Suggest Treatment For Pain In Throat And Paresthesia

Posted on Mon, 9 Mar 2015

Question: I'm a 63 year old male with a long history (20+yrs) of atypical chest pain. The chest pain is in the upper right quadrant and is accompanied by pain in my right throat and paresthesia in the right outer ear primarily in the tragus area. Here's the kicker, the pain only occurs after sitting down for 10-30 minutes. I have had an exhaustive cardiac workup that has ruled out cardiac involvement. Other testing has shown I have a sliding hiatal hernia with a slight amount of reflux. However I almost never experience heartburn, which I have experienced from time to time and the chest pain is definitely not heartburn. They harpooned a pH probe inside my esophagus and did a 24-hr pH study for reflux, and while I had about 4 episodes of the chest/throat/ear pain, the probe showed no rise in pH for the entire study. The pain is dull and on a scale of 1-10 usually a 3-4 level, but if I don't act to relieve it, it will spike to an 7-9. When the pain occurs, it is quickly relieved by lying flat on my back, or standing upright and walking it off. While it occurs only while sitting, there are variations in the pain level based on how I am sitting. It is the worst while sitting upright belted into a car seat, much less so when slouching in a chair. It has also been somewhat alleviated by wearing loose fitting pants, sweat pants are best. I also had an esophageal motility study that showed no abnormalities. I don't get rare illnesses, and my guess is that millions of people have this but they have concomitant reflux heartburn pain that masks this lower level pain. It seems to me to be related to abdominal compression, and I'm wondering if the compression pushes the sliding hernia against the vagus nerve within the hiatus and irritates the vagus nerve resulting in referred pain to the upper right chest, right throat, and right ear.

Answered by Dr. Shoaib Khan (1 hour later)

Brief Answer:
I concur with the explanation; no need to look for the cause any further

Detailed Answer:
Hello sir and welcome.

Thank you for writing to us.

I have gone through your query with diligence and would like you to know that you have a well constructed query, with all the information needed to get a medical professional thinking.

I would however like to point out something that I feel you may have missed out. You have primarily written to us because you could not find a cause or diagnosis for the chest pain, and currently the only confirmed diagnosis is of the hiatal hernia. But have you ever thought about the symptoms of hiatus hernia and whether the chest pain and all other symptoms could simply be due to the hiatal hernia, not requiring any further investigations?

Let me also list the documented symptoms of a hiatal hernia for your reference:

+Feeling excessively full after meals
+Heartburn
+Difficulty swallowing
+Chest pain and/or abdominal pain (mimicking cardiac chest pain)
+Vomiting (with traces of or moderate amount of blood in vomitus) - if present indicate a bleed
+Black or darkened stools (if present indicate a bleed)
+Chest pain or heartburn gets worse in certain positions (e.g. bending over, seating position, supine position, etc.)

Please also note that all the symptoms need not be present even after hiatal hernia is confirmed. And the explanation of the chest pain is quite possible, and can easily be the etiological cause for the chest, right throat and ear pain sir.

A cardiac profile is required as all chest pain needs to be investigated for a cardiac cause, and accordingly ruled out, so this is really good news.

I hope you find my response both helpful and informative. Please feel free to write to me for any further clarifications, I would be more than happy to help.

Best wishes.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar