frustrated w/ throat discomfort

[paul__0]

  For the past 6 months for the past 6 months I have had the feeling that there is something stuck in my throat or laranx; no real pain but minor difficulty swallowing.  In addition I frequently feel some pressure around my forehead and temples, which causes a little spaceiness and slight difficulty in concentrating. I am wondering if these two symptoms can be related. I am 46 years old, a moderate tobacco and marijuana smoker, relative non-drinker, with a bad diet which includes about a cup or two of strong coffee per day. After three visits to my community health clinic, where I was told I might have chest, throat or somesuch cancer, I had a chest ex-ray (negative) and then went to an ENT who diagnosed me with acid reflux, told me not to worry and suggested lifestyle changes. He shined a light down my throat, describing it as very red and swollen, and wondered if I drank alot or chewed tobacco. This was 6 weeks ago. Since then, I've cut back on both smoking and coffee ( about 60% ), have elevated  the head of my bed, am eating smaller and wiser meals and significantly less before sleeping, and generally trying not to worry. My condition is unchanged or perhaps slightly worse, and I am becoming annoyed. Is it possible that something is stuck in my throat? Doctor #2 at the clinic said there is a flap in the throat where some of his patients very rarely but occasionally get pills caught. I do recall thinking I inhaled a small piece of gum about the time this whole mess started. I'm really quite fed up and am wondering what to do next. In case your're  wondering, I'm skinny, financially and emotionally secure as far as I can tell,and haven't been sick at all until now. So, what's up doc? Please give me a reasoned response. Thank you in advance.
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Dear Paul,
There are several possible explanations for your symptoms.  You may have a post nasal drip or sinus problem that is causing your irritation.  Esophageal reflux of acid can cause a sore throat and inflammation of the oropharynx (back of throat).  Life style modifications, as you have done, improve symptoms in some people, but often medications (inhibitors of acid secretion, prokinetic agents) are necessary for complete relief.  If possible, you should completely eliminate tobacco and coffee for several weeks to observe if there is symptom improvement.  Finally, it is possible that you have an incoordination of the esophageal muscles that is causing the swallowing difficulty and sensation of something being stuck.  
To exclude these various possibilities and to determine if there is specific therapy for your symptoms, you should be assessed by a gastroenterologist.  If an upper endoscopy was not done, you should have this test.  An esophageal motility study may also be necessary.
I hope that this information is helpful to you.
This response is offered for your general information and should not replace the conclusions drawn from a careful and complete evaluation by your physician.
If you want, we would be happy to see you in the Division of Gastroenterology at Henry Ford Hospital, in order to review your records and investigate your symptoms esophageal disease.  He can be reached by calling the Henry Ford Physician Referral Line at [phone].
HFHSM.D.-rf
*keywords: dysphagia, swallowing, esophageal reflux
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