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Suggest Treatment For Constant Throat Discomfort

Posted on Thu, 26 Nov 2015

Question: What options does one have when they have constant throat discomfort for 6 months, and have seen 3 different ENT's four times each? I currently am trying 60 mg. of dexilant, and am eating a strict reflux diet. I have only done this for about 2 weeks, but I am anxious and the results are very minimal. Are there any other tests I am missing?

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Answered by Dr. Krunal Karade (9 hours later)

Brief Answer:
You are most probably having combination of conditions like GERD + PNDS .

Detailed Answer:
Hi,
Thanks for the query.

I have read your query and understand your concern.

In my opinion , you are most probably having combination of conditions like Gastroesophageal Reflux Disease (GERD) + post nasal drip syndrome (PNDS) .

If I were your treating doctor , I would advice
Investigations like CT Scan Nose with sinuses & endoscopy of throat with larynx .
Till then i would advice
salt water gargle twice daily ,
Antihistaminic levocetirizine + Montelukast combination like Tab Allegra M at night &
continue dexilant .

You will get relief .
You will need prescription for medication .

Hope this information helpful to you .If you have any further questions I will be happy to help.

Regards.

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Krunal Karade (8 hours later)

Would an MRI of the sinuses be the same as a cat scan?

Answered by Dr. Krunal Karade (4 hours later)

Brief Answer:
Hence for sinuses , CT Scan is preferred .

Detailed Answer:
Hi,
Thanks for the follow up query.

CT scan of nose with sinuses give information of bony framework as well as mucosal thickening .
MRI can give better information about soft tissue & mucosal thickening than bony framework .

Hence for sinuses , CT Scan is preferred .

Hope this information helpful to you .

Regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Krunal Karade (1 hour later)

For the rest of the throat..ie. larynx, pharynx, and top of the esophageus, would an MRI be prefered?

Answered by Dr. Krunal Karade (19 minutes later)

Brief Answer:
Endoscopy of throat , pharynx , larynx & esophagus will be prefer .

Detailed Answer:
Thanks for the follow up query.

For the rest of the throat..ie. larynx, pharynx, and top of the esophagus
Endoscopy will be prefer for your condition .

Regards.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

Follow up: Dr. Krunal Karade (2 hours later)

And if I get complete relief from this from .5mg of Ativan, what would that suggest concerning the tightening and pushing? I don't think this is anxiety based, but I feel another property of the Ativan is giving me complete relief. I feel like if I figured out what property of the Ativan relieves this, I may be able to figure out what this is.

Answered by Dr. Krunal Karade (10 hours later)

Brief Answer:
The common side effect of lorazepam is dryness of mouth , hence PND less

Detailed Answer:
Hi ,
Ativan contain lorazepam which is use in anxiety , insomnia , convultion & Chemotherapy-Induced Nausea/Vomiting .

The common side effect of lorazepam is dryness of mouth , hence decreasing post nasal drip (PND) .
In your case , it is causing dryness of mouth , decreasing your anxiety about throat discomfort & nausea hence giving you relief.

Regards.

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Krunal Karade (4 hours later)

So, Is there any other muscle relaxant that would do the same for me as ativan does on that LPR muscle, that wouldn't dry my mouth out?

Answered by Dr. Krunal Karade (1 hour later)

Brief Answer:
I would advice , Esomeprazole 40mg in morning .

Detailed Answer:
Thanks for the follow up query.

I would advice , Esomeprazole 40mg in morning to relax LPR muscle .

You will need prescription for medication .

Regards.

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Krunal Karade (9 hours later)

I swear this is my last question...

If I wanted a biopsy of my throat and tonsil, how do I get this done?
I really find it hard to believe that nothing is seriously wrong with me, since I have had this persistent sore throat for six months, every day. I know the only way to confirm this is a biopsy.

I am scheduled to see my gastroenterologist again next week, and she could do an endoscopy. Would she be able to take biopsies? How do I ask for this? And can she do a biopsy of the throat being that she is a gastroenterologist? I know the number one sign of throat cancer is a sore throat that won't go away, and I really feel like everyone has missed something! I promise this is the last time I write you! But you are the most helpful Dr. yet.
XXXXXXX

Answered by Dr. Krunal Karade (11 hours later)

Brief Answer:
Biopsy can be done only if some mass is found on endoscopy

Detailed Answer:
Hi ,

In my opinion , you are not having throat cancer , you only have combination of conditions like Gastroesophageal Reflux Disease (GERD) + post nasal drip syndrome (PNDS) .

I see many patients with same complains you are having since many years , getting relief with above treatment plan .
Throat , pharynx & larynx endoscopy can be done by ENT specialist not by gastroenterologist . Gastroenterologist can do endoscopy of esophagus & stomach .
Biopsy can be done only if some mass is found on endoscopy , otherwise not needed .
After reading yours query it seems that you are having cancer phobia , you are having only post nasal drip syndrome (PNDS) + Gastroesophageal Reflux Disease (GERD) which can be treated.

Hope this information helpful to you .

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. Prasad