Hi

Thanks for the query

The symptoms you seem to be suffering from could be related to either Eustachian tube or temporo-mandibular joint dysfunction.

1. Eustachian tube dysfunction can cause popping of the ears or make noise behind the nose. Normally, there is alternating opening and closing of the tube around the nasal end in order to equalize the pressure in the middle ear. When there is dysfunction of the muscles around the opening of this tube, a popping noise is heard due to sudden opening and closing of the tube. This usually happens during eating, yawning and swallowing.

2. Temporo-mandibular joint dysfunction – temporo-mandibular joint is a ball and socket type of joint, wherein the smooth condyle of the mandible glides in the socket filled with jelly like fluid. The dysfunction involved is most often with regards to the relationship between the condyle of the mandible and the disc. The sounds produced by this dysfunction are usually described as a "click" or a "pop" or heard as "crepitation".

Either of these conditions can be excluded only after a complete examination and a battery of investigations of the oral cavity and the nasopharynx

Burping is due to acid reflux disease, which will require a prokinetic such as domperidone or metoclopramide to control.

Apart from this, you need to follow few instructions:
1. Drink plenty of water
2. Avoid aerated drinks and dairy products
3. Take plenty of fruits and vegetables
4. Avoid chewing hard food for few days and take only soft feeds and try to chew equally on both the sides.

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

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

Q: The investigations u have stated...which specialist does these??
A: You need to consult an ENT specialist as well as a facio-maxillary surgeon.

Q: what treatments are available if it is the two things u have stated?
A: If it turns out to be steroid nasal spray and perform steam inhalation and also rule out any anatomical block in this area. If it is TMJ dysfunction, then depending upon the damage to the capsule the treatment will be recommended.

Q: So are you saying its an ear issue? that this noise is not any concern?
A: No, it is not a serious issue. The popping of the ears will reduce once the swelling around the Eustachian tube settles down. It is a tedious process, but you need to have some patience.

Q: I take pariet now for acid.
A: My XXXXXXX advice to you is to take Esomeprazole or Pantoperazole instead of Rabeprazole (Pariet) along with a prokinetic.

Q: If thoese two conditions are ruled out..what would u say next?
A: We should look for any other rare conditions such as Misophonia.

Q: 6 years and searching..anxiety? depression?
A: Do not worry! You do not seem to be having any serious underlying problem, this is a simple problem. The more the anxious you are the worse is the problem.

Eat fresh fruits and vegetables, keep yourself fit. You will be definitely alright. God bless you.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

Q: Im seeing my dentist today and he qill refer me to a TMJ specialist.
A: Please do request your dentist to refer you to a TMJ specialist.

Q: DO u mean things like nexium and zoton? for the acid?
A: Nexium is better than Zoton. Also, do not forget to take prokinetics, this will reduce burping and the acid reflux.

Q: Misophonia...How is this treated...?
A: Misophonia is a form of decreased sound tolerance characterized by extreme and irrational reactions when exposed to certain sounds that most people ignore or experience as background, i.e. chewing noises or tapping. 'Anxiolytics' and 'cognitive behavioral therapy' are the main stays of the treatment. Do not worry! This is a rare condition which usually goes unnoticed and with proper therapy this can be solved effectively.

I will be there to help you out at any time. My suggestion to you is to 'keep yourself cool and relaxed, things will automatically fall in place'. Good Luck.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

It's good that you met your dentist. You can try with the splint for a few days, it does help in majority of the cases.

If you have tried Nexium in the past and feel Pariet is better than Nexium or the same, you can go ahead with it till you consult your gastro. Remember! It should be taken half an hour before food. You can also try Simethicon which is found in over-the-counter medications such as Gas-X, Rolaids Multi-Symptom and Maalox for burping.

Avoid foods such as cabbage, beans, brussels sprouts, and milk which will increase acidity as well as burping. Also, avoid swallowing air; this happens when excess air is swallowed during chewing gum, smoking, or drinking a beverage rapidly.

Avoid Pristq for time being, because you are already on lots of medications and you need to be treated on priority basis. I do not find depression as a major problem in you, hence remove that word from your dictionary and mind as well.

