ENT referral

[Natalie1982]

Hi guys, looking to see if anyone has similar issues to mine. I've had ongoing acid reflex/Gerd type symptoms for 8 months with PPI medication seemingly helping. My throat however comes and goes with discomfort, not pain and not really sore just feels like my throat swollen inside. A few GPS have checked and it seems fine not lumps etc. These throat issues come and go which is weird. I've also had on and off sinus type things going on. Headaches (not major), muffled ears (not painful), stuffy nose type feeling and throat feeling puffy.I've also noticed my voice is hoarse and I find speaking or singing feels strained and I've had a cough for ages. Not bringing anything up phlegm wise and the chest xray was clear.

The GP has referred me to ENT thinking maybe it's LPR and Gerd related as my CRP has been raised also. All other bloods have been fine including live function. Chest xray was also fine. H pylori tests was negative and I've had a colonoscopy which was also all clear as I had lower issues that was thought to be PPI meds not agreeing with me at the time.

Does anyone have similar issues? 🤦‍♀️

[FeistyGirl]

Certainly sounds like LPR. Gold standard test for this is Oesophageal Manometry and 24 hr PH testing so that’s what you should push for. Treatment is often a PPI in combination with Gaviscon Advance

[Hidden]

Yes, I’ve had this - or something very similar.

It began in the latter half of last year. I was on cimetidine for suspected GORD and had been since April after a gap of two and a half months (I was first put on a thirty day course in late December 2019 but the problems began to come back and gradually worsen throughout March so I was put back on it). Some months later I began to get this feeling of pressure being applied to my larynx, as though someone was pushing down on it and yes, swallowing could get uncomfortable from it. It came and went - intermittent just as you describe. That was the case until May of this year when things got markedly worse. I contacted my GP, explained what had been happening and she referred me on an urgent basis to ENT. I was seen within two weeks. What they discovered came as a surprise.

I suffer from asthma. Reflux issues are not unusual in asthma sufferers (though the reason why that should be the case has not yet been established). I also suffer from allergic - and quite possibly non allergic as well - rhinitis (apparently it is possible to have both), also not unusual in asthmatics. I was using a steroid nasal spray (Avamys) on a daily basis to keep that under control; as a result when I went in to see the ENT specialist things were fine. So when the consultant took a look at my larynx (it’s done by inserting a fine tube with a camera on the end of it into the nose and down the back of the throat into the larynx) I was surprised when he announced immediately that there were very obvious signs of allergic inflammation and plenty of mucous from it as well. The nasal passages were inflamed as well as was the larynx, though that wasn’t too bad. He also found notes from my gastro consultant concerning 24hr pH monitoring done the month before, when it was established that the amount of stomach acid entering my oesophagus was on the low side of normal. That didn’t mean reflux wasn’t occurring (there is such a thing as non acid reflux) just that it wasn’t abnormally acidic. So his view was that I was probably suffering from LPR, but that my larynx was being additionally aggravated by unusual amounts of mucous resulting from the rhinitis and that was what was causing the discomfort. He prescribed a different nasal spray (Dymista) which contains a combination of an antihistamine and a steroid. I was also given a NeilMed sinus rinse (it’s a solution that you mix and put in a specially designed bottle so it can then be squirted into your nostrils to help keep everything there clear - yes, I know, it sounds disgusting, but it does work) to use on a daily basis. Since then the larynx problem has improved markedly. I’m also no longer getting sinus issues (which I’ve been rather prone to in recent years).

After a discussion with my gastro consultant I’m currently weaning myself off the cimetidine (no point being on medication to suppress stomach acid when the levels of that are fine). Inevitably, having been on the stuff for a year plus, I am suffering a little from the effects of rebound, but thus far my larynx is fine.

Now of course there is no guarantee that what you are feeling is caused by the same thing and it is always important to get any feelings of a lump in throat checked out so seeing an ENT specialist is a very good idea. But I have to admit that some of what you described does sound very familiar.

Hope things work out for you.

Take care.

[AHG123 in reply to Hidden]

Very interesting. I have suffered from the same allergic and inflammation issues you describe for years. My acid reflux only manifests itself as a cough. My senses of smell and taste have receded over the last few years. I will try the nasal spray route.Many thanks

[Hidden in reply to AHG123]

Have a word with your GP to see if they recommend one which might suit you. The Dymista I was put on is one of the more costly ones which may explain why it took a consultant to prescribe it (I’d never heard of it prior to that). The NeilMed sinus rinse is something I really would recommend for nasal allergies as well.

Are you under gastro consultant care for your reflux? If not, and it’s causing issues which the medication you are on is not helping with, you could request a referral.

[chotiroti]

Yes. Actually for about 15 years! Given up talking to Drs. who simply don't take it seriously. My neck glands regularly swell up and by the time you get an appt. they have gone down or else they say that is due to an 'infection' but what infectio n? Have had most of the referrals you mention. Seems to go in a cycle. And through takes different forms so I have 3 different cough mixtures. PPI have no lasting effect. Just manage it, with those, a puffer occasionally, gaviscon occasionally., and Glandosane throat spray at night which actually has made a difference. And I changed some things in my diet so not so acid.

[Bexter21]

I was referred to ent as they thought my dire throat and dry cough was throat cancer... it wasn't. Just told its possibly acid reflux

[Mauser1905]

My frequent sore throat symptoms were slowly resolved with Echinacea tablets. its herbal flower extracts. works for 50%. I am in the working side.

If that helps then good.

MY speculation is sensitive LES with conditional laxness and lower grade of HH though amplifiable with mental anxious issues!!Just speculation, dont shoot me for that.