Sore Throat

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What can be the causes of pain below Adam’s apple?

This Premium Q&A, reviewed and published, features a real conversation between an iCliniq user and a physician.

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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.

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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?

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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.

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?

Sore Throat

Isn’t a sore throat the worst? It hurts to talk, eat, drink, breathe – live! It’s possible that you have a throat infection that would require antibiotics, but most sore throats are caused by a virus and just need to run their course. I feel your pain but I promise it will get better as the virus goes away and you get a little sore throat treatment.

Let’s cover the basics of the sore throat:

• Different types of sore throat
• Sore throat causes
• Symptoms of a sore throat
• Sore throat home remedies
• When to call the doctor or seek medical advice
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Types of sore throat

There are three types of sore throat, which is classified by which part of the throat is inflamed and where you’re feeling the pain.

• Laryngitis is swelling of the larynx, which is your voice box or vocals cords. This is located in your throat – protected partly by the Adam’s apple.
• Tonsillitis is swelling or infection of the tonsils, the two pads of soft tissue in the back of your mouth.
• Pharyngitis is swelling of the pharynx, which is at the way back of your mouth and the start of your throat. Behind the tonsils but above the larynx and extends up to the back of the nose as well!
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Sore throat causes

There are multiple things that could be causing your raw sore throat – the number one thing being a viral infection. Typically we’re talking about the cold or the flu here, but it could also include croup, mono, or COVID-19, to name a few. These do not need treatment and simply have to run their course.

Less often, a bacterial infection could be the culprit of your sore throat feeling. The most common is group A streptococcus, which is what causes strep throat. Be in touch with your doctor if you are concerned you may have a bacterial throat infection, because your doctor has to diagnose strep throat after doing a throat culture and it does require antibiotics.

In addition to viral vs bacterial, a sore throat could be caused by allergies, irritants such as chemicals or smoke, acid reflux, dry air – especially if you notice it first thing in the morning and you’re a mouth-breather (try a humidifier!) – or other things that we aren’t going to stress ourselves out with here. Knowledge is power but too much of it can make us worry, so focus on your current symptoms and just talk with your doctor if you think something beyond the common cold is going on.

Symptoms of a sore throat

Things you are likely feeling: scratchy throat, swollen throat, sore throat with or without a fever, sore throat and a cough. It is painful and hurts to swallow. Your voice may be hoarse, you might notice the lymph nodes on the sides of your neck/jaw are swollen, and your throat and tonsils are likely red or inflamed. You may even see white patches on the back of your throat. A lot of the accompanying symptoms are caused by the virus, including:

• Body aches
• Headaches
• Fever
• Cough
• Runny or stuffy nose
• Sneezing
• Nausea and/or vomiting
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How long does a sore throat last?

• Typically 4-5 days, which will feel like a lifetime, I know. While there’s no true way to cure a sore throat, there are ways to soothe a sore throat and make things a little more tolerable.
• Remember: you should always stay home from work/school until you’ve been without a fever for 24 hours without the help of medication.
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How to get rid of a sore throat?

• Drink fluids! Add warm drinks such as tea or broth, as well as increasing your water intake. Cold options can feel good too, such as popsicles or ice cream. (Apparently we should avoid caffeine and alcohol, as they can dehydrate you. Sorry to share the bad news, Mom and Dad.)
• Salt water gargle. Mix ¼ teaspoon of salt with 8 oz of warm water. Gargle and spit it out! This is great for soothing a sore throat for adults and kids 6 years and up.
• Cool-mist humidifiers can moisten the air and help prevent a dry throat, which never helps when it is sore. The warm-mist humidifiers increase the risk of a burn, either from the hot steam or from a water spill. It is not proven to be more effective than the cool-mist humidifiers because the heat dissipates too quickly to make a difference by the time we are breathing it in. So go with safety and choose the cool-mist option!
• Hard candy has been shown to soothe a sore throat and be just as effective as a cough drop. Choking hazard here so use your best judgement if offering to a kiddo.
• Rest! Let that body heal while you sleep it out.
• Over-the-counter pain relievers, such as Tylenol or ibuprofen, can help with discomfort.
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Age reminders:

When to call your doctor if you have a sore throat?

• Sore throat for 5 days without improvement.
• Sore throat in kiddos
• Recent exposure to someone with strep throat.
• Blisters, pus, or petechiae (red dots) on the back of the throat.
• Fever, depending on age (0-3 months: >100.4℉; 3-24 months: >102℉; 2 years+: >104℉)
• Signs of dehydration: dry mouth, dry skin, decreased urination.
• Is something else going on? Ear pain? Neck pain? Sinus pain? Rash? Follow your gut and call.

Remember, we’ve got info to help you with ANY symptom! So use your Kinsa app to share more symptoms with me – that’s what I’m here for and nothing makes me happier than helping people feel better!

When to skip the phone call and head to the ER?

• Trouble breathing
• Drooling or difficulty swallowing
• Fever >105℉

Since most sore throats are caused by a virus it remains vital that you always wash your hands, tell those around you to wash their hands, and disinfect the daylights out of your environment. Keep this misery to one person in the household and just hang in there. 24-48 hours should be the worst of it, then hopefully you’ll be on the mend through the rest of the week. I’ll join you with a bowl of ice cream for solidarity’s sake.

Blake Wageman

Blake Wageman, RN, BSN has over 14 years of nursing under her belt, primarily focused on NICU babies and, just as importantly, their worried parents.