A throat ulcer is an open sore in the throat, esophagus, or voice box. Throat ulcers can develop due to injury or infection in the throat.
Throat ulcers can develop in response to underlying infections or diseases that cause inflammation and irritation in the throat. The treatment for a throat ulcer involves identifying and treating the underlying cause.
This article outlines the causes and symptoms of throat ulcers and their diagnosis, treatment, and prevention. It also addresses a possible link between throat ulcers and COVID-19 and offers advice on when to see a doctor.
Fast facts on throat ulcers:
- Treatment and management of throat ulcers will depend on what is causing them.
- Outlook 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.
Throat ulcers may develop in the following areas:
- the throat, known as the “pharynx”
- the esophagus, which is the tube that connects the mouth and stomach
- the voice box, which contains the vocal cords
Ulcers in the throat
Throat ulcers may develop as a result of the following:
- bacterial infections
- fungal infections, such as oral thrush
- viral infections, such as herpangina, which causes mouth blisters, and coxsackievirus, which causes hand, foot, and mouth disease
- certain inflammatory conditions, such as Behçet’s syndrome, which causes ulcers to form in the mouth, genitals, and other areas of the body
- certain chemotherapy or radiation treatments for cancer
Ulcers in the esophagus
Ulcers in the esophagus may relate to or arise from the following conditions:
- gastroesophageal reflux disease (GERD)
- excessive vomiting
- the use of certain medications, such as:
- non-steroidal anti-inflammatory drugs (NSAIDs)
- some antibiotics
- yeast infections, such as oral thrush
- viral infections, such as herpes simplex virus (HSV) and HIV
- overconsumption of acidic foods, such as those containing citrus and vinegar
- overconsumption of drinks containing caffeine and alcohol
- ingestion of corrosive agents, such as ammonia or sodium hydroxide
- chemotherapy or radiation treatments for cancer
Ulcers on the voice box
A person may also develop ulcers or granulomas on the voice box. A granuloma is a small cluster of immune cells that form in response to chronic inflammation.
Possible causes of ulcers and granulomas on the voice box include:
- injury from intubation, where a doctor passes a tube down the throat and into the trachea to assist in breathing
- laryngopharyngeal reflux, in which stomach acid leaks up into the throat and voice box
- excessive coughing or shouting
The symptoms of throat ulcers depend partly on the underlying cause. Possible symptoms include:
- a sore throat
- the sensation of a lump stuck in the throat
- pain or difficulty swallowing
- choking sensation
- stomach acid regurgitation
- vomiting with or without blood
- changes to taste or smell
- changes to the voice
- frequent coughing or clearing of the throat
- ear pain
- fever and chills
When diagnosing a throat ulcer, a doctor will begin by performing a physical examination and evaluating the person’s symptoms. They may then take a throat swab to test for bacterial or fungal cultures.
Depending on the suspected cause of the throat ulcer, a doctor may also order one or more of the following
- Barium swallow X-ray: This procedure involves drinking a barium liquid solution that coats the lining of the throat, esophagus, and stomach. The barium fluoresces in response to X-ray imaging, allowing a doctor to detect abnormalities, such as ulcers, hernias, or mass lesions.
- Esophageal endoscopy: This procedure involves inserting an endoscope device into the mouth and down into the esophagus. The endoscope is a tube with a light and usually a camera that allows a doctor to see any abnormalities in the esophagus. The doctor can also insert instruments into the tube to collect biopsy samples.
- Laryngoscopy: This procedure involves inserting a laryngoscope device down into the larynx and the hypopharynx, which is the bottom part of the throat. The laryngoscope may have a fiber-optic camera or small mirrors that allow a doctor to see inside the throat.
- Laryngeal videostroboscopy: This procedure involves using a laryngoscope and a strobe light to view the vocal folds as they vibrate. This allows doctors to check for abnormalities of the vocal folds in the voice box.
- Panendoscopy: This procedure uses a series of connected telescopes called a panendoscope to check for abnormalities of the mouth, throat, esophagus, and trachea.
- Other imaging tests: These may include:
Some throat ulcers may respond to simple lifestyle modifications, while others require more extensive medical treatment.
Treatment options for throat ulcers include:
- medications to treat the underlying cause, such as antibiotics, antifungals, or antivirals
- pain-relieving medications, such as acetaminophen
- prescription mouthwashes containing medications, such as the local anesthetic lidocaine
Treatment of esophageal ulcers
- antivirals, antibiotics, or antifungals
- medications to reduce stomach acid production or activity, such as:
- over-the-counter (OTC) or prescription antacids
- H2 receptor blockers
- proton pump inhibitors (PPIs)
- medications to make the stomach empty faster
- glucocorticoid therapy
- surgery, in some cases
Treatment of vocal cord granulomas may include:
- removal of an endotracheal tube, if one is present
- vocal therapy
- anti-reflux medication
- surgery, in some cases
People can take measures to help prevent throat ulcers. These include:
- Staying healthy: A person can reduce their exposure to infectious pathogens that would otherwise increase their risk of developing throat ulcers. Prevention involves the following:
- practicing good hand hygiene
- keeping surfaces clean to help prevent the spread of infection
- avoiding contact with people who are sick or have an infectious ulcer
- Taking medications properly: A person should take medications according to their doctor’s instructions. They should avoid taking pills without water, just before lying down and right before going to sleep.
- Quitting smoking tobacco or drinking alcohol: Smoking tobacco and drinking alcohol can worsen existing throat ulcers, and both increase a person’s risk of developing certain cancers. A person can talk with their doctor for advice on how to quit smoking or drinking.
- Managing risk factors: A person can talk with their doctor about managing any conditions that may increase the risk of a throat ulcer, such as diabetes mellitus and GERD.
Lifestyle changes and modifications that can help to manage throat ulcer symptoms include:
- 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
- eating and drinking lukewarm or cold foods and drinks
- eating sour cream before each meal to coat the mucous membranes
- rinsing the mouth or gargling with a mixture of water, salt, and baking soda
- staying hydrated by drinking small amounts of liquids throughout the day
- managing acid reflux or GERD by:
- avoiding acidic, spicy, or fatty foods
- avoiding large, fatty meals
- avoiding drinking alcohol or smoking tobacco
- elevating the head of the bed with blocks or risers to help prevent nighttime reflux
Certain viral infections can increase the risk of throat ulcers. The SARS-COV-2 virus that causes COVID-19 may increase the risk of throat and mouth ulcers, though these are not common symptoms of the disease.
Most case studies reporting a connection between COVID-19 and ulcers refer to ulceration and blistering of the mouth. For example, a
It is still unclear whether COVID-19 directly causes throat and mouth ulcers or whether it makes a person more susceptible to secondary infections that can cause these types of ulcers.
Anyone who experiences symptoms of a throat ulcer should see their doctor. The symptoms of a mouth ulcer may mimic those of other, more serious conditions, so it is important to receive an accurate diagnosis.
Symptoms that warrant a visit to the doctor include:
- pain that does not respond to OTC medication
- inability to eat or drink
- sores lasting for more than a few days
- symptoms of GERD that do not respond to OTC medication
In some cases, a throat ulcer may be a symptom of a serious underlying medical condition. Anyone experiencing the following symptoms should seek immediate medical attention:
- chest pain
- shortness of breath
- racing heart
- vomiting bright red blood or vomit that has the appearance of coffee grounds
- neck pain or a stiff neck
- flu-like symptoms
- changes in behavior
The outlook for a throat ulcer depends largely on the underlying cause.
Throat ulcers that result from an infection should resolve once the underlying infection has cleared. In such cases, medications, such as antibacterial, antifungal, or antiviral medications, can help speed up healing.
Esophageal ulcers may resolve following successful management of stomach acid reflux, such as GERD. People who take their medication as a doctor prescribes and eat an appropriate diet have a
Ulcers can recur, especially after treatment with PPIs. In this case, doctors would prescribe maintenance therapy to avoid relapse.
Throat ulcers that develop in response to certain medications should subside once a person has completed their treatment and is no longer taking the medication.
Throat ulcers are ulcers that can form in the throat, esophagus, or voice box. They may cause painful or uncomfortable symptoms, such as a sore throat, pain or difficulty swallowing, and changes in taste or smell.
There are multiple causes of throat ulcers. Most are due to infectious pathogens, such as bacteria, fungi, or viruses. Other possible causes include GERD, allergies, and taking certain medications.
The outlook for throat ulcers is generally good if people receive treatment for the underlying cause. A person should visit their doctor if they experience severe or persistent symptoms that do not respond to OTC medications.