Regarding IBS; since the cause of IBS is unknown, it's not possible to reliably prevent symptoms. With some planning and by taking appropriate steps to prevent the symptoms of dietitian can be of an immense help in solving your IBS.

Finally, instead of Brufen you can try Diclofenac sodium (both of them are anti-inflammatory medicines) but the latter is less gastric irritant than the former.

Take care and please keep me informed about the progress.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

Q: Well i have used the splint in the past and it did not really help with my swallowing problem..

A: Splint is given to prevent grinding of the teeth as well as to reduce TMJ problem. But it does not have any relation to the swallowing problems.

Q: Last night i had some corn chips..mince meat and salad..its like nacho..and after it i felt constipated..and mentally down depressed and really tearful..

A: I need to make a point over here... Corn causes constipation and increases acidity. Hence you need to avoid corn and wheat products.
Please check this link below: WWW.WWWW.WW
Q: when is the best time to take all these please and the doses..

A: 1. Pariet to be taken half an hour before breakfast
2. Brufen should be taken preferably immediately after meals only when you are
having pain.
3. PTU as advised by your doctor
4. You can take either metamucil or IBS support but not both
5. Fish oil can be taken once a day after meals
6. Hold on valium for few days

Remember! Taking excessively high intake of dietary fiber will also negatively affect the absorption process in the intestinal tract. It can decrease the absorption of minerals by decreasing the transit time, lowering the concentration of minerals by accumulating more fecal matter, and can also cause the minerals to become trapped in the feces, leaving the body without absorption. Thus, it deprives the body of essential nutrients.

Q: I used to and STILl check my swallowing and repeatedly swallow to check my swallow....gosh the noises it makes people get so scared..even me!

A: There are few more things to tell you. All your problems seem to be inter-related.
1. The prime cause of all your problems is stress
2. Stress causes acidity and constipation
3. Constipation in turn will increase acidity; hence it is a vicious cycle
4. Reflux of the acid in throat will cause inflammation of the mucosa of the throat and the esophagus. The inflammation in the throat causes swelling of the mucosa which is perceived as lump or foreign body sensation in the throat.
5. Stress will add on to the throat problems, because the muscles will go for spasm making it difficult to swallow.
6. Try to chew the food well (equally, on both the sides) and take time to eat. In between take sips of water, it keeps the mucosa moist and helps in easy swallowing. If you try to force food into the throat, you will be swallowing air leading to aerophagia and repeated burping. Keep yourself relaxed and concentrate while eating.
7. No alcohol

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Dear XXXXXXX

I do understand the psychological turmoil you are undergoing. Depression is not the solution to all your problems, in fact it will make the things worse for you. I really appreciate your efforts; you are very brave and faced so many problems all these years and trying to cope up with them. There is a solution for most of the problems; we need to find a way out.

As we have discussed previously, there are various medical problems bothering you, we need to solve one by one to reach our goal. It is difficult to put an end to all these at once. But, I can assure you, with sincere efforts from both the sides your problems can be solved.

Q: I just want a normal throat..well if reflux causes inflammation of throat..does that mean the ibrufen will help?

A: Ibuprofen can give you some relief if you are having pain while chewing or swallowing. But, it should be taken for a short duration, but not for long. Ibuprofen can help in reducing the inflammation in the throat.

Q: .i want something to help my throat muscles..since ur saying its muscles in the throat that spasm.. what do u suggest..for muscle throat spasms..??

A: It is an involuntary muscle spasm in the neck, which happens during stress, reduced hemoglobin in the body and rarely due to neurological causes. Acid reflux will cause inflammation of the mucosa of the throat and induce swelling, which in turn causes difficulty in swallowing. But acid reflux does not have any relation to the muscles in the neck.

I was advising you to keep relaxed because, this will reduce most of your throat problems by half. Believe me, sooner you will feel better once you keep yourself relaxed.

Q: just to confirm TMJ does not cause swallowing problems? is this true?

A: Yes, TMJ does not cause swallowing problems, but if there is TMJ dysfunction certain noises can be produced while chewing the food.

Q: what is your advice..what treatments combined do u feel will give me the most benefits in terms of not feeling stressed knowing i have all these limitations..

