Throat 'Clicking/Gulping' on Swallowing

[rogerthat777]

Any experience or advice on this would be appreciated:

Dec last year came down with a horrible sore throat, was unable to swallow, throat felt closed over, went on anti-biotics, seemed to improve but never fully, have had recurring sore throats since, anti-biotics twice since the first course, then visited an ENT who referred me to a Hospital ENT they used the probe to see down my throat to say there's a bit of yeast infection down throat/tongue and red voice box, was put on Nystatin and Omeprazole, they diagnosed reflux oesophagitis.

Now it's been nearly a month on Omeprazole and there's not much improvement, throat seems to make a 'gulp' noise when i swallow saliva (not when eating though), never did this before dec last year's throat infection.

No signs of anything else they could see, done many an hour of research on the net but it's still the same.

Has anyone had any experience with this?

[baggersup]

One guess is that it sounds suspiciously like mononucleosis. Have had it twice and it's a b*gger. But if a blood test for that comes back negative, my second guess is you might have a hiatal hernia of the esophagus. Also, mono most usually comes with a high fever at the onset and extreme fatigue--though it's not in all cases.

The throat closed, etc. severe infection and all is a classic symptom of mono, so it might have been that. When I had it first at university age, even water trickled down the throat was excrutiating as it was closed up. The yeast they are finding is probably a side effect of the antibiotics, which can cause this. The fact though that your problem keeps recurring, means it might be something else.

My experiences with mono occurred 20 years apart. Like most viruses of that nature, once they run their course, you aren't bothered by symptoms--even though with mono my doctor told me you always have it in your body and can get it again if you get exceedingly run down.

As a serious viral condition, antiobiotics will not touch it. They only help with the secondary infections that come as a result of the viral condition.

A blood test will confirm whether or not you had it. That is the only way it can be diagnosed (something to do with white or red cells and lack thereof tell the tale).

A secondary possibility, which I also have, so recognize the gurgling effect, is a hiatal hernia of the esophagus. It's a common condition, usually inherited, and can be diagnosed with an endoscopy exam. The hernia constricts the esophogas to a great extent causing a rather severe acid reflux action in the throat--making the throat unbearably sore when the condition is in its height. During times when it is most bothersome, the gurgling effect is annoying because the food and drink simply cannot clear the esophagus very well and that effect happens.

The normal acid in the stomach also backs up behind the hernia and comes into your throat--often causing such a severe inflammation that it feels and looks like a virus related condition. But it's not. Also, another tell tale sign is a constant soft cough that comes from the throat being constantly irritated.

It's worse at night when you lie flat, as well. The reflux situation is at its worst lying prone.

A common effective treatment for acid reflux (other than having the hernia treated surgically which most don't need) is a prescription for Prilosec, the specific med for acid reflux. It works very well.

I recognized your symptoms--on both accounts! The constricted throat sounds more mono, but it can also feel that way once it's so irritated from the acid that it's a bit swollen in there.
:)

[gingernut]

Re-assuring that the camera test was negative.

My money's on reflux, go and see your GP, he may be willing to fiddle around with empirical treatment or re-refer you depending on the answers to the questions you give.:)

[mercurydancer]

Rogerthat

I work in ENT and have for a few decades.

Reflux sounds about right. It really does do some damage. Essentially your upper respiratory tract is not equipped to handle acid. Acid gets into the pharynx by two valves which are not as secure as they might have been when you were younger. A hiatus hernia means that there is a structural problem allowing the stomach to move upwards where the diaphragm squeezes it and sends the acid upwards instead of down. In any case, the clicking and gulping are responses to having acid hit the pharynx and below that the vocal cords. The vocal cords go into spasm when acid affects them and this can be extremely distressing. For some it feels like choking.

Proton pump inhibitors sounds like a star trek warp drive but what it means is that they inhibit acid production in the first instance. Omeprazole is a PPI, one of many. It cannot affect the basic valve weaknesses. A PPI is only part of the solution.

