Clicks when I swallow/Chest pain

[agent86]

I am a 44yr.old female excellent health,vegetarian for 22yrs,do drink alcohol(red wine & in the summer some Coronas),no meds,never had heartburn,never taken any antacids.On 3/11/03,p.m.,I ate a taco(black bean)salad & a piece of the tortilla shell got stuck & scraped my throat severly.Woke up in the middle of the night and when I swallowed,an audible & palpable "click" happened in the back of my throat.Next morning,sore throat & by mid-afternoon I was naseaus.Nasuea lasted 24hrs followed by chest pain/pressure right of upper sternum.(I also had/have a sensation that in the back of my throat.I can best describe it like,when you try not to cry for whatever reason, and you get that sensation that is almost painful in the back of your throat that only goes away when you finally let the waterworks go).Pain lasted a few hours, then on & off for days.Made appt. w/Gastro for endoscopy.Pain got worse,ER visit: EKG,Barium swallow,X-ray all neg.(throat click all along)suggested I had GERD, given nexium but didn't want to take any meds till I had an endoscopy.Stopped eating four hrs. before bed,cut out alcohol,no spicy stuff either.Had endo 4/2,neg for reflux,hiatal hernia...Doc put me on nexium for three weeks.I still had chest pain radiating around right shoulder,down arm,tingling burning sensation down arm & back too on & off during that time(still clickin').Saw doc 5/5 said if the nexium didn't help,it wasn't my esophagus and could not explain the "click" other than it was my hyoid bone or the surrounding cartilege, but no explanation as to WHY it was clicking.Went to fam. doc,suggested chest CT scan & manometry.Had CT today 5/15 sched for 24hr ph study on 5/29.The pain & radiating sensations have intensified & have been going on now non-stop for three days,effecting my sleep as well.I beleive the chest pain & "click" are related.Any ideas? And if all comes back neg.,what type of specialist would I see,and what docs ARE the hyoid guys?? Hellpp Meee!!! THX!

[Kevin Pho, MD]

Hello - thanks for asking your question.

You note a "clicking" in your throat after eating the tortilla shell.  EKG, barium swall, "X-ray" (unknown what kind) negative.  Nexium not efective.  Upper endoscopy was negative for reflux or hiatal hernia.  Chest CT and manometry scheduled.  

You are obviously obtaining a comprehensive GI workup.  Without seeing you it is impossible for me to say what is going on.  If the GI workup is negative, I would suggest obtaining an ENT referral to further evaluate your throat.  

The hyoid bone is a U-shaped bone which is located in the upper neck.  If this is suspected, that is all the more reason for an ENT evaluation.  They may perform a laryngoscopy to further evaluate the throat as there may have been some residual damage from eating that chip.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

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