Tired Eyes, Blocked Nose, Dry Throat, Deeper Voice!

[sjdean]

Around seven years ago, I presented to my GP with the following symptoms:

Tired Eyes - I felt a pressure behind the eyes
Blocked Nose - Nose always feel congested, but the blockage shifts from side to side
White tongue - Always Furry
Dry Throat (and mouth to a certain extent, at the bottom of the throat)
Voice Deeper - Voice sounds deeper and croakier

I was subsequently diagnosed with an underactive thyroid and received appropriate medication. I also had severe stomach acid which came under control once my thyroid was adequately medicated.

Seven years later however, and the Nasal Congestion and Dry Throat still exist. It also takes me a long time to get over colds and flu that always shift to my chest leaving me coughing regularly.

The doctor blames all my issues on either Sinusitis, or Post Nasal Drip. Ok, fair enough, I thought that was a symptom rather than the actual problem - and that we should really have been looking for some kind of physical abnormality, an infection or an allergy etc.

While I do have some Post Nasal Drip (and it's worse at the moment due to me getting over a common cold), I didn't really notice it that much.

I've had steroidal nasal sprays, steroidal nasal drops, I've tried steam inhalation, menthol, eucalyptus and sudafed to pretty much no effect. They may give a little bit of respite for a fraction but nothing more than weak.

I've tried Clarityn for allergies, Olive Leaf Nasal Extract nasal spray, and my own home made saline spray (salt in water). The last two have given me more relief and allowed me to breathe through my nose, but there's still some post nasal drip as far as I can tell.

The doctor has also "tested me for asthma", by breathing into one of those cylindrical meters which I understand isn't foolproof.

So with these symptoms that are really getting me down, what do I do? I need to clear sinus pressure I think, which will help my eyes and nose, and of course post nasal drip may be causing my throat issues, but I feel I have the same sort of dryness and achiness on my tongue as in my throat - that I wouldn't be surprised if it was something else.

What should I get my GP to do next? Should I seek to see someone who specialises in allergies, or perhaps get a referral to ENT in case there's something physical going on in there, like Polyps? Should I get a scope down to see what's going on, as I just don't belief a wooden stick and a light can see round the kind of corners a scope can. I've also just joined the choir, and Im after some reassurance my throat isn't destroyed, I also want to make sure my voice isn't destroyed further and if I can help it, then I want to help it.

[bsmsl]

Great!! It sounds like you are responding well to LPR treatment.  My LPR probably would have gone a lot longer without diagnosis, but I just happened to have an ENT apointment when I first started losing my voice.  The scope is an excellent diagnositic for that.  Then you know exactly what you are dealing with.

Good luck with the barium swallow.  Word of caution - drink it slowly.  Nasty stuff, but you will do better the more time you give you tummy to adjust to the stuff.  I finally told the tech I had had enough.  She said, "Can't you get a little more down."  To which I replied, "If I do, what I have gotten down won't stay down."  The she looked at my cup and said, "Oh, you have done an excellent job!"

The speach therapy should be helpful as well.  

Take care and keep me posted.

[sjdean]

Great news everybody.

Got my FT3 results which show them as normal, although someone reckons they're in the lower half of the quadrant than the FT4 so possibly indicates a small conversion issue.

On top of that, I have had my referral to ENT, in and out in 15 minutes, scope down, and guess what?

Doc said I made my own diagnosis - couldn't see anything wrong with my vocal chords, just horrible red and inflamed. Great great news.

He said most likely LRP. He then gave me a prescription for Lansoprazole, a high strength dose and you know what, my voice is beginning to feel better already, not so many cracks, and not tiring. Still deeper and coarser, but hopefully that'll come soon enough.

Also got an appointment for a Barium Swallow and Im being referred to speech therapy (which I think is to ensure I don't hurt my voice any further).

[sjdean]

Thanks for all your support. I have an appointment with my GP in the next week and a half. I'll see what happens and let you know .

[bsmsl]

AWESOME!!  

I have had to take a major player role in my care.  All patients really should look more as their doctors as part of a team with them included.  Many times you have to be your own advocate to get what you need.  

So get to an ENT and keep me posted.

[sjdean]

That's interesting. Yes, I think I've heard of that one. You don't get typical heart burn issues but that doesn't mean it's not happening.

I have lost about 12 pounds in weight recently, now at 18.0 stone, Im drinking more water, less caffeine, eating more healthily, I don't smoke, and rarely drink.

I forgot to include my age - 33.

Thanks again, looks like I have some more to go back to my doctor with.

Im going to tell him I've had enough and want something done. I'll happily do more tests to rule things out, given my thyroid history, Im going to demand a FT3 test, and try and get a Cortisol test too. Im going to tell him with the best will in the world, he doesn't know what's causing my symptoms and that I know PND can be caused by XYZ so test me for whatever he wants but lets get to the bottom of this. In the meantime Im going to demand to incrase my thyroxine slightly so Im overmedicated according to lab results (it's the only time I've ever felt good again, and get a good nights sleep etc). I'll demand a referral to ENT for my own peace of mind if nothing else so that we can rule things out there and talk about LPR...

