Which Specialist Should I See for Chronic Throat Issues?

Which department should I make an appointment with?

Hello Doctor: Two years ago, I had pharyngitis for the first time and it resolved after medication.
However, less than two months later, it recurred, and after treatment, it improved again.
Yet, just a month later, it happened again.
This time, I visited an ENT specialist at a large hospital.
The doctor diagnosed me with chronic pharyngitis, possibly caused by gastroesophageal reflux disease (GERD), and prescribed only medication for my stomach without any treatment for pharyngitis.
After two weeks, my throat pain subsided.
Due to my busy work schedule, I didn't pay much attention to it.
However, by mid-last year, I noticed a sensation of something being stuck in the area near my throat above the collarbone, which would pulsate and cause pain when pressed, and I felt like I couldn't swallow food properly.

On one occasion, I experienced stomach pain along with pharyngitis and visited a clinic.
I informed the doctor about my previous issues, but he suggested it might be caused by a cold.
After finishing the prescribed medication, I still felt the sensation of something being stuck.
Later, at the end of last year, I took the opportunity to undergo an upper endoscopy at Tzu Chi Hospital after work, but the doctor reported that my esophagus, stomach, and duodenum were normal.
He suggested that my discomfort might be due to anxiety and stress, and prescribed anti-anxiety medication.
However, after taking it, the discomfort in my throat persisted.
I would like to ask the doctor, having consulted both ENT and gastroenterology specialists and even undergone an endoscopy, what other specialties should I consider? Sometimes, my throat suddenly feels bitter, and the phlegm and saliva I expel contain yellowish substances and have an unpleasant odor! I also experience significant gas in my stomach that produces loud sounds.
Are these issues related to my throat discomfort? I have mitral valve prolapse, and could this be contributing to my discomfort (although I usually take medication sparingly, as my doctor advised to take it only when I feel unwell)? Thank you, Doctor.

winney, 20~29 year old female. Ask Date: 2009/01/15

Dr. Cai Jueren reply Family Medicine

Hello, your symptoms are likely due to anxiety disorder.
Patients with mitral valve prolapse often experience anxiety as well.
Individuals who have long-term anxiety or high levels of stress frequently develop gastroesophageal reflux disease (GERD), gastritis, or even peptic ulcers.
Some patients may also complain of throat discomfort or a sensation of a foreign body in the throat.
I recommend that you do not worry too much about your current physical symptoms, as these can improve with medication and are not likely to cause permanent harm.
Instead, you should pay attention to your anxiety disorder, as it can be a long-term issue that may lead to other mental health disorders in the future.
Therefore, please make sure to regularly visit a psychiatrist for follow-up.
Other symptoms can be addressed in a general family medicine clinic.
Thank you for your inquiry, and I hope this information helps alleviate your concerns.
Dr.
Jue-Ren Tsai, Hualien Hospital.

Reply Date: 2009/01/15

More Info

Chronic throat issues can be quite complex and frustrating, especially when they persist despite seeing multiple specialists. Based on your description, it seems you've already consulted with an otolaryngologist (ENT specialist) and a gastroenterologist, which are the appropriate specialists for throat and gastrointestinal issues, respectively. However, since your symptoms persist, it may be beneficial to explore a few additional avenues.

Firstly, it’s important to understand that chronic throat discomfort can arise from various underlying causes, including gastroesophageal reflux disease (GERD), allergies, chronic sinusitis, or even psychological factors such as anxiety. Given that your ENT specialist suggested that your chronic throat issues might be related to GERD, it’s crucial to manage this condition effectively. GERD can lead to acid reflux, which can irritate the throat and cause symptoms like a sensation of something being stuck in the throat, pain, and even chronic cough.

Since you mentioned that you have been prescribed anti-anxiety medication, it’s worth noting that anxiety can exacerbate physical symptoms, including throat discomfort. Stress and anxiety can lead to muscle tension in the throat, which may contribute to the sensation of tightness or discomfort. Therefore, consulting with a mental health professional, such as a psychologist or psychiatrist, could be beneficial. They can help you explore stress management techniques, cognitive behavioral therapy (CBT), or other therapeutic approaches that may alleviate your symptoms.

Additionally, you might consider seeing an allergist if you suspect that allergies could be contributing to your throat issues. Allergies can lead to post-nasal drip, which can irritate the throat and cause discomfort. An allergist can perform tests to identify any allergens that may be affecting you and recommend appropriate treatments, such as antihistamines or allergy shots.

Another potential specialist to consider is a speech-language pathologist (SLP). An SLP can assess your swallowing function and provide exercises or techniques to improve swallowing and reduce the sensation of something being stuck in your throat. They can also help with voice therapy if you experience hoarseness or other voice-related issues.

In summary, while you have already seen an ENT and a gastroenterologist, it may be beneficial to consult with a mental health professional to address any anxiety-related symptoms, an allergist to rule out allergies, and a speech-language pathologist for swallowing issues. It’s essential to take a comprehensive approach to your health, considering both physical and psychological factors that may be contributing to your chronic throat discomfort.

Lastly, regarding your concerns about the yellow phlegm and gas, these symptoms could indeed be related to your throat issues. Yellow phlegm often indicates an infection or inflammation, and if you experience a foul taste or odor, it could suggest a sinus infection or other respiratory issue. It’s crucial to communicate these symptoms to your healthcare providers, as they may warrant further investigation or treatment.

In conclusion, navigating chronic throat issues can be challenging, but by considering a multidisciplinary approach and consulting with various specialists, you may find the relief you seek. Remember to advocate for yourself and ensure that all your symptoms are thoroughly evaluated.

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