Question: I have had trouble swallowing since December 2011. I found that I have vocal cord motion disorder and gastroporesis but my mouth feels like its burning, I get sores on my tongue if I eat something sugary, I have lines on the insides of my cheeks. I feel as though my palate and back of it is stiff and can't get a a good swallow and not enough saliva, although an oral surgeon said that my saliva was producing enough. I think that it just isn't working correctly for some reason. I feel that I get alot of inflammation and feel there is pressure in my head and temples. I have had several blood tests and no diseases. The only thing that came up a little high, but dr's don't seem to worry, is my thyroid stimulating hormone and epstein barr titers for a past infection. I have been given systemic antifungal meds for 2 weeks in February and it seemed to help, although dr's are telling me it was a placebo effect. I do feel like my mouth is not pushing the food back when it get's to the palate stage, which makes me believe that there is an infection in my palate or something just not working right. What tests do you think I need? I've had manometry testing, barium swallow (which I think I need to have done again), gastric emptying scan which found the gastropresis, 2 endoscopy, and larynscopy where they found some bumps in the nasal passage, that looked like allergies. In all my studies they found mid inflammation and different points in time. Is this something viral that just needs to take it's course? I get really anxious when I cannot eat correctly. I feel like first thing in the morning I can somewhat swalllow but it just gets tougher and tougher, so I don't know if it is inflammation, or an infection with inflammation. The dr did KOH's (swabs) of my mouth and did not come back with signs of yeast or fungus after about a week.

Brain MRI normal, blood tests for mythenas Gravis negative. Neuro is setting up emg, muscle kinase testing. Will this be necessary even though I already had the brain MRI and mythenis testing. I will send my paperwork when I have my computer fixed later
To answer your questions, morning I have eye muscle weakness, like I've been squinting all night. Caffeine seems to trigger my pressure feeling in the head. My last tsh was a little high, dr wanted my primary to retest. Mouth feels very dry, no vomiting, sometimes feel nauseous in morning, but have had that for a while. No diabetes, weakness feels to get worse toward end of day. I have to be careful what I eat as it creates phlegm and makes it difficult to swallow even more.
Also I noticed this morning the line in my mouth goes all the way around to the front of my teeth, and has just came back.

Please see my attached reports. My most recent freeT4, free T3 were normal. I noticed that during times where I'm working hard around the house, I feel ok, but when at rest like right now, I feel the symptoms almost in my upper jaw or temples the issue swallowing. I almost feel a little shaky or tingling in my fingers. It's not really bad but it's noticeable. I am working with a XXXXXXX University ENT and Neurologist because it is closest to me.
I also wanted to add this, I started talking to a different doctor and want to make sure you have all of the information as I want to just speak to one doctor.



I have white lines on both sides of my inner cheeks, my mouth feels swollen and painful, and have trouble swallowing. It feels like I am having inflammation and pressure in head and from nose to mouth.
Asked by Me , 1 day ago



Doctor's reply to your question above...
HiThanks for the queryThe white lines on both the sides of the buccal mucosa are due to the teeth bite. This is the junction where the teeth of the both upper and lower jaw XXXXXXX and this part of the buccal mucosa usually gets trapped in between the jaws while chewing the food. It is a harmless condition and disappears slowly when the irritation passes off.Regarding the painful swelling in the oral cavity, it could be mucositis or inflammation of the buccal mucosa secondary to vitamin deficiency or allergy to some food/medicines. This will require a thorough examination of the oral cavity and throat as well as blood investigations to rule out anemia.If you can mail me a photograph of the oral cavity, I will be able to help you in a better way. For the time being you can try the following measures which will give you some relief:1. Drink plenty of warm water; avoid hot/cold food and beverages.2. Avoid fizzy drinks, alcohol and smoking if any.3. Try taking mild anti-inflammatory medicines such as diclofenac or paracetamol for the pain relief and multivitamins for increasing the body immunity.4. Also, you can try taking short course of oral steroids such as prednisolone for a quick relief.Hope I have answered your query; I will be available for the follow-up queries.RegardsDr. XXXXXXX XXXXXXX N.ENT and Head & Neck Surgeon
Replied by Dr. XXXXXXX XXXXXXX , 23 hours ago


Disclaimer: The Expert's advice is provided for general informational purposes only and SHOULD NOT be relied upon as a substitute for sound professional medical advice, as a complete assessment of an individual has not taken place. Please consult your nearest physician before acting on it. The advice is not valid for medico-legal purposes also.



