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Suggest Treatment For Acid Reflux, Sore Throat And Post Nasal Drip
Question: Hello,
my name is XXXXX and I am 33 years old. I am originally from Germany but I live in Costa Rica. I have been suffering from a pain in my throat which changes from day to day in its severity but also in its location, sometimes it is very difficult for me to say where the pain is, apart my throat is slightly red and I have to constantly clear my throat with very thin mucus. In the middle of the throat there are from time to time red spots. The pain is not in the pharynx, I rather feel it further down in the area of the larynx. Sometimes I feel pressure on my eyes and a slight headache. I was first suspected to have acid reflux and went through a ph metry, manometry and gastro endoscopy with all negative results. Since the doctor however still insisted in acid reflux i was treated with an aggressive acid reflux treatment (twice a day Nexium 40mg, after every meal Malox and still other anti-acids i do not remember). There was no response and I continued to have the same symptoms. I was then recommended with an ENT specialist who first made a CAT scanner check and I was diagnosed with chronic sinusitis, cysts in my paranasal sinuses and a deviated septum. After a treatment with antibiotics and cortisone nasal spray with no response i received 6 weeks ago a surgery. Unfortunately there was no improvement. I am still suffering from this pain in my throat/larynx. Last week I went again with my doctor and this time my pain was very easy to describe as I could easily tell him the painful location (exactly over my larynx) the ENT specialist supposed it could be a problem with a tyroglosal cyst so he sent me to do an ultrasound and yes he was right. They found two cysts which however are small with a size of 8mm and 4mm. This doctor who did the ultrasound pushed exactly on the point where the pain was and said here is the cyst so it was clear were the pain was from. He then inserted an injection and extracted the liquid out of it which was very little actually and he said that he cannot imagine that my general throat pain is related to this. I am very confused now and also very nervous since nobody can tell me what I really have. The ENT specialist says he thinks this was the root of all of my problems and that we will do another surgery but I am not sure what to do now. I have had already a surgery which did not help anything related to my problem and now they find something were I hear different opinions if this might be the activator of my symptoms or not. The day I went to the ultrasound and when say extracted the liquid out of the tyroglosal cyst was one week ago and I still have a painful throat – not anymore were the pain was (the place of the cyst) but the general pain in my larynx is still there. Sometimes I have still slight headaches.
i would like to still mention that there was an incredably big amount of blood tests which were made including allergies, thyroid, hiv etc etc with all normal/negative results. The result of the cyst was that it was filled with macrophage material. Furthermore I need to mention that whenever I went to the ENT specialist he said my throat looks dry and slightly foamy of saliva – whatever that might mean or cause… do I have several problems at the same time? Does all come from the cyst and I need a surgery or do we have several problems here? What should I do?
my name is XXXXX and I am 33 years old. I am originally from Germany but I live in Costa Rica. I have been suffering from a pain in my throat which changes from day to day in its severity but also in its location, sometimes it is very difficult for me to say where the pain is, apart my throat is slightly red and I have to constantly clear my throat with very thin mucus. In the middle of the throat there are from time to time red spots. The pain is not in the pharynx, I rather feel it further down in the area of the larynx. Sometimes I feel pressure on my eyes and a slight headache. I was first suspected to have acid reflux and went through a ph metry, manometry and gastro endoscopy with all negative results. Since the doctor however still insisted in acid reflux i was treated with an aggressive acid reflux treatment (twice a day Nexium 40mg, after every meal Malox and still other anti-acids i do not remember). There was no response and I continued to have the same symptoms. I was then recommended with an ENT specialist who first made a CAT scanner check and I was diagnosed with chronic sinusitis, cysts in my paranasal sinuses and a deviated septum. After a treatment with antibiotics and cortisone nasal spray with no response i received 6 weeks ago a surgery. Unfortunately there was no improvement. I am still suffering from this pain in my throat/larynx. Last week I went again with my doctor and this time my pain was very easy to describe as I could easily tell him the painful location (exactly over my larynx) the ENT specialist supposed it could be a problem with a tyroglosal cyst so he sent me to do an ultrasound and yes he was right. They found two cysts which however are small with a size of 8mm and 4mm. This doctor who did the ultrasound pushed exactly on the point where the pain was and said here is the cyst so it was clear were the pain was from. He then inserted an injection and extracted the liquid out of it which was very little actually and he said that he cannot imagine that my general throat pain is related to this. I am very confused now and also very nervous since nobody can tell me what I really have. The ENT specialist says he thinks this was the root of all of my problems and that we will do another surgery but I am not sure what to do now. I have had already a surgery which did not help anything related to my problem and now they find something were I hear different opinions if this might be the activator of my symptoms or not. The day I went to the ultrasound and when say extracted the liquid out of the tyroglosal cyst was one week ago and I still have a painful throat – not anymore were the pain was (the place of the cyst) but the general pain in my larynx is still there. Sometimes I have still slight headaches.
i would like to still mention that there was an incredably big amount of blood tests which were made including allergies, thyroid, hiv etc etc with all normal/negative results. The result of the cyst was that it was filled with macrophage material. Furthermore I need to mention that whenever I went to the ENT specialist he said my throat looks dry and slightly foamy of saliva – whatever that might mean or cause… do I have several problems at the same time? Does all come from the cyst and I need a surgery or do we have several problems here? What should I do?