[bsmsl]

My guess would be that you have chronic Gerd and really need to be under a GI's care for this.  I think it will take stronger meds than you can get OTC.  

There is a form of reflux called laryngeal-pharyngeal reflux (LPR) that can seem to be asymptomatic.  It can cause sinus infections, laryngitis, and asthma like symptoms.  I think that when you weaned yourself off the meds your reflux wasn't really controlled, but that you had calmed it down enough that you no longer experienced the typcial reflux symptoms.  The good news about this type of reflux is that it doesn't cause the degree of esophageal damage that regular reflux does.

[sjdean]

Incidentally, I did have the usual round of acid reflux meds, including Lanzaprozole. I think there was another one but I can't remember what it was called now.

They did help, but after a while, the acid reflux cleared up and I could wean myself off it.

Do you think I should probably try popping the Rennie antacid stuff for a while and see how I get on?

Thanks
Simon

[sjdean]

Thanks again for the reply. I get the feeling Im going to have to be pretty sure to get that referral. I've got several GP's at my surgery, and they all seem reluctant to refer me, but not one of them can give me an answer.

Perhaps I should try another practice?

I presume that once someone knows what it is, whether it be some kind of acid reflux laryngitis or some damage somewhere, that whatever it is can be fixable! It's just a case of finding what it is.

Is there anything I can say or tell my GP to really push the point?

Can my GP really check my sinus and throat issues by looking with that pointy light and a wooden stick?

Thanks again for your advice.

Simon

[bsmsl]

Hello again.

Your discription of your voice problems sound a lot like what I went through with acid reflux laryngitis a year ago.  Have you tried acid reflux meds at all?

Also, you really should see an ENT.  He/she will do a scope of your sinuses and throat.  You could have a polyp on your vocal coards as well.  Since this is very long term, I would really pust to see an ENT to have a scope done.  An ENT will also be able to tell you if acid reflux is contributing to the problem.  If it is, you should see a gastro-interologist to have an EDG done.  If you have had sever acid reflux causing laryngitis, you are a good candidate for very serious esophageal damage.

I suggest you ask your friends for names of good doctors around your area.  I am blessed with an amazing GP.  He sends me to specialists as soon as he thinks I am beyond him.  Since I am am challenging my allergist (she is the leading allergist in the area (large number of allergists in the area too) teaching at the med school and lecturing around the country and world), I am certainly beyond my GP.

Take care.  I pray that you get the help you need soon.

[sjdean]

Thanks for the reply. Was hoping for some more feedback. Any thoughts on what it could be?

I think my two main concerns are the "post nasal drip" or the "sinusitis" which I thought were symptoms, but I'd love to get my sinuses clear. I know post nasal drip can be caused by all sorts of stuff though.

The best I've tried to clear it is a home made saline spray, but it doesn't do a 100% job.

Worse still my GP's (and I've tried several) don't really give me any other options or causes, and if the steroids don't help, then I have to live with it. But as there are a number of causes, it would be great to find that cause and put a stop to it, whether there be a physical problem, allergy or whatever.

The second major issue is my throat issue. That and the sinuses just makes me feel like I've got a constant cold. I don't know whether it's a dry throat or a tight throat.

I used to be able to sing great falsetto, matching many songs by Queen and The Darkness with ease. I could only ever break out my Darth Vadar voice after a cold. Now I can do Darth Vadar at will and I struggle with falsetto.

Again, my GP's don't have an answer.

Im sure my voice sounds croakier than it used to. My voice used to be very clear, but it seems only I can hear the problem.

If you were me, keen to sing, keen to protect your voice, would you seek a referral to ENT or something? Would you go to the GP and demand more in depth treatment?

I do worry that it's not even thyroid related in that my FT4 was normal and my TSH was only slightly elevated. They've never tested my FT3 and I feel so much better when Im technically over medicated in my thyroxine dosage.

Could I be a strange person who needs to be overmedicated?

Thanks
Simon

[bsmsl]

I would recommend that you get a referal to an ENT.  Before you got to your questions, that is where my thinking was going.  Allergies and asthma are still possible, but acid reflux should be discussed as well.  An ENT scope will be able to see if there is any vocal cord damage and possibly determine the cause if there is some.  The ENT may order a sinus CT which will tell if there are polyps, deformations, or other conditions that predispose you to sinus issues.

If he suggests allergy testing, I would recommend that you not let him do it.  ENTs rarely use skin ***** testing which is the most accurate.  They tend to use RAST blood tests which are not as accurate.  Frequently ENTs don't use immunotherapy shots like an allergist will.  

I hope that helps you.

Have a Merry Christmas.