Breathing Difficulties with No Clear Diagnosis: Seeking the Right Specialist

Q: Breathing Difficulties with No Clear Diagnosis: Seeking the Right Specialist

Hello： It is recommended to see an otolaryngologist to check for any inflammation or post-nasal drip. <br>If there are symptoms of stomach pain or acid reflux, after consulting the otolaryngologist, consider seeing a cardiologist to check for any arrhythmias.

Difficulty breathing, with no findings upon examination?

Hello, Doctor.
On December 15th, during a phone call around noon, I suddenly felt like I couldn't breathe, as if someone was choking me.
Since then, I have been experiencing shortness of breath and rapid breathing.
(It was just a regular phone call, and there were no significant emotional fluctuations.) When I close my mouth and breathe through my nose, I occasionally feel a sensation of my tongue pressing against the roof of my mouth, making it hard to breathe, which also occurs when swallowing.
Occasionally, I experience a feeling of nausea when I smell more pungent odors (like gasoline or cosmetics).
Breathing through my mouth feels more comfortable, but my inhalation is short, and I feel dizzy.

I have no history of mental health issues, asthma, or heart problems, although I do have mild anemia.
Recently, I have not had any sleep or stress issues, and I do not experience chest tightness while breathing.
On the afternoon of December 15th, the factory nurse noted that my blood pressure was slightly low.
After visiting a clinic that evening, the doctor suspected throat inflammation (possibly from coughing hard in the morning).
On December 16th, my blood pressure was normal, but I continued to have shortness of breath.
On December 17th, I went to a regional hospital and was referred to the pulmonary department but was discharged.
The family medicine department suspected a possible tracheal issue and suggested intubation, transferring me to the emergency department.
After an evaluation, including blood pressure, chest X-ray, ECG, and blood tests, no abnormalities were found.
I received IV fluids and Entacapone before returning home.
The doctors at that hospital agreed that my condition did not severely impact my daily life and only prescribed the medications given by the emergency physician.
Although my diet and sleep have not been affected, the dizziness resembling hypoxia does impact my normal activities.
I would like to ask which department I should consult to receive proper treatment.

Ms. S, 20~29 year old female. Ask Date: 2020/12/20

Dr. Yang Wenda reply Pulmonology

Hello: It is recommended to see an otolaryngologist to check for any inflammation or post-nasal drip.
If there are symptoms of stomach pain or acid reflux, after consulting the otolaryngologist, consider seeing a cardiologist to check for any arrhythmias.

Reply Date: 2020/12/20

More Info

Based on the symptoms and medical history you've described, it sounds like you're experiencing a complex set of respiratory issues that have not yet been clearly diagnosed. Your symptoms of sudden shortness of breath, a sensation of choking, and difficulty swallowing, along with the occasional nausea triggered by certain smells, can be quite distressing. Given that you've already seen multiple specialists and undergone various tests without a definitive diagnosis, it’s understandable that you’re seeking further guidance on which specialist to consult next.

Understanding Your Symptoms
1. Breathing Difficulties: The sensation of not being able to breathe properly, especially if it feels like someone is constricting your throat, could be related to several conditions. These might include anxiety or panic attacks, which can mimic respiratory distress, or physical issues such as laryngospasm, where the vocal cords spasm and temporarily block airflow.

2. Throat and Swallowing Issues: The feeling of something stuck in your throat or difficulty swallowing could indicate a condition known as globus sensation, which is often associated with anxiety or gastroesophageal reflux disease (GERD). Inflammation of the throat (pharyngitis) could also contribute to these sensations.

3. Nausea Triggered by Smells: This symptom could be linked to a heightened sensitivity of your olfactory system, which can occur due to various factors, including anxiety or even a post-viral syndrome if you've had a recent respiratory infection.

Recommended Specialists
Given the complexity of your symptoms, I would recommend the following steps:
1. Pulmonologist: Since your primary concern is breathing difficulties, a pulmonologist (lung specialist) would be a good choice. They can conduct further tests, such as pulmonary function tests, to assess your lung capacity and function more thoroughly.

2. ENT Specialist (Otolaryngologist): An ENT specialist can evaluate your throat and airway for any structural issues or inflammation that might be causing your symptoms. They can perform a laryngoscopy to visualize your vocal cords and throat more clearly.

3. Gastroenterologist: If there’s a suspicion of GERD or other gastrointestinal issues contributing to your throat discomfort and swallowing difficulties, a gastroenterologist can provide insight and treatment options.

4. Psychiatrist or Psychologist: If anxiety or panic attacks are suspected to be contributing to your symptoms, consulting a mental health professional could be beneficial. They can help you develop coping strategies and may recommend therapy or medication if necessary.

Next Steps
- Follow-Up Appointments: Schedule appointments with the recommended specialists. Be sure to provide them with a comprehensive history of your symptoms, previous evaluations, and treatments you've undergone.

- Symptom Diary: Keeping a diary of your symptoms, including when they occur, their severity, and any triggers you notice, can be helpful for your doctors in diagnosing your condition.

- Emergency Plan: If your symptoms worsen or you experience severe shortness of breath, seek immediate medical attention. It’s crucial to ensure that there are no underlying conditions that could pose a risk to your health.

Conclusion
Navigating complex medical symptoms can be frustrating, especially when you feel like you’re not getting the answers you need. By consulting with the right specialists and providing them with detailed information about your symptoms, you can work towards finding a diagnosis and effective treatment. Remember, your health is paramount, and seeking the right care is an important step in managing your symptoms.

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