Throat and Oral Symptoms: A Guide to Neurological Concerns

Oral and throat issues?

Hello Doctor, I would like to consult you.
I have difficulty describing the exact location of my symptoms, but I will try to explain.
For the past few months, the area around my uvula and the posterior pharyngeal wall (below the nasopharynx) has been in a constant state of inflammation, accompanied by a throbbing pain and sharp sensations.
The mucosa at the base of my left tongue and the area where my teeth meet also experiences sharp pain and a foreign body sensation.
Occasionally, when I eat, I feel a sharp pain in my throat.
The middle to root of my left tongue sometimes has a sour taste, and the pharyngeal wall and deep throat feel like something is stuck, causing a sharp pain that feels like a bone.
This sensation is less intense upon waking but becomes noticeable after about 5 to 10 minutes.
Additionally, I have been experiencing persistent tinnitus in my left ear for 24 hours a day for the past five months.
The symptoms do not alleviate throughout the day, but swallowing is generally not an issue, although there is occasional sharp pain and a persistent feeling of inflammation in certain areas.
I am uncertain about the cause of the tinnitus (I have had a brain MRI that showed no abnormalities).
Currently, the area at the base of my left tongue and the site of my previous tonsillectomy also feels inflamed and pulsating, with sharp pain and a foreign body sensation.
I feel as though there has been a constant sensation of something being stuck in my throat (below the nasopharynx, uvula, or the posterior nasopharyngeal wall) for the past five months.
I had a bilateral tonsillectomy five months ago and have followed up with my doctor.
In June, the doctor suggested that it might be caused by acid reflux.
An endoscopy revealed some swelling in my throat and inflammation at the left base of my tongue, but I was not informed about the discovery of lymphadenopathy on the right side of my tongue.
Due to the severity of my symptoms, I underwent an upper gastrointestinal endoscopy in early July, which showed only mild acid reflux.
I have been taking medication for my stomach, but my symptoms have not improved.
At the end of July, I returned to my doctor and mentioned a lump on the right side of my tongue and throat with a white spot on its surface.
The doctor said it was a lingual tonsil and that everyone has one, and the white spot might be food residue that would eventually fall off.
I expressed my concerns about the persistent foreign body sensation and inflammation in my throat, but the doctor only stated that the wound had healed and did not take further action.
I have since observed the lump in the mirror.
Because I still feel a foreign body sensation and sharp pain in my pharyngeal wall and deep throat, along with a persistent state of inflammation, I am very anxious and worried.
Sometimes, when I speak, I feel a sharp pain around the left base of my tongue.
I am unsure if there is a pathological change in the underlying tissue or mucosa.
In August, I visited another ENT specialist and explained my symptoms.
The doctor performed a nasopharyngoscopy and stated that there were no obvious abnormalities, and the lump at the back of my tongue was lymphadenopathy, which would gradually resolve.
When I asked the doctor to examine my tongue, he said it was unnecessary and arranged for a neck ultrasound, which I have to wait until mid-September for.
This waiting period is very difficult, especially since my oral cavity and throat are in a constant state of inflammation and pulsation, with a foreign body sensation and sharp pain.
The left base of my tongue has been painful for months, and the surgeon mentioned inflammation in that area.
Why is it still painful? The uvula has been adjusted; could the sensation of something stuck be due to the sutures? Is it possible that the surgery damaged a nerve? Is it abnormal that I have not recovered after several months? Could this be a complication? If I have already undergone nasopharyngoscopy and endoscopy, can we rule out any oral cancers or esophageal lesions? If I want to pay out of pocket for an MRI, would that provide more certainty? Or do I need to undergo another endoscopy with a narrow-band imaging (NBI) examination to check inside my mouth and tongue? (If further examinations are needed, please advise where I can find this equipment.) I am very worried that I might have oral cancer or tongue cancer, or head and neck cancer.
The more uncomfortable I feel, the more fearful I become.
My child is not yet three years old, and I am genuinely afraid of having a serious illness that is difficult to treat.
What examinations can be done to confirm that there are no early lesions in the oral mucosa, nasopharynx, or throat wall? Or is it possible that my nerves are misfiring or that I am experiencing postoperative complications? I am feeling very scared and helpless, unsure of where to seek medical help (the original surgeon thought it was related to my emotions and only prescribed emotional medication, and traveling to the hospital in the south is not convenient anymore).
I currently live in Taipei and have attached photos, hoping you can advise me on where to seek medical attention or what examinations I should undergo to rule out serious issues.
If I have made any errors in my inquiries, please forgive me.
Thank you.
Should I see an oral surgeon again? Or do I feel that my nerves are abnormal? How should I express my concerns to the doctor? Thank you.

