Cancer / Oncology Ear, Nose and Throat

What you should know about throat ulcers

At times, a person may have an ulcer in the throat, esophagus, or voice box that can cause problems eating, drinking, chewing, swallowing, or talking.

Many things, including chemotherapy and radiation, fungal, bacterial or viral infections, cancer, stomach acid reflux, and other conditions that cause inflammation and irritation can cause these ulcers.

Ulcers may develop in the throat, esophagus, and the voice box as a result of many conditions and causes.

Fast facts on throat ulcers:

  • Treatment and management of throat ulcers will depend on what is causing them.
  • Prognosis is typically good, especially for those who take their medications and follow their recommended diets.
  • The pain caused by the ulcers can lead to a range of symptoms, such as difficulty eating, drinking, chewing, swallowing, or talking.

Causes

Throat ulcers
Symptoms of throat ulcers may include pain when swallowing, nausea, fever, and a sore throat.

Ulcers found in the throat may be related to or caused by:

  • certain chemotherapy or radiation treatments for cancer
  • bacterial infections
  • fungal infections such as thrush, which is a yeast infection caused by Candida albicans
  • viral infections, such as herpangina (mouth blisters), and hand, foot and mouth disease, which are caused by Coxsackie A virus.
  • conditions such as Behçet’s syndrome, which is an inflammatory disease that causes ulcers to form in the mouth, genitals, and other areas of the body
  • cancer

Ulcers found in the esophagus may be related to or caused by conditions such as:

  • gastrointestinal reflux disease (GERD)
  • the use of certain medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), bisphosphonates, and some antibiotics
  • infections such as Candida species (yeast), Herpes simplex virus (HSV), and HIV
  • over consumption of acidic foods, such as those containing citrus and vinegar, and drinks containing caffeine and alcohol
  • ingestion of corrosive agents, such as ammonia or sodium hydroxide
  • chemotherapy or radiation treatments for cancer (mucositis)
  • excessive vomiting
  • allergies

Ulcers or granulomas found on the voice box may be related to or caused by conditions such as:

  • injury from intubation — where a tube is passed down a person’s throat into the trachea to aid in breathing
  • laryngopharyngeal reflux, an inflammatory condition caused by GERD, where stomach acid gets into the lower throat and voice box
  • excessive coughing or use of the voice
  • cancer


What are the symptoms?

Symptoms associated with throat ulcers may depend on the underlying cause and include:

  • a sore throat
  • fever and chills
  • joint pain
  • difficulty swallowing
  • pain with swallowing
  • stomach acid regurgitation
  • chest pain or burning (heartburn)
  • feeling as if there is a lump in the throat
  • nausea
  • vomiting with or without blood
  • choking sensation
  • voice changes
  • frequent coughing or clearing throat
  • taste changes (acidic or bitter or sour taste in mouth)
  • smelling changes
  • ear pain
  • Diagnosis

In the first instance, doctors will do a physical exam and evaluate a person’s symptoms. They may then need to take throat cultures, using mouth swabs. Sometimes blood tests and urine tests may be required.

However, diagnosis of throat ulcers will depend on the suspected cause of the condition and may include:

  • Barium swallow X-ray: To evaluate for esophageal narrowing, hernias, or mass lesions; this is done by drinking a barium liquid solution that coats the lining of the throat, esophagus, and stomach.
  • Esophageal endoscopy: To evaluate for abnormalities in the esophagus by using a lighted camera that is placed in the esophagus. Biopsies or skin samples may be taken at this time.
  • Laryngoscopy: To evaluate the larynx and hypopharynx (area of the throat where the pharynx and esophagus meet behind the larynx), using a fiber-optic camera or small mirrors.
  • Laryngeal videostroboscopy: To evaluate the vocal cords and voice box with strobe lighting through a laryngoscope and video recording.
  • Panendoscopy: To evaluate the mouth, nose, throat (including the larynx and hypopharynx), esophagus, and trachea for potentially cancerous tumors.
  • Other imaging tests: These may include a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan. In some instances, especially if a doctor suspects cancer, they may recommend a positron emission tomography (PET) scan.


