Throat Issues: Chronic Inflammation and Diagnosis Challenges - Otolaryngology

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Throat issues


Around mid-November, I experienced cold symptoms and initially visited a doctor.
After finishing a three-day course of medication, my throat discomfort did not improve; instead, I felt discomfort on the right side of my throat.
At times, the right side felt tight or swollen, making it difficult to breathe, especially when swallowing saliva or food, which felt like it was getting stuck, occasionally accompanied by a prickling sensation.
I also had a persistent urge to clear phlegm from my throat.

Later, I consulted a second ENT specialist.
Initially, they used a standard laryngoscope for examination.
Since my symptoms did not improve, during the second visit, the doctor palpated the lymph nodes in my neck and performed a rigid laryngoscopy, noting that phlegm was stuck on the throat wall.
Both visits resulted in prescriptions for anti-inflammatory medication, but there was no significant improvement.

At the beginning of December, I went directly to the ENT department at Chang Gung Memorial Hospital.
After describing my symptoms, the doctor suspected a fish bone might be lodged in my throat.
A standard laryngoscopy was performed, and again, it was noted that phlegm was stuck on the throat wall.
I was prescribed expectorants, and my symptoms initially improved.
However, in mid-December, I contracted influenza, during which I experienced yellow phlegm with blood.
After recovering from the flu, I no longer had similar yellow phlegm with blood, but the symptoms on the right side of my throat reappeared and have persisted until now.
Occasionally, I would expel jelly-like thick phlegm.

I subsequently consulted two more doctors, who mentioned mucosal inflammation, and one suggested it might be gastroesophageal reflux disease (GERD).
I recently underwent an upper gastrointestinal endoscopy, which confirmed the presence of GERD.

To summarize my recent condition:
1.
I have excessive phlegm, which is sometimes thick, mostly clear, but occasionally slightly yellow (not much).
2.
There is no significant cough.
3.
The right side of my throat feels tight, and there is a sensation of something getting stuck or a prickling feeling when swallowing.
4.
When swallowing, I can see that the cartilage just below the right side of my Adam's apple is more prominent and can be pressed (not sure if this is relevant).
5.
Sometimes, the swallowing action makes the right side of my throat and neck feel tighter.
6.
The uncomfortable area is approximately from the right lower jaw to the height of the Adam's apple.
7.
I have a history of allergic rhinitis, which previously caused frequent runny nose; however, after the throat discomfort began, the runny nose has become less frequent, and the consistency has changed from watery to slightly thicker (still clear).
8.
Doctors have noted the presence of lymphoid follicles in the pharyngeal wall.
9.
Palpation of the lymph nodes showed no abnormalities.
I would like to ask:
1.
If the doctor has used an indirect laryngoscope/rigid laryngoscope (pressed against the tongue) for examination, can they detect any growths or abnormalities in the throat? Are the lingual tonsils, epiglottis, and vocal cords visible?
2.
Can chronic throat inflammation cause unilateral throat discomfort?
3.
If there is still no improvement, should I pursue further examinations?

Duo Duo, 20~29 year old female. Ask Date: 2019/01/28

Dr. Zheng Jueyi reply Otolaryngology


Hello,
1.
Both indirect laryngoscopy and rigid laryngoscopy can examine multiple deep areas of the throat, including the lingual tonsils, epiglottis, and vocal cords.

2.
Chronic inflammation of the throat may also cause unilateral throat discomfort.

3.
If there is no improvement, it is recommended to continue follow-up visits for treatment.

Wishing you safety and health,
Director of the Department of Otolaryngology, Taoyuan General Hospital, Ministry of Health and Welfare,
Dr.
Cheng Jue-Yi

Reply Date: 2019/01/28

More Info


Chronic throat issues can be quite challenging to diagnose and manage, especially when symptoms persist despite treatment. Based on your detailed description, it seems you have been experiencing a range of symptoms including discomfort in the right side of your throat, difficulty swallowing, and the presence of phlegm. These symptoms have persisted despite multiple consultations and treatments, which can be frustrating.

1. Throat Examination and Findings: When doctors use indirect laryngoscopy or rigid laryngoscopy, they can visualize the larynx, including the vocal cords, epiglottis, and surrounding structures. These examinations are generally effective in identifying abnormalities such as lesions, swelling, or foreign bodies. However, certain conditions, especially those affecting deeper structures or causing subtle changes, may not be easily detectable. If your doctors have noted that phlegm is adhering to the throat wall, this could indicate irritation or inflammation rather than a structural abnormality. The tonsils and other lymphatic tissues can also be visualized during these examinations, and if there are any significant issues, they should be identifiable.

2. Chronic Inflammation and Unilateral Symptoms: Chronic throat inflammation can indeed present with unilateral symptoms. This can occur due to localized irritation or infection, which may not necessarily affect both sides equally. Conditions such as gastroesophageal reflux disease (GERD), which you mentioned has been diagnosed, can lead to inflammation of the throat and may cause discomfort primarily on one side. The presence of lymphoid follicles in the throat, as noted by your doctors, can also be a sign of chronic irritation or infection, which may contribute to your symptoms.

3. Further Investigations: Given that your symptoms have not improved significantly, it may be prudent to consider further evaluations. This could include imaging studies such as a CT scan of the neck to assess for any structural abnormalities or additional laryngoscopic evaluations to rule out any subtle lesions or growths that may not have been visible during previous examinations. Additionally, if GERD is suspected to be a contributing factor, a referral to a gastroenterologist for further management may be beneficial.
In summary, while your current examinations have provided some insights, the persistence of your symptoms warrants further investigation. It is essential to communicate openly with your healthcare providers about your ongoing discomfort and the impact it has on your quality of life. They may consider additional diagnostic tests or referrals to specialists to ensure a comprehensive evaluation of your throat issues. Chronic throat inflammation can be multifactorial, and addressing all potential contributing factors is crucial for effective management.

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