The lining of the throat, which includes the pharynx and esophagus, is susceptible to damage from both heat and corrosive substances. A true burn injury to this area constitutes a medical emergency that requires immediate attention. This damage is defined as a thermal or chemical destruction of the mucosal layers, potentially compromising the airway and the entire upper gastrointestinal tract.
Common Sources of Injury
Injuries to the throat and esophagus result from thermal or chemical exposure. Thermal burns occur when extremely hot liquids or steam are ingested, causing heat transfer that coagulates tissue proteins. Ingesting a superheated beverage, such as coffee or soup, can damage the mucosal lining, causing acute pain, though this damage is often reversible.
Chemical burns involve corrosive agents, categorized as acids or alkalis. Alkaline substances, such as lye or drain cleaners, are particularly dangerous because they cause liquefaction necrosis, allowing deep penetration into tissue layers. Acidic substances, like rust removers or battery fluids, tend to cause coagulation necrosis, which forms a protective eschar that may limit the depth of injury.
The physical form of the substance influences the burn pattern. Liquid corrosives pass through the pharynx quickly, often causing extensive damage lower down in the esophagus and stomach. Solid caustic materials tend to adhere to the oropharyngeal region, resulting in more localized burns to the mouth and upper throat. The concentration of the substance and the duration of tissue contact determine the extent of tissue destruction.
Recognizing Symptoms and Severity
The initial presentation of a throat burn ranges from mild discomfort to severe, life-threatening symptoms. Acute pain in the mouth, throat, or chest is an immediate sign, often accompanied by drooling or an inability to swallow (dysphagia). Swelling of the pharynx and larynx can lead to voice changes, such as hoarseness, or the complete inability to speak, signaling a serious complication.
Stridor, a noisy sound upon breathing, indicates that the airway is rapidly narrowing due to tissue edema. This symptom signals impending respiratory compromise and requires emergency intervention to secure the patient’s breathing. Note that burns in the mouth or on the lips do not always predict the severity of internal damage, especially with liquid ingestion where the esophagus may be severely injured without external signs.
Medical professionals use endoscopic examination and established classification systems to assess internal damage. The Zargar classification is commonly used for chemical injuries to grade mucosal severity.
Zargar Classification Grades
- Grade I burns are superficial, involving only redness and swelling.
- Grade II burns include ulceration and blistering.
- Grade III burns represent full-thickness necrosis, characterized by black or gray discoloration of the tissue.
Injuries reaching Grade IIB or Grade III carry the highest risk of perforation and long-term complications, including the development of esophageal strictures (narrowings of the food pipe).
Immediate First Aid Actions
When a throat burn is suspected, seek emergency medical help immediately. If the individual has difficulty breathing or ingested a chemical substance, call emergency services. Contact a Poison Control Centre for specific guidance based on the chemical ingested; have the substance’s container ready to read the label.
If the person is conscious and can swallow safely, offering small sips of cool water or milk may help dilute and cool the area, especially for thermal injury. If the person is struggling to swallow or is in severe pain, do not force them to drink anything. The priority is preventing further injury and stabilizing the patient for professional care.
Avoid inducing vomiting, as this causes the corrosive substance to pass over the pharynx and esophagus a second time, worsening the burn. Do not attempt to neutralize a chemical burn with a counter-agent, such as an acid with a base, because the resulting exothermic reaction can generate heat and intensify tissue damage. Remove any contaminated clothing or jewelry near the area to prevent further skin exposure.
Professional Medical Treatment and Recovery
Upon arrival at a medical facility, the focus is securing the patient’s airway, especially if breathing difficulties are present. If laryngeal swelling threatens obstruction, intubation may be performed to establish a stable airway. Intravenous fluids are administered to maintain hydration and stabilize the patient, as they will be unable to safely swallow for a period.
Upper gastrointestinal endoscopy is typically performed within 24 to 48 hours to assess internal tissue damage. This allows the medical team to accurately grade the burn severity using classifications like the Zargar scale, guiding the treatment plan. Patients with severe burns may require admission to an intensive care unit for monitoring due to the risk of complications, such as perforation or systemic infection.
Long-term recovery manages delayed complications arising from the healing process. Scar tissue formation can lead to esophageal stricture, where the passage narrows, making swallowing difficult months after the injury. Treating these strictures involves endoscopic dilation, a procedure using specialized balloons or tubes to stretch the scarred area. Multiple dilation sessions may be required to restore the esophagus’s function and allow for normal eating.