Did I upload the pictures correctly? Also, this happens every time I eat and my vitamin intake seems to be good, I have had my b12, folic acid, iron, vitamin d checked recently and all in normal levels. I almost feel as if my jaw sounds like its craking when I open an close it. Again, I do have the vocal cord motion disorder and gastroporesis and have had unusual eye symptoms since January where I'm senstive to light and see an abundance of new floaters.
Asked by Me , 23 hours ago




Also, what is the best CT testing to show the mouth and jaw? I will be having a sinus and neck cat scan. Can this show irregularities in the mouth/ears as well? I am also feeling fullness in my ears and the clicking.
Asked by Me , 22 hours ago



Doctor's reply to your question above...
HiThanks for writing backYes, I do have received the images and I have examined it thoroughly. You seem to be having mucositis (inflammation of the mucosa) over the soft palate which could be secondary to the pharyngeal infection. If this is recurrent, then further evaluation has to be done to look for any chronic infection in the sinuses/throat and acid reflux disease. The crackling sound could be either due to opening and closing of the Eustachian tube following sinus inflammation or temporomandibular joint dysfunction. In either of these conditions there can be noise in the ear during jaw movements and yawning as well as fullness in the ear.CT scan of the paranasal sinuses will rule out any sinus pathology, it can also show any irregularities in the mouth. But for the ears, a different position has to be adapted and finer cuts are required; it is a high resolution CT scan of the temporal bone.If you can revert back to me after the CT scan, I will be able to come to a conclusion and advice you accordingly. Meanwhile, you can follow the instructions as I mentioned in my previous response.I wish you good health.Also, my doctor ordered an ultrasound of my thyroid.

How can I request that when my doctor already worked up my neck ct scan? Also, we thought that the mouth stomatitis was because if thrush and I had two swabs done and they came back negative however the systemic antifungal ketakaze that the rheumatologist gave me seemed to work and my symptoms came back. Also my dentist noticed that I grind my teeth, could any of this be causin tmj?
Also, do I have to be Concerned with the mouth issues? I've had them for sometime and they seem to have gotten worse, ESP if I eat something really cold or sugary, but it also feels like my mouth is fryer than normal.

The only other thing that I did not mention is that I had eye symptoms at the same time this all started, sensitivity to light, I have had several eye exams and a test looking at the optic nerve and they were all normal, except for some inflammation and dryness, I was producing about 1/2 the tear film than usual, I have been taking fish oil for about 4 months and it's almost back to normal, but not quite there yet. Could this all be related to my other symptoms? In the beginning I felt as if I could not focus and felt almost dizzy. That went away but have the light sensitivity which my opthamologist said this will not go away, however I feel it has improved somewhat. Also, in the beginning I would have bad after images. I still have it but it's not as bad.
also, sorry one more question, I thought in my paperwork i had the muscle kinase testing, is it the same thing? I think it was called muscle specific kinase.

I think we ruled out most autoimmune problems. I have attached my reports which includes the report from my rheumatologist. I just had the muscle kinase test and the comprehensive metabolic testing done this morning, ordered by my neurologist. On Wednesday I will have the CT scan of sinuses and neck and the thyroid ultrasound. On Thursday, I will have the EMG.

I just emailed again to the attachments email.

Thank you,
XXXXXXX XXXXXXX

I think it could be inflammation. I feel it in my eyes now two like it is a sinus thing too. They only approved the thyroid test and ct of neck but not the sinuses.

CT scan, thyroid ultrasound was normal. I had a video swalllow and the tech said she could see food sticking in the esophogus and when I drank water, she saw it wash away. Then the doctor looked at it and said it was normal. I was pretty upset. My stomach distension has gotten worse. I almost threw up eating breakfast this morning and it was small. I have dizzy spells again and my vision seems foggy, this was happening in december when this all started and I feel like back of my palate, mouth is stiff, having a hard time swallowing still.The tech said that I'm feeling like I have a hard time initiating the swallow but its really happening in the esophugus. I am going to see my gastro in two weeks to try and treat the gastroporesis. Its odd to me that the only thing that worked temporarily was the ketakazole back in march and all my symptoms seemed to go away temporarily. Why is that?
Also, my eyes seem to be getting dry and painful like they were when this all started.
I also started having really swollen gums.

muscle kinase was normal as well has thyroid ultrasound. The doctor was hesitant on doing the nerve testing because if they were testing for swallowing disorders, she said that he should really be testing all four limbs so I tried to go back to the neurologist and havent received a call back yet to change the I am really hesitant about the test because I heard it is very uncomfortable.Also, I believe I had all of these tests, I would have to check with my dr again, but I saw a rheumatologist in April and they all came back normal.

would you think that all four limbs should be tested?

My doctor said that all those tests were negative, I would try and stay positive, however I feel like my whole mouth is stiff and swells up and feel like I cannot swallow. When I try to eat something that makes me mucousy, it is uncomfortable because it feels like my mucuous membranes are all blocked. I feel like my head will explode one of these times, that's how awful it is, and feel like it is getting worse everyday. The nerve test is the last one I believe I have left. I do have my GI and ENT appt this week, so hope to be able to get my swallow study to them. Also, I take about .5 mg of the alzoprham, that helps me through the night and about 1/2 the day, that's it.