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Difficulty in swallowing, drinking & breathing, speech affected, have tightness in throat since long. Scans normal. Cause & whom should i see?

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i've been having tightness in my throat for close to 8 years and it got worse in the last 1 months. I have difficulty in swallowing, drinking and breathing. My speech has also been affected and there are certain words which i cant pronounce properly. Each time when i swallow i will feel cracking sound in my ears. I'd seen ENT doctor few times and every scanning showed nothing wrong. Its worrying me a lot nowadays, causing lack of concetration on everything i do. What really cause it, and which specialist should i really see? Please help.

Worried
Posted Tue, 22 May 2012 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Naveen Kumar 3 hours later
Hi,

Thanks for the query.

According to your description, all the tests done pertaining to your throat and neck are normal. And hence, any anatomical deformity or growth in the throat or neck is also ruled out.

I do feel, all of your symptoms are closely related to a condition called Laryngo-pharyngeal reflux, which is secondary to reflux of the gastric contents (gastro-esophageal reflux disease) from the stomach.

The lining mucosa of the throat and the esophagus (good pipe) are very different from that of the stomach. When there is reflux of the acid from the stomach into the throat, it causes irritation and swelling in the throat. This swelling in the throat is perceived as tightness and foreign body sensation. When the acid traverses through certain parts of the voice box, it causes inflammation of the voice box leading to hoarseness and straining of the voice.

I would suggest you to consult a good gastroenterologist for a complete evaluation of the upper digestive tract and subsequent management.

Also, you need to drink plenty of warm water to reduce the congestion in the throat. Avoid coffee, tea, spicy food, alcohol, smoking, stress and skipping your meals. With these preventive measures, most of your symptoms can be relieved.

Hope I have answered your query; I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Difficulty in swallowing, drinking & breathing, speech affected, have tightness in throat since long. Scans normal. Cause & whom should i see? 1 hour later
Thanks Dr XXXXXXX i do have further queries. What about the cracking sound in my ears? Is it related?

However, my main concern is more on difficulty in swallowing, breathing and speaking. By speaking to a gastroenterologist, what will be than the te next step taken?

Can what i am suffering right now also be due to stress which cause the muscle to strain? Kindly advise. Appreciate your comments.

 
 
Answered by Dr. Naveen Kumar 3 hours later
Hi,

Thanks for writing back.

I sincerely apologize for not answering your second query. The crackling sound which you hear in the ear is due to opening and closing of the Eustachian tube (the tube connecting nose and the ear). The Eustachian tube helps in maintaining the pressure balance between the middle ear and the nose. The sudden opening and closing of the nasal end of the Eustachian tube in situations like yawning, swallowing and speaking creates a snapping sound which is heard as crackling. This is not related to your throat problem.

Secondly, gastroenterologist will conduct an endoscopic examination so as to find the cause of the acid reflux. The commonest causes of acidity and acid reflux are lax lower esophageal sphincter, erosive gastritis, and hiatus hernia and H. pylori infection. Depending upon the endoscopic findings the further treatment will be advocated.

The difficulty in breathing is mainly due to inflammation and swelling of the certain regions of the voice box, which is the entry point of the lower respiratory tract. All these will subside once the acidity and the reflux is controlled.

Yes, even stress can cause the throat discomfort and also increase your acid reflux problems.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Difficulty in swallowing, drinking & breathing, speech affected, have tightness in throat since long. Scans normal. Cause & whom should i see? 5 days later
Hi Dr XXXXXXX

I underwent the endoscopic test last Thursday (22.03.12) and the test showed presence of reflux and ulcer, which the doctor said probably caused the symptoms im having.

He prescribed ganaton 50mg tab/Itapride and contreoloc tab 40mg/pantoprazol, and i might have to take it for 6 weeks. What trouble me is that, im not seeing any improvement over last few days. My throat is getting tighter and as of today, im having more difficulty in talking, like my tongues is blocking my speech. It is also getting more difficult to swallow food, and now when i swallow i could hear some cracking sound on the throat.

Are the tables prescribed correct and what possibly could be other reasons for my condition (when scanning on throat showed nothing, due to ears?) or could it be it is still at early stage of the medication. It is causing so much of stress to me right now

Appreciate your valuable advise.
 
 
Answered by Dr. Naveen Kumar 5 hours later
Hi

Welcome back

The treatment what has been advocated to you by your gastroenterologist is correct. According to your endoscopic results, there exists acid reflux which could be the prime cause of your throat problems.

Well, it does take some time for the complete improvement of the symptoms. As the reflux and the throat inflammation have already been there for quite some time now, it takes couple of weeks for the symptoms to start subsiding.

My sincere advice to you is to take the necessary medicines and also request your doctor for an anxiolytic (Alprazolam), which will reduce your stress.

Remember! The stress itself can lead to a condition called Globus pharyngeus, which will later become difficult to treat. Cheer up! Allow sometime for the medicines to act, you will definitely be alright.

Wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Difficulty in swallowing, drinking & breathing, speech affected, have tightness in throat since long. Scans normal. Cause & whom should i see? 27 hours later
Thanks Dr XXXXXXX for the assurance. I shall be positive and continue to eat the medicine and look forward to be healed in weeks to come. I do agree it might take weeks for the 8 yrs symptoms to go. How many weeks do you think it will take?

You'd explained before why i have cracking sound when i swallow and open my mouth. Im feeling that its getting lounder nowadays. Is it harmful and are there any ways to get rid of the disturbing sound?

Thanks
 
 
Answered by Dr. Naveen Kumar 18 hours later
Hi

Thanks for writing back

It will take at least 4 to 6 weeks for the difference to be noticed. Louder cracking noise does not indicate any major problem. As I have mentioned in my previous posts crackling sound is due to opening and closing of the Eustachian tube, this worsens when there is dysfunction of the tube. Do not worry! This is not going to affect you in any way. You can try doing steam inhalation to reduce the congestion around the tube opening. Hope, this can solve your problem.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
Follow-up: Difficulty in swallowing, drinking & breathing, speech affected, have tightness in throat since long. Scans normal. Cause & whom should i see? 2 hours later
Thanks, and sorry for the many questions that i have.


As for my speech, lately, my speech has deteriotated. Im having hoarsing voice and difficulty in speaking smoothly and there are some noun, especially s and r that I find difficulty to pronounce. Im feeling like my tongue is blocking my speech. This has kept me passive.

Will the speech problem subside as tightness in my throat healed? Any other reasons?

Many thanks.
 
 
Answered by Dr. Naveen Kumar 23 hours later
Hi

Thanks for writing back

Please do not feel sorry, we are here to help you out and clear all your doubts, to the best possible extent.

Do steam inhalation 2-3 times a day, this reduces the throat congestion and helps in recovery of the speech. Avoid talking continuously; frequent pause between each sentence will reduce the strain on the vocal cords. Difficulty in pronouncing of s and r could be due to congestion of the throat and vocal cords. This should improve as the congestion reduces.

Finally, if you still feel the throat symptoms and the tightness in the neck is not improving with the medications, you can try consulting a neurologist to rule out any neuro-muscular disorders.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by
 
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