painless. After a few months, the fatigue went away. The ENT sent me twice for fine need aspiration biopsy of the lymph nodes, but it found nothing. He said that my symptoms are due to my body being exhausted from the infections. Years have passed, the lymph nodes never went down, but I am doing fine. Now all of a sudden, I have developed a sore throat. I do not have redness, inflammation or white spots, and it is further down from my Adam's apple and a little to the right. It feels a little tight or sore when I swallow sometimes, and it becomes more pronounced if I turn my head to certain angles and swallow. It really is not all that bad, but considering everything that I have been through in the neck and throat area, I get concerned quickly. I have had this discomfort for about five or six days. Now I know I have to see a doctor and I will. But given this information, how concerned would you be that I might have a tumor in my neck causing this feeling? I am growing very concerned about that. What else could it be? It definitely is not a normal sore throat.
Hi,
Welcome to icliniq.com.
Can you please send me pictures of your throat and of the prescription of the surgery done before? I feel you have recurrent follicular tonsillitis, and you got peritonsillar abscess for the same reason. Chronic throat infection also causes lymph node enlargement, which does not dissolve easily. Other symptoms of recurrent tonsillitis are fever, easy fatigues, and inability to eat. Kindly send pictures of your throat to be surer of the diagnosis.
Thank you doctor,
I have attached a picture of my throat. It is not very clear, but as I said there is no redness, inflammation, or white spots. I have had that before with tonsillitis and do not have it now. In fact, the discomfort I feel does not even seem to be in the back of my throat near my tonsils. It seems much deeper in my throat near Adam's apple. I am worried about throat cancer. I do not smoke, and I know throat cancer at my age is far fetched. But, I cannot understand what else would cause discomfort in that spot. As a doctor, would you think I likely have a tumor or something less serious?
Hello,
Welcome back to icliniq.com.
The picture you uploaded (attachment removed to protect patient identity), is quite normal. The pain near Adam's apple can be due to multiple reasons. It could be due to laryngitis, which is inflammation of the lower throat, due to an infection, chronic reflux, injury while swallowing (say fish bone causing abrasion of the mucosa or any other sharp object), etc. We can rule that out by doing a laryngoscopy. We can rule out any growth, mass or cancer in the region as well. Usually, cancer is accompanied by foreign body feeling, feeling of lump in the throat, visible or palpable swelling, loss of appetite, loss of weight, etc. Considering your age and you being a non-smoker, it is unlikely to be cancer. Your symptoms also do not match. Cancer in larynx region causes a change in voice as well. Next, for the problem you have described, I suggest you try doing the following. 1) Take a good antacid tablet before meals twice daily. Pantoprazole 40 mg or Rabeprazole 20 mg will be good enough. 2) I recommend you use Digene or Mucaine gel (combination of Oxetacaine, Aluminium hydroxide, and Magnesium) two teaspoons after each meal. 3) Temporarily, avoid all cold and spicy foods. 4) Drink plenty of liquids. If tonsils have caused you enlarged lymph nodes and if you have been having tonsil issues for long, discuss with your doctor regarding their removal. Tonsillectomy seems to be indicated in you. Though it is done under general anesthesia, it is a safe procedure. In my set up, I do it using coblation technology, which ensures almost zero bleeding and early recovery. Please note if there is any external visible or palpable swelling in the region, or if there is any fever, loss of weight, appetite, malaise, difficulty in swallowing, globes sensation, difficulty in breathing, cough, breathlessness, etc. Do revert back with the details.
Hello doctor,
Thank you for the reply. I saw an ENT today. He felt my throat, looked at my tonsils, and then gave me a laryngoscopy. He said that everything looked fine, there is just some mucus. Just to be safe he sent me for an ultrasound of the neck to see if anything odd pops up, but he said he fully expects everything to be fine. This is definitely reassuring to me and brings me some peace of mind. Do you think the laryngoscopy and the ultrasound (assuming it comes back fine), are enough to rule out anything cancerous in the throat area fully? What about the tonsils? If there were anything cancerous in the tonsils, would the laryngoscopy show that?
Hello,
Welcome back to icliniq.com.
Yes, laryngoscopy and ultrasound are enough to rule out any growth in the neck in your case. Only if we find any growth in the laryngoscopy or ultrasound, we advise for further investigation. A growth in the tonsils can be seen by routine oral examination. In your case, if the ultrasound is normal, I would advise you to take antacids and multivitamins for a month. Do get back, if you have any doubts about the ultrasound report.
Thank you doctor,
After the ENT visit today, I took a good look at my tonsils and noticed this little bump on the right tonsil pillar. It is about the size of half of a pea. But when I touch it, it feels firm. And there is nothing like it on the other side. Is this something I should be concerned about being malignant?
Hi,
Welcome back to icliniq.com.
Are you having any pain in the throat? If yes, then you might have recurrent chronic tonsillitis because of which you see a little bump on the tonsillar pillar. If you do not have pain, then tonsil is an irregular structure (lymphoid tissue), it has crypts which make it irregular. Your tonsils are enlarged, but a lot of people have normally enlarged tonsils. If it is not troubling you, then need not bother. To be sure of any pus or growth inside tonsils, a CT scan of the neck is required. According to me, if you do not have any pain or irritation in the throat (tonsillar area), you need not bother.
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