How is it treated and managed?

Acetaminophen for throat ulcers
Acetaminophen may be used as a treatment for throat ulcers.

In some cases, simple lifestyle modifications may be all that is necessary, and these will be discussed in the section below.

However, some types of throat or esophageal ulcers require more extensive medical attention and people should discuss treatment options with their doctor.

Treatment of throat ulcers may include:

  • medications such as antivirals, antibiotics, and antifungals
  • pain-relieving medications, such as acetaminophen
  • prescription mouthwashes containing medications such as the local anesthetic lidocaine

Treatment of esophageal ulcers may include:

  • antivirals, antibiotics, antifungals, or antiparasitics
  • medications to reduce stomach acid production or activity, such as over-the-counter or prescription antacids, H2 receptor blockers, or proton pump inhibitors
  • medications to make the stomach empty faster
  • glucocorticoid therapy
  • surgery in some situations

Treatment of vocal cord granulomas may include:

  • removal of the endotracheal tube
  • vocal therapy
  • medications to treat stomach acid reflux
  • sometimes surgery may be warranted


Home remedies

Lifestyle changes and modifications that can be made to treat and manage the symptoms of throat ulcers may include:

  • avoiding acidic or spicy foods, mouthwash or drinks containing alcohol, and tobacco smoking
  • eating soft, creamy, and mild foods, such as cheeses, mashed potatoes, and yogurt
  • avoiding rough and hard foods, such as chips, nuts, and some fruits and vegetables
  • rinsing mouth or gargling (do not swallow) with a mixture of water, salt, and baking soda
  • eating and drinking lukewarm or cold foods and drinks; frozen fruit or ice pops may be soothing
  • eating sour cream before each meal to coat the mucous membranes
  • staying hydrated by drinking small amounts of liquids throughout the day
  • reducing risk for GERD by maintaining a healthy weight and avoiding irritating, acidic foods, including tomato-based foods, citrus, mint, and chocolates
  • avoiding eating large, fatty meals right before bed

Prevention

woman shows a broken cigarette. Quitting smoking may help with throat ulcers
Avoiding smoking is recommended as it may make throat ulcers worse.

There are measures that people can take to prevent throat ulcers in some cases and may include:

  • Staying healthy: Prevent the spread of communicable illnesses, which can cause infectious throat ulcers, by practicing good hand hygiene and avoiding contact with people who are sick or have an infectious ulcer. Keeping surfaces clean can also prevent the spread of infection.
  • Taking medications properly: Take all medications as directed; avoid taking pills without water, just before lying down and right before sleep.
  • Stop smoking tobacco or drinking alcohol: Avoid or stop smoking tobacco and drinking alcohol, which can make throat ulcers worse and increase a person’s risk for cancers.
  • Manage risk factors: Talk with a doctor about managing any conditions that may lead to a higher risk of developing an ulcer, such as diabetes mellitus.
  • Prevent or manage acid reflux: Maintain a healthy weight, avoid acidic or trigger foods, and avoid large, fatty meals. Elevating the head of the bed with blocks or risers may also be helpful.


Healing time

Each situation is unique. Individuals should discuss the prognosis with their doctor.

Anyone experiencing new or unusual symptoms should contact a doctor as soon as possible, as medical attention may be required.

People experiencing any of the following should contact a doctor:

  • pain unrelieved by over-the-counter medication
  • symptoms not relieved with over-the-counter antacids or other GERD treatments
  • inability to eat or drink
  • sores lasting for more than a few days

Anyone experiencing the following symptoms should seek immediate medical attention:

  • chest pain, shortness of breath, racing heart, or lethargy
  • a headache, vomiting, neck pain, or a stiff neck
  • changes in behavior and flu-like symptoms
  • vomiting large amounts or vomiting bright red blood
  • vomit that has the appearance of ground coffee

Takeaway

Throat ulcers can be caused by a variety of conditions and medical treatments. They can cause pain, which, at times, can be severe and debilitating. Though painful, treatment and prognosis are typically good, but this depends on the condition that is being treated.

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