The other element is dietary. Fatty foods and alcohol affect the reflux. White wine and spirits especially. Some foods have acid reflux written all over them, Curries for instance. So do pastries. Fruit juices whilst sounding so healthy can really rot the upper respiratory tract. Alkaline mineral water is hugely effective in combating reflux if taken regularly. This type of water is often the most expensive or not available at all but many mineral waters do have some effect on reflux. So do yoghurt and yoghurt based drinks such as lassi or ayran. In fact, yoghurt coats the pharynx with a milky lining, making acid effects minimal. Horlicks does exactly the same thing! Stir fries tend to capture the little amount of fat they have in the food which is cooked, so dont cause many problems. Some people swear that weetabix with milk at supper does the trick excellently. Other wheat based foods are available.

[lofo101]

Reflux is my guess too. It sounds nothing like mononucleosis, where a sore throat is just one of the symptoms.
One other thing to consider (I caught up on this again in a case report in a medical journal recently): are you asthmatic? The combination of a fungal infection in the throat, and the feeling of 'something there' may be the result of long-term use of steroids for asthma.
Just a thought ....but anyway, you're seeing a Dr that's the main thing.

[pax80a]

I am feeling exactly the same, don't know how this started, but I've been feeling this for 2 months.

did the symptoms go away, did you dicover what was the problem?

[homonculus]

A hiatus hernia and reflux are effectively the same

This isn't asthma nor mononucleosis

I agree with the others - all I would add is that it needs monitoring and blindly putting you on proton pump inhibitors is not a great idea. Any loss of weight or reduction in fatty foods is to be encouraged. Further cameras - nasendoscopy or oesophagoscopy - will indicate if the drugs and change in lifestyle are working

Finally make sure you tell your anaesthetist you have this condition before any operation - otherwise you can get lung problems

[pax80a]

so what is it?

[sevenstrokeroll]

there is alot of good information here and I want to say I'm not a doctor...but

the closing of the throat and a few other things make me want to offer thoughts on hysterical globus...a feeling like there is a ball in your throat choking you...it can be due to stress. Maybe a tranquilizer might help (don't fly with it) While I don't want you to get addicted, try a few xanax for a few days...don't get a prescription for more than a week , watch out for addiction.

also, how about an allergy like to foods like peanuts or something?

there is a liquid form of antihistimine (liquid benadryl), over the counter, for children...sometimes gargling with this helps.


I also think nexium is a better drug than the ones you mentioned. I tried the former and didn't get better till using the nexium.

have you ever used NASIDs like indocin? it can rip you up inside.

I would also offer this advice...and yes I am a Yankee. come to America for some medical treatment...maybe try Boston as its pretty close to the UK. We do medicine for profit here (at least for now) and you get what you pay for.

I would also try sleeping upright instead of laying down flat if it is acid reflux.

[homonculus]

It is reflux

Pure and simple

Nexium is no better than any other drug in the group

Yes non steroidal anti inflammatory drugs such as voltarol can make it worse

And Boston is a small town in one of the ex colonies that will happily take your money for exactly the same treatment you can get free at point of use on the NHS

seriously the Mass General is a great hospital - I was there only last month - but this is a common and well understood disease you can get properly treated in your local hospital

[sevenstrokeroll]

homonculus.

ifyou are a doctor, say so and remember your oath

first do no harm...no one can make a diagnosis as final as YOURS without looking down someone's throat.

to the original poster...if your current medical treament was correct, wouldn't you be feeling a whole lot better and not bothering discussing it on an AVIATION forum?

And yes Boston was part of the ex colonies. I suggested it because it is physically closer to England. I could have suggested San Francisco or chicago...but saving a few minutes wouldn't hurt.

And some do find better luck with nexium. I personally didn't fully heal until I changed from prevacid to nexium.

[homonculus]

Wow sevenstrokeroll what rattled your cage?

I suggest you look at the disclaimer at the top. This is a rumour network which doesn't replace a consultation with a doctor BUT we try to give advice. You have seen the replies suggesting it is reflux. It is. And despite your experience the evidence says the difference is more to do with the pharmaceutical companies marketing budget than anything else.

Good night

[pax80a]

I'm sorry but this was the only place where I found a match to my symptoms.

Thank you for the support.

[Bearcat]

Homom....re your post with lung issues post surgery with the problem discussed.....I had fluid on my lungs post surgery recently......I told them I was on nexium but it was never flagged by the anesthetist to why......took me a day or two to shake it off.