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. It does seem that you have multiple issues. However such situations are commonly seen with chronic throat pain. Silent reflux would be treated first, followed by allergies and a post nasal drip. If these are unsuccessful, treatment of sinusitis would follow. After this a search for other causes ensues.
2. As per the above details, you are still in the early phase of recovery from the nasal surgery. a comparison of the pre and post op CT image (taken after a couple of months) may help here.
3. The Thyroglossal cysts are small, none the less they should be operated in due course to avoid the risk of cancer developing in them later. They are one of the commonest congenital mid-line neck cysts. The aspiration report seem to be in line with a thyroglossal cyst, the presence of macrophages signifying some inflammation and hence a source of the neck pains. Thyroid function tests are a must and it should be confirmed that these cyst are not the only functioning thyroid tissue before the Sistrunk's Operation is carried out.
4. The dry throat and foamy saliva may be due to dehydration or mouth breathing in the aftermath of the nasal surgery, snoring / sleep disordered breathing or salivary/ dental issues.
5. I do not have access to a lot of the data and a direct examination, but do get a video-laryngoscopy and the above investigations done. It is good to hear that your blood tests are within normal limits. However, I would consider a successful endpoint to your treatment only as control of the chronic throat pain and headaches.
I hope I have answered your query. If you have any further questions I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for your query.
1. It does seem that you have multiple issues. However such situations are commonly seen with chronic throat pain. Silent reflux would be treated first, followed by allergies and a post nasal drip. If these are unsuccessful, treatment of sinusitis would follow. After this a search for other causes ensues.
2. As per the above details, you are still in the early phase of recovery from the nasal surgery. a comparison of the pre and post op CT image (taken after a couple of months) may help here.
3. The Thyroglossal cysts are small, none the less they should be operated in due course to avoid the risk of cancer developing in them later. They are one of the commonest congenital mid-line neck cysts. The aspiration report seem to be in line with a thyroglossal cyst, the presence of macrophages signifying some inflammation and hence a source of the neck pains. Thyroid function tests are a must and it should be confirmed that these cyst are not the only functioning thyroid tissue before the Sistrunk's Operation is carried out.
4. The dry throat and foamy saliva may be due to dehydration or mouth breathing in the aftermath of the nasal surgery, snoring / sleep disordered breathing or salivary/ dental issues.
5. I do not have access to a lot of the data and a direct examination, but do get a video-laryngoscopy and the above investigations done. It is good to hear that your blood tests are within normal limits. However, I would consider a successful endpoint to your treatment only as control of the chronic throat pain and headaches.
I hope I have answered your query. If you have any further questions I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Bhatti
I have a question regarding the silent reflux. I did a ph metry specilized for silent reflux where the sensor is located in the throat. The result was that i am still within the limits, the two normal ph metries and the manometry where negative. Can i exclude the chance of silent reflux? An allergy blood test was negative. Thank you
I have a question regarding the silent reflux. I did a ph metry specilized for silent reflux where the sensor is located in the throat. The result was that i am still within the limits, the two normal ph metries and the manometry where negative. Can i exclude the chance of silent reflux? An allergy blood test was negative. Thank you
Brief Answer:
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. A normal esophageal manometry will rule out silent reflux in over 90% cases.
2. However it must be noted that there is acid and non-acid reflux (for example, digestive enzymes, bile).
3. Even in a normal healthy individual, acid reflux may be seen 4-5 times a day on dual probe pH monitoring and esophageal manometric studies.
4. Hence you can assume that with normal studies you have less than a 10% chance of silent reflux.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
As below:
Detailed Answer:
Hi,
Thank you for writing back.
1. A normal esophageal manometry will rule out silent reflux in over 90% cases.
2. However it must be noted that there is acid and non-acid reflux (for example, digestive enzymes, bile).
3. Even in a normal healthy individual, acid reflux may be seen 4-5 times a day on dual probe pH monitoring and esophageal manometric studies.
4. Hence you can assume that with normal studies you have less than a 10% chance of silent reflux.
I hope that I have answered your query. If you have any further questions, I will be available to answer them.
Regards.
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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