A: Try to take a wholesome and healthy food. I have posted a link in my previous response which will suggest you the food stuff to be avoided. Please follow the other measures as discussed in the previous response. Apart from that, try doing meditation, exercise, play outdoor games, keep yourself fit and healthy. And finally, try to forget you are having any problem. I can bet after a month you will be feeling a lot better than before.

Q: but i cant live with this throat crisis and mental symtoms its just too hard..o man!! God gave me one tough road..to take..

A: Dear XXXXXXX don't give up; there is no single human being who is completely normal without any problem. There are lot more individuals who are suffering from various other diseases or health related problems. 'You need to pass through the difficulty in order to overcome the difficulty'.

To summarize:
1. Try to chew the food well (equally, on both the sides) and take time to eat. In between take sips of water, it keeps the mucosa moist and helps in easy swallowing. If you try to force food into the throat, you will be swallowing air leading to aerophagia and repeated burping. Keep yourself relaxed and concentrate while eating.

2. Follow the list of foods to be avoided

3. Take only the required medicines as discussed before

4. Do physical and relaxation exercises.

5. Even after the above measures if you are not feeling better, you can definitely consult a head & neck surgeon.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Thanks for writing back

Q: How will a head and neck surgeon help my throat issues..
A: A head and neck surgeon can study the anatomy of the neck thoroughly and try to rectify any neuromuscular problems, anatomical deficits, etc. either medically or surgically.

Q: The chiropractor said my neck is tilted really forward but i can surely correct this through posture.
A: I doubt whether correction of the posture will make things normal.

Let’s start with the root cause of all your problems and treat it first. Just follow the instructions; I can assure your problems will be solved.

Wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

Thank you, I am fine and doing well. I hope the same from your side also.

1.     Yes, you can try taking pariet in the night before food and also Mylanta 10ml 3 times a day after food.
2.     Nurofen is a combination of both ibuprofen and codeine; you can use it only when you feel you are having painful swallowing.
3.     St. XXXXXXX Swallow Centre is a reputed institution in Sydney; you can definitely take their consultation. They do have lots of diagnostic tools which can be of immense help to you.
4.     You can take products made of rice which is less acidic compared to that of wheat. Unlike red meat, white meat is good for health and also reduces acidity problems.
5.     Do you believe in a plant based diet only they say is the healthiest and low acid. and reduces disease. and some fish...no red meats or chicken.
A: Yes, plant based is good for health as well as reduces many systemic problems such as cholesterol, diabetes, acidity, vitamin deficiencies, etc. Also, white meat present in the fish is good for health. Eating fish is an excellent way to get some of the vital nutrients your body needs. Fish is also a good source of omega-3 fatty acids. It reduces the incidence of heart disease, reduces blood pressure and help in the prevention of abnormal heart rhythms.

I wish you good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Dear XXXXXXX

Thanks for writing back

Q: Can i take this supplement to assist thyroid function, with all my medications.
A: Yes, you can take them all together. There is no inter-drug reaction with those medicines, they are safe.

Q: Ive never heard of Wilsons temprature syndrome. Have you heard of it? i have similar symptoms.
A: I am sorry, I too had never heard of this condition before. None of our medical text books mention about this condition. I googled on the web and discovered that it is noticed with those people with hypothyroid like symptoms in the presence of normal thyroid hormones. But, in your case you have been diagnosed as having hyperthyroidism and hence PTU has been prescribed to you.

Please avoid thyrocare as well as activated B3. Thyrocare is a herbal medicine for treating hyprothyroidism and not for hyperthyroid conditions. Secondly, activated B3 contains calcium, which in turn can worsen the acidity problems.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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Hi

Welcome back

Pariet alone without a prokinetic (domperidone) is ineffective in reducing your burps and throat discomfort. Also try syrup simethicone 3 times a day after food, which will reduce the burps.

Please try to get a consultation of your gastroenterologist at the earliest for a thorough check-up. The way the things are progressing, I feel, sooner you will become physically weak and land up with other problems. I understand, this is very disgusting, but let us hope for the best.

You can definitely have some wine once or twice in a month, it is not harmful.

Avoid chips as far as possible as it worsens your problem. Try to make a diet chart for yourself and follow accordingly.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

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