This question was answered on Fri 11, Jun 2010 11:14pm by Dr J Singh

Difficulty breathing with mild chest pain, enlarged tonsils, bad breath, bad taste in throat

    
Asked by bayonovo (Male; 26; UNITED STATES; see question and history; Relevant drugs:I take a fish oil supplement and multivitamin daily starting about 2 weeks ago. I've taken Protonix and Prilosec in the past for GERD. I am currently not taking these. ) on Fri 11, Jun 2010 10:31pm

I'm a 26 year old male. I'm 5'6 and weigh 190 lbs. My weight has not fluctuated in the past 3 yrs. Here are my current problems: Since 6/2/10 my throat has started hurting. The pain ranges from 1-5 on a scale of 10. It hurts most in the morning (perhaps from dryness). I've used Cepacol a few times in the past 2 weeks to numb the pain. I have white patches on the roof of my throat. In the past 4 days my throat is feeling more obstructed and I am having slight difficulty breathing. I currently have mild chest pain. I have a bad taste in my throat and it feels like something is stuck in there. This has given me very bad breath. My biggest concern is having difficulty breathing and the bad breath. In the past 3 days I must sleep on my side. Sleeping on my back causes me to choke and makes it difficult to breathe. Other symptoms that may be related: I sneeze a lot. My back teeth on either side sometimes hurt for a day, then feel fine the next. My throat pain is sometimes accompanied with sharp ear pain very intermittently that subsides quickly (twice in the past 2 weeks). Either of my ears will sometimes ring briefly then my hearing fades out as if I was covering my ear slightly (this happens weekly and my hearing returns to normal shortly after). I cough up a small amount of phlegm every morning and a few times after coming home work. I have to clear my throat often. My nose gets a little runny sometimes. Zyrtec has not helped. I suspect I have some kind of infection. What might be causing my problems and what are my next steps? Should I get my tonsils removed? Should I get the sleep study done? Thank you for reading this. I very much appreciate your time. ------------------ Here is a history of when I started having problems: Since October '09 I've had the feeling of something constantly stuck in my throat, like food or mucus. This was accompanied by very bad breath. I can taste the source of the bad breath in my throat. In December '09 my throat felt more obstructed and I was having difficulty breathing. I went to urgent care and the doctor prescribed Protonix (in previous years I had GERD problems). He advised me to take this for a month and see if it clears. It did not help. On 1/19/10 I went to the ER as I was having difficulty breathing as my throat felt obstructed and it was worse than before. My airway was clear. The doctor noted my lymph nodes were swollen. He again prescribed Protonix at my request. Strep test was negative. Later in January '10 on 2 occasions I had difficulty breathing. I felt temporarily light headed and had mild chest pain. The feeling subsided within a few hours at most. I realized at this time that I cannot sleep on my back or I will choke or be unable to breathe. I have to sleep on my side to breathe normally. On 1/27/10 I went to my primary physician. She noted my large tonsils and said I may have sleep apnea. She referred me to an ENT and sleep center. I did not have the sleep study done. In the next 2 months I mostly slept on my side and occasionally felt like I had difficulty breathing and had mild chest pain. The feeling seems to come and go. On 4/21/10 I finally went to an ENT. The doctor noted I have enlarged tonsils and my tonsil crypts are trapping bacteria. He advised me to gargle aggressively with mouthwash 4x daily for 4-6 weeks. If this does not help he said I may need to remove my tonsils. I followed these instructions and it seemed to help some. My tonsils felt less enlarged and my breathing felt improved. My breath is still very bad and I still feel something in my throat. On 5/16/10 my throat started hurting. It subsided on 5/24/10 but I noticed I had 2 small lesions at the back of my palate. I had no pain at this time, even when touching the lesions. I went to urgent care thinking I had strep throat. Strep test was negative. The doctor told me it was viral, so no medicine was prescribed. He noted my tonsils do not seem so large that they would warrant removal. My tonsils did feel less enlarged and I was breathing better. I did notice white patches on the roof of my throat, and I often notice this comes and goes.

