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What Is The Reason For Difficulty In Swallowing,throat Pain And Red And White Patches On Throat?

Posted on Tue, 17 Apr 2012

Question: Difficulty swallowing: considerable sharp, stabbing pain at base of tongue, voice box, speaking is very hard, specifically plosives (anything involving pulling on the tongue) e.g. l, w, m, s, c. Cannot cough, spit, suck now as no muscular ability to do so. Pain extends up throat on both sides in to jaw and just below the ear. Externally: large areas of red across whole of neck/throat when attempted to use voice. White patch very noticeable at base of throat precisely where point of pain is. Pressure and pain worse when lying down on back. General feeling of malaise. Hot and cold. 12 weeks in to this and no diagnosis. Second tranche of antibiotics. Have taken continuous paracetamol and ibuprofen as advised. Have also taken aspirin. None are effective in controlling pain. Have MS and this tends to be a problem, as warned by MS specialist nurses, because focus in medics' assessment deflects to MS rather than symptoms presenting as with any other adult. Usual summary: "I'm not a specialist in MS." Need someone to assess throat/swallowing/pain/swelling as is. Have had CT scan which was normal, and bloods for infection and thyroid. Results of an MRI still to come back. Symptoms worsening.

Answered by Dr. Dr. Naveen Kumar Nanjasetty (4 hours later)

Hi

Thanks for the query and detailed history

According to the history you have mentioned, the cause of your problem could be an ulcer over the base of the tongue or a candid infection (also called as Oral thrush). Both of these conditions present with severe pain with difficulty in swallowing. As you have already taken one course of antibiotics and on the second one now, if it were to be of bacterial infection it would have definitely subsided by now.

An ulcer with the slough over the floor of the ulcer can look like a white patch. Similarly, even candid infection can also present as a white patch with the above mentioned signs and symptoms. Hence, you require a thorough examination of the throat by an apt ENT specialist followed by telescopic laryngoscopy.

Secondly, you need to stop certain medicines like, aspirin and antihistaminic, the former will induce gastritis and the latter one will cause dryness of the throat leading to worsening of the symptoms.

I would suggest you to drink plenty of warm water, as it improves the blood circulation and reduces the inflammation. If it is only an ulcer, then you might require steroids to reduce the inflammation and Vitamin B-complex to help in faster healing of the ulcer. And, if it turns out to be a candid infection then you will require antifungal medicines.

Finally, malignancy cannot be ruled out, which has to be confirmed by laryngoscopic examination and biopsy if required.

Hope I have answered your query; I will be available for follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Naveen Kumar Nanjasetty (6 hours later)

Thank you, Dr Kumar: would both cause much accumulation of 'gunk' at the base of the throat which I cannot clear? I have been taking Vitamin B12. I will get a more comprehensive vitamin B mixture. I can get an oral antifungal today: this may be the case as antibiotics would, of course, worsen the symptoms. Would both cause general feeling of malaise and being unwell? I know that the MS always takes a hit if there is something else, and sleep has obviously been very disrupted because of the high level of pain (throbbing, stabbing pain), amount of discharge I can't clear and the pressure on the windpipe as I lie down.

Thank you again for such a comprehensive response.

Yours faithfully, Elspeth McPherson

Answered by Dr. Dr. Naveen Kumar Nanjasetty (15 hours later)

Hi

Welcome back

1. Would both cause much accumulation of 'gunk' at the base of the throat which I cannot clear?
Yes, during any inflammation involving the mucosa, there will be increased production of the secretions in order to reduce the effects of inflammation. If these secretions are viscid in consistency it can affect the swallowing mechanism and sometimes induce vomiting.

2. Would both cause general feeling of malaise and being unwell?
Yes, again both of these conditions can cause generalized weakness, because of the inability to take adequate food and water due to pain, leading to electrolyte imbalance.

Finally I would like to suggest you to consult a good ENT specialist and then start on antifungal drugs if required. Beware! Self medication can prove XXXXXXX And also, drink plenty of XXXXXXX warm water so that the inflammation will subside and the secretions will clear.

Wish you good health

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T