Miss Lin, 40~49 year old female. Ask Date: 2021/08/21

Dr. Jiang Junyi reply Neurology

Dear Ms.
Lin,
You have many symptoms that seem to be related to gastroesophageal reflux disease (GERD) or sleep apnea.
I wonder if you have any issues with metabolic syndrome? From a neurological perspective, I recommend improving autonomic nervous system function to regulate gastrointestinal function.
Generally, the sympathetic and parasympathetic nervous systems work together to regulate bodily functions—one acts as the accelerator, while the other serves as the brake.
The sympathetic nervous system is responsible for stimulating the body, leading to increased heart rate, faster breathing, and increased sweating, while gastrointestinal motility decreases, which can exacerbate GERD.
Once physical activity stops, the parasympathetic nervous system takes over, slowing the heart rate, reducing breathing rate, and decreasing sweating, allowing gastrointestinal motility to return to normal.
This is why you may feel very hungry about an hour after exercising.
My suggestion is to consolidate your information at the same medical center or regional hospital (preferably one near your home in the northern part of Taiwan).
You can consult different specialists to integrate your medical information, as sometimes the side effects of certain medications, such as gastrointestinal drugs, antipsychotics, and antihistamines, can present similar symptoms.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new pandemic prevention measures before and after your medical visits.
Thank you for your inquiry.
If you have any related questions, feel free to discuss further!
Wishing you good health and peace,
Dr.
Jiang Junyi
桃醫神內

Reply Date: 2021/08/21

More Info

Your symptoms, which include persistent pain and discomfort in the throat, tongue, and surrounding areas, along with ear ringing (tinnitus), can indeed be complex and multifaceted. Given the history of your tonsillectomy and the ongoing inflammation and pain, it’s understandable to feel concerned about the underlying causes.
From a medical perspective, there are several potential explanations for your symptoms. First, the sensation of a foreign body in the throat and the pain you describe could be related to post-surgical changes. After a tonsillectomy, it is not uncommon for patients to experience lingering discomfort as the tissues heal. The presence of scar tissue or changes in the anatomy of the throat can lead to sensations that feel like inflammation or pain.

The inflammation you are experiencing could also be due to gastroesophageal reflux disease (GERD), which you mentioned was diagnosed as mild. GERD can cause acid to irritate the throat and esophagus, leading to symptoms such as pain, a sensation of a lump in the throat, and even ear pain due to referred sensations. The fact that your symptoms seem to worsen at certain times of the day may correlate with your eating habits or the timing of your medications.

The presence of a lump or swelling in the area of the tongue or throat, particularly if it has been noted by multiple physicians, could indicate lymphoid tissue hyperplasia, which is a common response to chronic irritation or infection. This could explain the white spot observed, which may be food debris or a benign lymphoid hyperplasia rather than a malignant process.

Regarding your concerns about cancer, the fact that you have undergone both a nasopharyngoscopy and an esophagogastroduodenoscopy (EGD) with no significant findings is reassuring. While no test can completely rule out cancer, the combination of these examinations typically provides a good level of reassurance. If there were any concerning lesions, they would likely have been noted during these procedures.

As for the neurological aspects, if you are experiencing persistent pain and sensations that feel like nerve-related issues, it may be worthwhile to consult a neurologist. They can assess for conditions such as neuropathy or other nerve-related issues that could be contributing to your symptoms.
In terms of further investigations, if your symptoms persist and you feel that they are not improving, you might consider discussing with your healthcare provider the possibility of advanced imaging, such as an MRI, to rule out any structural issues that might not have been visible on previous scans. Additionally, a narrow-band imaging (NBI) endoscopy could be beneficial for a more detailed examination of the mucosal surfaces in your throat and mouth.

Lastly, managing anxiety and stress is crucial, especially when dealing with chronic symptoms. Psychological factors can exacerbate physical symptoms, and addressing these through counseling or therapy may provide additional relief.

In summary, while your symptoms are concerning, they may be related to post-surgical changes, GERD, or benign lymphoid hyperplasia rather than a malignancy. Consulting with a neurologist and possibly undergoing further imaging could provide additional insights. It’s essential to maintain open communication with your healthcare providers and advocate for your health as you navigate these complex symptoms.

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