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Answer by Dr J Singh  on Fri 11, Jun 2010 11:14pm:

Hello, Welcome to the forum and thanks for posting on it. A few possibilities are there for your symptoms which need to be ruled out. The first differential for your symptoms is pharyngitis or sore throat. Sore throat (pharyngitis) is a painful inflammation of the pharynx, which is the part of the throat that lies between the mouth and the larynx (voice box). Sore throat may be caused by either viral or bacterial infections. There is no simple way to distinguish a viral sore throat from a bacterial sore throat. In your case,I feel it can be caused by coxsackie virus. This virus causes a disease known as herpangina.It is most common during the summer. Symptoms include a high fever and the presence of tiny grayish-white blisters on the throat and mouth. The blisters erupt in a few days and are followed by a scab which may be very painful. The other causes are fungal infection like candidiasis and tonsillitis. Sometimes it is difficult to determine whether the cause is viral or bacterial, so antibiotics may be needed as a precaution. Nonprescription over the counter drugs of ibuprofen and paracetamol (acetaminophen)help relieve throat pain. Drink plenty of fluids throughout the day and use over-the-counter throat lozenges. Salt water gargle is also a good way to relieve a sore throat. Also get a throat swab and bacterial as well as fungal culture done. This will differentiate whether it is bacterial or fungal infection and then specific antimicrobials can be started. The second differential for your symptoms is infectious mononucleosis. It is a viral infection causing fevers, sore throat, and swollen lymph glands, especially in the neck. It is usually linked to the Epstein-Barr virus (EBV), but can also be caused by other organisms such as cytomegalovirus (CMV). Diagnosed by mono spot test(takes only a few minutes, and can be done in a physician's office), Epstein-Barr virus antigen by immunofluorescence and Epstein-Barr virus antibody titers. So these investigations should also be done. Thirdly you seem to be having gastroesophageal reflux disease(GERD) and post nasal drip. Both may be responsible for bad breath, bad taste in mouth, chest pain, difficulty breathing and feeling of fullness in ears and ear pain. Post-nasal drip (PND) occurs when excessive mucus is produced by the sinuses. The excess mucus accumulates in the throat or back of the nose. It can be caused by rhinitis, sinusitis, or laryngopharyngeal acid reflux. It can be enhanced or sometimes even caused by allergies. Please check out with an ENT specialist if you are having chronic rhinitis or sinusitis. If you have chronic sinusitis then it can lead to continuous production of mucus and less drainage leading to post nasal drip. Transillumination test and X-Ray or CT sinuses can help in diagnosing it. Regarding the GERD, Try raising the head of your bed about four inches with blocks. It also might help to avoid eating or drinking for two hours before you lie down. To help control the stomach acid, one should not drink alcohol or drinks with caffeine in them, or eat chocolate or spicy or greasy foods . Take some OTC antacid like Mylanta. You can also take zantac(ranitidine)or omeprazole after prescription from your doctor.These will help. Also keep your fluid electrolyte balance optimum by drinking lots of fluids. If the symptoms are severe then upper GI endoscopy may be needed. In nutshell, please consult an ENT specialist and get done an ENT examination and all the investigations mentioned above. Till then the general treatment mentioned above should help you.I hope it helps. Take care and please do keep us posted in case you have any doubts.

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Comments:

Comment by Dr Rowena S, MD on Sat 12, Jun 2010 01:08am:
Hi, How are you? Dr Anand has extensively discussed the possible causes of your symptoms. It is good that the strep test was positive. It is important that you check with an ENT if your symptoms persist to rule out rhinitis or sinusitis. Additional tests such as x-ray, blood tests or illumination test, will help rule out these conditions. You should also watch your food intake because some food such as spicy food may increase the risk of bad odor. If the patches in your throat persists, a culture may also be done to determine if this is fungal or not and will help with the diagnosis. Enlarged tonsils may cause sleep disturbances as well and if you still experience this a sleep study may also be indicated. At this point, inform your doctor about these patches also and any additional symptoms you feel for proper management. Take care and do keep us posted. Warm regards.

Comment by connor on Mon 05, Jul 2010 11:15am:
hi there it looks like you have a phenomia case i could be wrong but you seem to have all the symptoms weakness ringing in your ears (electricity sound?)stabbing pains in chest and cough also short breath and strugglin to get air dont worry i could be wrong however i would recommend seeing a doctor just to be on the safe side phenomia is pronouced enomia with silent p and h

Comment by Tushar on Wed 05, Oct 2011 04:13am:
hello,my throat has little redness appearance and i have difficulty in breathing since from 2 years whenever i eat the heavy protein diets such as meat eggs etc my breathing problems relieves for 2-3 days what can i do now...please reply

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