Every time I go to the clinic, I often meet patients with chronic sore throat who come to see me and tell me: I have been suffering from sore throat for a long time, and I have been going around to many hospitals without being cured, and many hospitals diagnose it as chronic pharyngitis, but how to use anti-inflammatory drugs do not work. And whenever this happens, I will sink my heart and ask carefully about the characteristics, nature and location of the pain, because years of clinical experience tell me that chronic sore throat actually has a lot to learn, and if we ignore the culprit behind the sore throat, it will be difficult to help patients solve the problem. 1. Stem syndrome: The stem is located in the parapharyngeal space, which is a normal physiological structure of the human body. The normal stem is a bone spur about 2.5cm long and has no special function. However, when the stem is too long or the tip of the stem is pointing abnormally, it will cause pharyngeal pain or neck pain on one side, and the patient has a long period of pain, often several months or years. The pain is often felt as a fish stinging, pulling sensation, and is aggravated by swallowing, can be aggravated by turning the head, and can occasionally cause a violent cough. The diagnosis requires a photograph of the stromal process. If the stromal process is found to be more than 3 cm or its pointing is abnormal and there are typical symptoms, the diagnosis is established. The treatment is to remove the mutated stalk and medication is not effective. 2. Hyoid bone syndrome: The hyoid bone is a bony structure located in the upper neck, horseshoe shaped, to which many neck muscles are attached. When the inflammation of the muscles around the hyoid bone or the hyperplasia of the large horn of the hyoid bone will produce pressure on the adjacent vascular nerves, it is characterized by pain in the upper cervical region and a foreign body sensation in swallowing, which will radiate to the ear, and the symptoms are similar to those of stem syndrome, but the difference is that because the hyoid bone is more superficial, obvious pressure points can often be palpated in the upper cervical region, while the stem is deeper and cannot be palpated in the neck. The treatment method is local closure or surgical excision. 3.Trigeminal neuralgia: Before talking about this disease, it is important to understand the characteristics of neuralgia, which is manifested as severe lightning-like pain in the face, neck and pharynx lasting for several seconds or minutes, and no symptoms when it does not occur. The pain can be triggered by minor irritations in the mouth and face, such as brushing the teeth, rinsing the mouth, washing the face, etc., causing the patient to be afraid to do the above actions. The trigeminal nerve is in charge of the sensation of our head and face, and it is distributed in the face, throat, ear, and hyoid muscle groups. The pain is severe and mostly unbearable for patients. The treatment of medication mainly adopts carbamazepine, and the treatment is ineffective can use trigeminal nerve avulsion or radiofrequency surgery of ganglion, and a few patients are caused by intracranial tumor compression, then they need to go to brain surgery. 4.Neurosis: some patients have not severe pain and longer time, and there is no fixed pain site, and there is no abnormal change in clinical examination. And after in-depth communication, it is found that the patient is more anxious and afraid that he has cancer, which may be neurosis. And after the doctor’s patient enlightenment and assist some anti-anxiety drugs, the patient’s symptoms will be relieved. There is a lot to learn about chronic sore throat, far from being as simple as chronic pharyngitis. These are some common causes, but there are actually some rare causes, such as pterygoid hook syndrome which manifests as pain in the palate, linguopharyngeal neuralgia which manifests as neuralgia in the tonsillar region, and of course some tumorous lesions need to be excluded. As a patient, knowing the relevant scientific knowledge can help to relieve the anxiety as well as choosing the appropriate way of consultation, so as not to rush to the doctor.