So I have had a history of rhinitis/polyps for the past 14 years, it is treated with daily nasal steroids/(drops if bad) and an antihistamine- though all allergy tests have been negative.
About 2 months ago (after a period of anxiety it so happens) I had been using the steroid drops and started to experience an odd intense tingle in my lower throat/below adams apple. This was followed by weeks of feeling as though my breathing was raspy, closed off at the throat and I heard a whistling noise through my mouth at night. At times my chest felt tight which made me panic
My gp said it could be reflux and prescribed omeprazole and a salbutamol inhaler. The oneprazole seemed to help a little the salbutamol not so much. I had a ent consultation (nasoendoscopy - it was clear) and a barium swallow which showed slight dysmotility but he didn’t think there was reflux/it was causing symptoms. I was told that my throat issues were likely anxiety and Globus. My symptoms are a little better now but still present I have been trying to relax.
I happened to have a spirometry appointment today which I was told was normal/above average apart from one thing- it showed some upper airway obstruction. He showed me the abnormal curve. The pulmonologist said that he would have recommended a camera down my throat but as I’ve had one it could be that I had my tongue in the way, inflammation or unusual anatomy.
I have a 8 week wait to see the resp consultant and am now back to worrying again. As the area were I have symptoms and feel as though my breathing is restricted (adams apple/upper trachea) is where the test showed an obstruction.
Has anyone’s spirometry shown this/upper airway obstruction? I had just begun to convince myself that my throat issues were due to stress and today it seems I have had ‘proof’ of obstruction. Maybe I am worrying to much but I don’t know what to make of it.
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Blueforest23
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Good morning, I suffer from frequent upper respiratory infections where it causes much inflammation and wheeze, I have one at present, went the doctors on Monday again and now trying a second antibiotic as well as Azithromycin which I take Mon, Weds & Fri
If I don’t address the infection it ends up in my lungs and always resus & a week in hospital
My O2 sats are fine but occasionally my airway blocks and I need a few good coughs to clear the mucus & I really can speak a sentence without having a coughing episode
I can taste when an infection is starting which mucus & wheeze following shortly after.
Mine is definitely infection driven & not caused by stress or reflux
I have allergy/acid reflex asthma . i also try to keep to a low acid diet. im on 2 inhalers with omeprazol with also feoxafindine. i take gaviscon 3 times or more a day.
It can be frustrating and nerve-wracking waiting for tests and referrals in order to receive a diagnosis. Reflux and post nasal drip can both affect upper/lower respiratory health, but it appears these have been ruled out and talk of an obstruction has worried you. Obstruction can mean anything from a breathing dysfunction to polyps to eosinophilic esophagus, it just means that the airways aren't performing as expected. Has your ENT consultant ruled out vocal chord dysfunction? You've had the spirometry but wonder if they've done a laryngoscopy? It's not unusual to develop a breathing dysfunction after having polyps for so long. It would be good if your doctor could rule out any form of breathing dysfunction, including vocal chord dysfunction, along with any possible physical change in your trachea.
Has the ENT established whether you have CRSwNP (chronic rhinosinusitis with nasal polyps) or AERD (aspirin exacerbated respiratory disease)? It's important that you know the reason for your nasal polyps as these diseases affect asthma in different ways and treatment and options are different.
If your ENT doctor hasn't considered the above it may be worth asking why they haven't, just so you know what their thoughts are and understand why they are eliminating potential culprits without testing. The overlap between nasal and respiratory health can be important but usually only ENT will diagnose upper respiratory diseases (throat & nasal) which can have a huge impact on lower respiratory health. I've experienced this Venn diagram first hand and it can be difficult to get respiratory doctors to see above the lungs.
Thanks that has helped. The diagnosis provided by ENT is chronic rhinosinitiswith polyposis -I have had this for 13 years. The polyps tend to be small/grade 1 (but then I only have a small nose). They were last seen on nasoendoscopy 6 months ago however a few weeks ago during I was told by ENT that he couldn’t see them (maybe due to nasal steroids).
My main issue with my nose is not so much the polyps but the inflammation/blocked nose. Even though ENT said my sinus CT wasn’t too bad/he didn’t feel surgery would benefit my symptoms are very bothersome.
To pain a whole picture it could be argued that the recent throat issues began about 1.5 years ago. I noticed that when I used the steroid nasal drops (my go to med when things are bad -which used to work a treat) I would feel a fullness/pressure in my nasopharynx region which sometimes made my upper throat feel tight too. This ceased when I would stop the drops and go back to the spray. This is the reason I had a recent sinus ct - it revealed a clear nasopharynx and the consultant put the issue down to dryness.
