Doctor's Answers (3)
The most important aspect of your symptoms so far is that you have had an endoscopy which has ruled out the possibility that you have cancer. The findings from the endoscopy tell you that the symptoms you are suffering from are just "acid reflux", meaning that the acid from your stomach is managing to flow back up to your throat. The stomach is naturally protected from its own acid by the type of tissue it is made from and the mucus it produces to protect itself. However, the oesophagus (the food pipe) does not have this protection and so when acid reaches up to your throat it will give you the problems that you are having now.
Why should acid reach your throat? There is a natural valve at the junction of your oesophagus and stomach which normally prevents the acid from migrating up into the oesophagus. There are also several other mechanisms which also help to prevent this from occurring. When you have acid reflux it means that this valve is faulty and not functioning properly. Most of these case is due to a very lax muscle valve or that you may have a small hernia of the stomach making that valve not function properly. The acid reaching your throat is causing the red bumps. The earache occurs because there is a draining tube from your ear that sits in that part of the throat. If you have acid reflux which reaches this part of the throat then it will give you the pain in the ear.
How should you prevent the acid reflux? The overall treatment is to prevent the acid from reaching your throat and this can be achieved in several ways.
1. Eat regular meals and do not have a late evening meal just before you go to sleep. Eat 2-3 hrs before you go to sleep so that your stomach is not full of food when you lie down and this will lead to the acid reflux.
2. Reduce on foods that can induce lots of acid production or relaxes the oesophageal valve eg. alcohol, smoking, caffeine as found in coffee and coke cola, sour/bitter and spicy food
3. Reduce weight if you are deemed overweight
4. Medication which stops acid production such as omeprazole (this is the first drug that was ever developed and since then there have been numerous others which have been developed and will have better acid production)
5. Other medication can also be added which helps to speed up the food leaving your stomach can help eg. Motilium
6. If you find that you have a lot of symptoms at night when you are sleeping then elevate the head end of your bed with books or bricks so that you are not sleeping flat. By elevating it, then you are trying to lift the head up let gravity keep the acid down in your stomach
7. During your endoscopy, your doctor would have tested for the presence of a bacteria (Helicobacter pylori) which can cause an increase in the amount of acid that your stomach produces. If it is present then you need this to be eradicated with a 2-week course of antibiotics. Once this is done you may find that the acid reflux will subside a lot and your symptoms will improve.
8. Failing all the simple measures, the next step is to consider surgery to restore the oesophageal valve (fundoplication). This is performed by keyhole surgery and it involves wrapping the top of the stomach to the lower part of the food pipe to strengthen that valve and hence prevent the acid reflux. This is an option for those who don't want to take the acid tablets for the rest of their life or for those where the medication still fail to work. Once the surgery is done all the medication for the acid reflux can be totally stopped. Prior to performing surgery, you will need one other test (pH Manometry) to ascertain for sure that you do have acid reflux causing your symptoms.
One thing to remember, is that prolong acid reflux in the oesophagus can lead to damage to the oesophagus and in a small proportion of patient this can lead to changes in the tissue lining of the oesophagus. This in turn for a small percentage of people can lead to cancer. It is therefore important to adopt all those treatments above and stop the acid reflux either with the medication or surgical treatment. If you should have persistent symptoms then make show you have regular endoscopy to assess the lining of the oesophagus.
Thank you for your question. From the clinical history that you provided, I agree with the doctor whom you saw and with Dr Winston Lee that your symptoms are suggestive of acid reflux from the stomach. Specifically, since your symptoms are mostly in the throat, it is called Laryngopharyngeal Reflux (LPR).
The most likely reason that you have a feeling of something stuck in the throat or a feeling of a “lump” in the throat (aka as globus sensation) is due to swelling of the voicebox (larynx). The voicebox is a delicate structure and can be easily inflamed (and swollen) from irritations from acid reflux from the stomach or from nose mucous flowing down your throat (aka postnasal drip from sensitive nose or sinusitis).
The small red bumps at the back of your throat may be “cobblestone throat”, again from acid reflux or postnasal drip.
The inflamed voicebox and throat can lead to persistent cough and sorethroat. Your earache may be referred pain from your throat, but it is best to have it checked by your doctor.
As the voicebox is a very sensitive organ, once inflamed, it takes weeks or evens months for the inflammation to settle. Hence during this period, it is strongly advisable for you to reduce both acid reflux and postnasal drip.
This can be done with a combination of antireflux measures, antireflux medication and medications to reduce mucous in the nose.
This would also be a good reason for you to stop smoking as cigarette smoking does cause inflammation of the throat and voicebox, reduces the self-cleansing mechanism of the nose and sinuses (predisposing you to nose and sinus infections) and is a risk factor for cancer in the head & neck region (as well as cancer in most parts of your body!)
To learn more about LPR and sensitive nose, do look at the following articles previously published on DxD:
Feel free to visit an ENT Specialist for a re-evaluation as it can be frustrating dealing with a condition that is chronic. Although less likely, you might also want to rule out serious conditions like cancer in the nose & throat region (as highlighted by Dr Winston Lee). Hope this helps and all the best!
I will give you my suggestions based on my experience at A&E (of which I had plenty at in the past).
You mentioned that you are worried about your throat health. But yet it appears that you have not taken steps to reduce or stop the smoking, which increases your risk of:
I would suggest you consider seeking smoking cessation help if you can’t battle your addiction alone.
The reflux CAN cause throat irritation. You can reduce risk factors of reflux by:
Lastly, I would suggest you consider seeing an ENT specialist to get a nasoscopy done.
This will help to rule out a Nasopharyngeal tumour, as that can interfere with your inner ear secretions and lead to increased ear aches.
Although your symptoms can really be attributed also to simple respiratory infections (cough/threat/ear symptoms), but if a scope can help you reduce your anxiety..why not?