Persistent Throat Discomfort and Vision Issues: A Neurological Perspective

Q: Persistent Throat Discomfort and Vision Issues: A Neurological Perspective

Hello： I see that your family has undergone numerous examinations. <br>I would like to suggest a principle to follow, which is the concept of "local healthcare." As we age and experience various symptoms, the recommended approach is to find a nearby hospital with an emergency dep

Feeling of a lump in the throat, sensation of foreign body, difficulty breathing, blurred vision, eyelids often feel sticky as if sweating, fatigue, hair loss, and poor skin condition?

Hello, doctor.
My family member is experiencing significant discomfort, so I would like to inquire about your professional knowledge.
My family member has had a persistent sensation of a foreign body in the throat for a long time, and when eating, a small piece feels stuck in the area of the uvula, which needs to be coughed out.
We visited Kaohsiung Veterans General Hospital and saw an ENT specialist who performed a laryngoscopy and found no abnormalities, so a CT scan was arranged, which also came back normal.
An esophagram was performed, and again, no abnormalities were found.
My family member was then referred to the gastroenterology department, where a gastroscopy revealed and removed a benign polyp.
A check-up with the family medicine department included blood tests, and the results were normal.
We also consulted a pulmonologist, and everything was normal.
An X-ray was done in orthopedics for the thoracic, lumbar, and cervical spine, and they said there were no issues.

My family member has also experienced discomfort in the eyes.
After undergoing cataract surgery two years ago, their vision is still not quite right, with monocular double vision and a sticky sensation in the eyelids, described as feeling like the eyelids are sweating, which is very uncomfortable.
The ophthalmologist said everything appeared normal, including the fundus examination.
They also mentioned that they breathe with their mouth open while sleeping, and the left side feels somewhat obstructed.
During the day at work, they sometimes feel as if there is something on the left side of the throat that needs to be moved for easier breathing.

We consulted a traditional Chinese medicine practitioner who diagnosed "plum pit qi," but my family member said that after taking the prescribed treatment, the symptoms persisted.
We also saw a neurologist who arranged for an electromyography, which showed no issues, and blood tests were also normal.
After discussing with my family member, we decided to visit the Department of Metabolism at E-Da Hospital.
The doctor took a history and noted that my family member had seen many specialists and had many tests done, all of which were normal.
The doctor reviewed the reports and said that the blood tests and ultrasound were normal, with no masses found.
When I asked the doctor what to do next, they suggested testing for Marfan syndrome, and referred us to E-Da Cancer Hospital for further evaluation.

Today, we visited E-Da Cancer Hospital, and the doctor listened to my family member's description and said it was not Marfan syndrome and that there was no need for testing.
I then asked if it could be cervical sympathetic nerve disease, and the cancer treatment hospital doctor suggested consulting orthopedics or neurology, stating that this falls under the expertise of neurology.

Could you please advise which specialty my family member should see and how to proceed with their situation?

Mr. Chen, 10~19 year old female. Ask Date: 2021/09/26

Dr. Jiang Junyi reply Neurology

Hello: I see that your family has undergone numerous examinations.
I would like to suggest a principle to follow, which is the concept of "local healthcare." As we age and experience various symptoms, the recommended approach is to find a nearby hospital with an emergency department to consolidate medical information in one place.
You mentioned seeking care at E-Da Hospital; if you live near E-Da, I recommend continuing your treatment there.
However, if you are closer to Kaohsiung Veterans General Hospital, I suggest relaying E-Da's opinions to Kaohsiung Veterans.
Regarding the diagnostic aspect, I recommend consulting a neurologist and seeking opinions from different physicians to approach the diagnosis from various perspectives.
It would be beneficial for you to accompany the patient during consultations.
Please ensure to practice self-protection and maintain cleanliness and disinfection before and after medical visits.
Implementing new preventive measures is essential.
Thank you for your inquiry, and feel free to discuss any related questions further! Wishing you good health, safety, and happiness.
Dr.
Jiang Jun-Yi from Taoyuan Medical Center cares about you.

Reply Date: 2021/09/26

More Info

Your family member's persistent throat discomfort and vision issues can be quite distressing, especially after undergoing numerous tests across various specialties without a definitive diagnosis. Given the complexity of the symptoms, a multidisciplinary approach may be beneficial.
From what you’ve described, the throat discomfort seems to be a sensation of a foreign body, which can be associated with several conditions, including gastroesophageal reflux disease (GERD), anxiety-related somatic symptoms, or even muscular tension in the throat area. The fact that multiple ENT evaluations and imaging studies have returned normal results suggests that there may not be a structural issue, but rather a functional or neurological one.
The sensation of having something stuck in the throat, often referred to as "globus sensation," can sometimes be exacerbated by anxiety or stress. It’s important to consider whether your family member has experienced any significant stressors or anxiety, as these can manifest physically in various ways, including throat discomfort.
Regarding the vision issues, the symptoms of double vision and sticky eyelids could be indicative of several conditions, including dry eye syndrome, which is common in individuals who have undergone cataract surgery. The sensation of sticky eyelids, particularly upon waking, may suggest a need for artificial tears or other lubricating agents to alleviate dryness. If the eye examinations have consistently returned normal results, it may be worthwhile to explore the possibility of ocular surface disease or even neurological conditions that could affect vision.

Given the complexity of the symptoms and the lack of a clear diagnosis, it may be prudent to consult a neurologist again, particularly one who specializes in functional neurological disorders. They can evaluate for conditions that may not have been considered previously, such as cervical dystonia or other movement disorders that could contribute to both the throat and visual symptoms.
Additionally, if there are concerns about the autonomic nervous system, a referral to a specialist in autonomic disorders may also be appropriate. Conditions like dysautonomia can lead to a variety of symptoms, including those affecting breathing and swallowing, and can sometimes be overlooked in standard evaluations.

In summary, I would recommend the following steps:
1. Neurological Evaluation: Seek a second opinion from a neurologist who specializes in functional disorders or autonomic dysfunction.

2. Ophthalmology Follow-Up: Consider a follow-up with an ophthalmologist who specializes in dry eye or ocular surface disease, especially if symptoms persist despite normal findings.

3. Psychological Assessment: If anxiety or stress is suspected to be a contributing factor, a consultation with a mental health professional may be beneficial to address any underlying psychological issues.

4. Multidisciplinary Approach: Given the complexity of the symptoms, a coordinated approach involving multiple specialties may provide the best chance for a comprehensive understanding and management of your family member's condition.

It’s understandable to feel overwhelmed by the situation, but persistence in seeking the right care is key. Encourage your family member to keep a detailed symptom diary to help healthcare providers understand the patterns and triggers of their symptoms, which can be invaluable in reaching a diagnosis.

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