Then a few months ago the issue which I described above started to occur - a strong tingling in the hollow region below adams apple and raspy/tight breathing. It almost felt at times like my upper trachea had a kink in it/narrowed breathing.
Alongside my worrying that it could be something serious (thyroid pressing on trachea, some mass blah blah) I had some instincts of what it could be.
Firstly due to a particular prolonged period of using my drops I wondered if it was chemical irritation from these
Secondly as you mentioned I wondered if it could be vocal cords as sometimes it felt like air was being paused when it was comming out.
The issues came on after a period of anxiety and stress I do remember during this feeling lots of air hunger(like I wasn’t getting enough oxygen) and also taking a lot of deep breaths through the day by habit - maybe this led to dysfunctional breathing as you said. The best way I can describe the air hunger is the sensation you get after being hit in the stomach by a football, it’s like a mild cramp that makes me feel like I need more air - this is why initially I believed the gp’s suspicion of reflux/gastric issues, but the gastro doctor doesn’t think my symptoms are connected
As for what ENT have suggested - not much really - he did the nasoendoscopy said it was clear and followed up with a barium swallow, then referred me to gastro. I have not had a laryngoscope (want to avoid it if I can). He did suggest to give my nose a break from the daily steroid spray I tried this but my inflammation/sneezing worsen.
As you suggest it is probably worth me trying some vocal cord exercises, thanks. I do try other breathing exercises too when I can breath through my nose ha.
Not sure if this will help, but this video by an ENT consultant goes through the most effective ways to use nasal sprays and drops. Once I had mastered the best way to take my spray I really noticed a difference, plus I wasn't swallowing the meds unnecessarily (uncomfortable side effects too). Now I only have a nasal spray for emergencies, like a head cold. It took a few years, but I eventually got control of my polyps and modified my diet & take Montelukast (but then I have AERD). I also practice Buteyko breathing most days and this has definitely helped my nasal health and my asthma.
It doesn't seem logical, but if we don't use our nose as part of our respiratory system, it will have a tendency to inflammation. I've seen countless doctors and consultants and not one of them advised me on the best way to breath. It was a respiratory physiotherapist who got me on the right track, after she observed my awful breathing habits and my poor inhaler technique. Basically, our respiratory system goes from our nostrils to our diaphragm and if we don't get it right we can over breath and still feel air hunger. And we can also feel anxious if our breathing is dysfunctional - doctors may say the poor breathing is anxiety driven, but I think it's the other way around. Anyway, my respiratory physiotherapist recommended Buteyko breathing and you can find more information on YouTube (I think the most informative videos are by Patrick McKeown, he's also asthmatic).
If you do have vocal chord dysfunction then a speech therapist would teach specific respiratory exercises, so Buteyko may not be appropriate.
That’s some sound advice there it’s all things that are simple to do but make a big difference but they just don’t tell you at appointments.
I never thought of all that stuff I was just assuming that it was my own immune system that was causing the inflammation (as I have tested negative for allergies numerous times). Although this will be the prime reason as you said maybe things like anxiety, mouth breathing, over breathing are making things worse I’l be sure to monitor this more
Yea at think I mostly have the spray technique right but it’s great to know. These are all things that should be gone through in appointments but never are. It makes you wonder how much of the population are deemed non responders to nasal sprays when it is simply their poor technique. I think my dad is the biggest example. . he sprays his nasonex in then blows his nose straight afterwards lol.
As Poobah said it could be vocal chord dysfunction, this can cause the symptoms you describe and also show up on spirometry. I was misdiagnosed with it a few years ago as I have a weird flat bit on the start of my expiratory loop, so I had two years of ENT poking about before deciding I didn't have it! It can come and go which adds to the difficulty of diagnosing it but the closed off/raspy feeling in your throat can be a sign of it.
I think generally it's relaxation/physio exercises that are the treatment as it's the vocal chords going into spasm usually in response to stress or illness. There are some exercises you can do online for VCD, it may be a case of trying them yourself to see if they help then informing your ENT, sometimes consultants need the evidence of something working before they agree with your own diagnosis!
I think my main issue is that it is really affecting my job, psychologically. One day 3 weeks ago I felt so anxious and uncomfortable/felt a restriction in my upper chest/ like I couldn’t get air out properly that I panicked and went home. Call me a wimp but has happened twice and both times have been put on my attendance record. I strongly considered having a career break until this is fixed or until I can better manage it.
Just to update I was sent a copy of my spirometry results and am waiting for the follow up in a few weeks. I was told at the time of the test that the lungs looked good but the curve showed some upper airway obstruction.
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