Throat Discomfort: Insights from ENT Specialists

Throat issues

Hello Dr.
Li, thank you for your response.
Let me first describe my current symptoms.
It has been four months since my surgery, and I have been experiencing discomfort in the left side of my soft palate and the area around the left base of my tongue, with a sensation of a foreign body and pain deep in my throat.
I have been returning for monthly check-ups, and the doctors have said that the wound is fine and has healed.
However, over a month ago, the sensation of a foreign body in my throat became significantly worse, causing discomfort and pain, even when I am not eating; it feels like something is stuck in my throat.
The sensation of saliva in my mouth has become more pronounced, and sometimes I experience sudden sharp pain.
I have undergone an endoscopy, which showed no significant issues, and the gastroesophageal reflux is very mild and unlikely to cause the severe sensation in my throat.
On the night before my follow-up appointment on July 26, I wanted to take a picture to show the doctor where I was feeling uncomfortable.
I asked my child to help me take a picture, and I accidentally discovered a mass that appeared in my throat when I exerted pressure on the right side of my tongue.
There was also a white spot on it, which I couldn't reach with a cotton swab.
During my follow-up, I mentioned this to the doctor, who used a tongue depressor to examine me and said it was the palatine tonsil at the back of my tongue.
He mentioned that if I wanted surgery, it would be complicated, and he was concerned that the sensation of a foreign body might persist post-surgery, which would not resolve the issue.
The doctor said that many people have similar masses, which are the lingual tonsils.
However, before this follow-up, I had felt around the base of my tongue and did not notice this mass; I only felt a hard lump on the posterior pharyngeal wall.
I had previously looked into my throat and had not seen anything unusual until I discovered it on July 25.
During this follow-up, I again told the doctor that the mass only protrudes on the right side when I exert pressure, and there is a small white object on it.
The doctor suggested it might be food debris and that it could disappear with time, but I requested that he use an endoscope to examine it more closely.
The doctor was unwilling to perform another endoscopic examination, but I expressed that the sensation of a foreign body and the pain were very distressing, making me fearful of what the problem could be.
The doctor prescribed medication to help alleviate my anxiety, stating that others who had their tonsils removed in June were now fine.
At that moment, I did not want to continue pursuing what the issue could be, especially since I have not found relief since the surgery, and now there seems to be a mass.
Due to previous tonsil issues, I have visited the hospital multiple times, and I have been labeled as a patient with discomfort and pain.
I have a picture from before the surgery where a biopsy was taken from that area due to the presence of a white substance.
That area still causes pain (between the palatoglossal arch and the palatopharyngeal arch, originally where the palatine tonsil was located, or is it called the lingual tonsil?).
However, since the surgery, I can no longer see inside, but I continue to experience pain and the sensation of a foreign body.
About three months ago, I suddenly developed high-frequency tinnitus in my left ear, accompanied by sharp pain inside my ear, which has not stopped since.
Hearing tests have indicated normal results, so I am very concerned that there may be another underlying issue.
I often feel as though there is a foreign body at the back of my left tongue, and at times I feel it in the posterior pharyngeal wall.
This situation is truly overwhelming.
Dr.
Li, please help me.
I am genuinely afraid that these discomforts and pains will remain unresolved, and by the time a visible problem arises, it may be too late for effective treatment.
My child is still very young.
I would like to ask you if the swollen area in the picture of the lingual tonsil could be something concerning (is it located at the base of the tongue near the pharyngeal wall)? I am willing to pay out of pocket and hope to clarify that there are no lesions.
Would it be possible for me to arrange a head and neck MRI with you? What would the cost be? Thank you.

Miss Yang, 40~49 year old female. Ask Date: 2021/07/28

Dr. Li Jiaxuan reply Otolaryngology

It is recommended to go to a medical center for narrow band imaging to examine the submucosa for any issues.
After all, the discomfort you are experiencing may vary depending on your posture (open mouth or closed mouth).
Once a clear assessment is made, you can decide whether an MRI is necessary.
Wishing you good health.

Reply Date: 2021/07/28

More Info

Hello, thank you for sharing your concerns regarding your throat discomfort. It sounds like you have been experiencing significant discomfort and anxiety related to your symptoms, especially after your surgery. I understand how distressing it can be to have persistent sensations of a foreign body in your throat, along with pain and other associated symptoms.

From what you've described, it seems that you have been evaluated multiple times by your ENT specialists, and they have indicated that your surgical site is healing well. However, the ongoing sensations of discomfort, pain, and the recent discovery of what appears to be a lump on the right side of your throat are understandably concerning for you.

The sensation of a lump or foreign body in the throat, known as "globus sensation," can be caused by various factors, including muscle tension, inflammation, or even gastroesophageal reflux disease (GERD), which you mentioned has been assessed as mild. The presence of a lump that is described as a "tongue tonsil" or "lingual tonsil" is not uncommon, as many individuals have variations in the anatomy of their throat that can lead to such findings. These structures can sometimes become enlarged or inflamed, leading to discomfort.

Given that your symptoms have persisted and worsened, it is reasonable to seek further evaluation. While your doctor may have suggested that the lump could be food debris or a normal anatomical variant, your insistence on further investigation is valid, especially since you are experiencing significant discomfort. An endoscopic examination can provide a clearer view of the area and help determine if there are any underlying issues that need to be addressed.

Regarding your request for an MRI of the head and neck, this imaging modality can be helpful in assessing soft tissue structures and identifying any abnormalities. However, the decision to pursue an MRI should be made in consultation with your ENT specialist, who can evaluate your symptoms in the context of your surgical history and current findings. The cost of an MRI can vary widely depending on your location, the facility, and whether you have insurance coverage, so it would be best to inquire directly with the imaging center or your healthcare provider for an estimate.

In the meantime, managing your anxiety and discomfort is crucial. If your doctor prescribed medication to help alleviate your emotional distress, it may be beneficial to follow their guidance while you continue to seek answers regarding your physical symptoms. Additionally, consider discussing your concerns with your healthcare provider about the possibility of a referral to a specialist who can provide a more in-depth evaluation of your throat discomfort.

Remember, it is essential to advocate for your health and well-being. If you feel that your concerns are not being adequately addressed, seeking a second opinion from another ENT specialist may provide you with additional insights and reassurance. Your health is paramount, and you deserve to have your symptoms thoroughly investigated and treated appropriately.

Please take care, and I hope you find relief from your symptoms soon.

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