HomeAnswersInternal Medicineacid refluxI have rhinosinusitis along with chest fullness. Help me.

What could be the reason for isolated hiccups especially after eating?

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Published At March 28, 2023
Reviewed AtOctober 11, 2023

Patient's Query

Hello doctor,

I am 37 years old and have been having rhinosinusitis (allergy tests negative) treated with intranasal steroids. I have had this condition that has been going on for six weeks now and is getting worse. I could feel chest fullness, mucus, and restricted breathing. I have been to the physician several times and he always says my lungs are clear when listening. I have tried prednisone and antibiotics which did not help. I have tried salbutamol. I had particular breathing difficulty three days ago so went to urgent care they did a chest X-ray and the doctor said I had anxiety and that it was a panic attack. A nurse said that she thought I had acid reflux and gave me Omeprazole 4 days ago. However now sometimes it feels like I cannot swallow liquids properly without them collecting in my upper throat. I have no chest burning however for the past two years, I have had isolated hiccups throughout the day particularly after eating. I was wondering do you think this sounds like acid reflux but without heartburn.

Kindly help.

Hello,

Welcome to icliniq.com.

Thank you for your query.

I understand your concern. You have had breathing difficulty on and off with whistling sounds during inspiration. Recently you had breathing difficulty three days ago and medical investigations were normal. You also tried prednisone, antibiotics, and salbutamol inhalation. Was there any kind of relief in the symptoms after taking the above medication? If yes how many days it the relief lasted? You have also mentioned swallowing difficulty to liquid sometimes. Taking Omeprazole has helped you in lowering your cough. I have a few questions for you.

  1. Do you feel to clear your throat most of the time?
  2. Any cough sensation?
  3. Any sensation of a lump in the throat?
  4. Any sore throat with hoarseness of the voice?
  5. Any regurgitation or bloating symptoms?
  6. Any environmental allergies?
  7. Any wheezing or asthmatic symptoms that would get precipitate due to external stimuli?
  8. Any recent anxiety or phobia that could precipitate a panic attack?

Revert back with answers.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

There was no real relief after the antibiotics and prednisone, or salbutamol. I think that Omeprazole has helped my cough and raspy breathing a little but I still have the intense tickle feeling at the bottom of my throat. As for clearing my throat, I do a little, I find that sometimes when swallowing saliva, and drinking water I get the sensation that liquid is accumulating in my lower throat and nasopharynx. As for my cough, I do feel like I need to cough because of the tickle in my neck. I would not say that I feel a lump in my throat, it is more of an intense tickle at the bottom of my neck. However, I do feel fullness in my throat and upper chest sometimes when swallowing saliva and liquid. My throat is not sore and it does not sound hoarse. It is just my breathing that sounds raspy and whistly when I have difficulty breathing. There is no regurgitation but I did get this sensation yesterday when swallowing liquids it felt like only half of the water I was swallowing was going down my esophagus on each swallow.

I have no bloating symptoms. I have no allergy that I know of. I had allergy tests several months ago due to my rhinitis but all were negative. There is no wheezing as such, more a whistling noise from my mouth. I did experience chest tightness during an episode of difficult raspy breathing and took some salbutamol but this did not help. I do have anxiety, I have been off work for several months with anxiety and returned to work last week however the difficult breathing episodes have been making me more anxious and I left work early yesterday due to it. Two days ago I attended the emergency room after an episode of breathing difficulty and was told that my chest sounded clear, an X-ray was clear, and that it was likely a panic attack. However, breathing difficulty sometimes occurs at a milder level.

Hello,

Welcome back to icliniq.com.

After reading your medical history:

  1. Only PPIs like Omeprazole have helped so far to you.
  2. Your symptoms are confined around the nasopharynx area.
  3. Chest X-ray is clear ruling out lung pathology or involvement during respiratory discomfort.
  4. The main symptom is a tickling sensation in the throat, the sensation of fullness while drinking or swallowing liquid, and sometimes accompanied by chest tightness and respiratory discomfort.
  5. No wheezing or environmental allergy and the test was negative ruling out asthma.
  6. Anxiety issues.

I think it could be LPR with some anxiety problems. You should visit an ENT doctor to check the nasopharyngeal and oropharyngeal area and if needed endoscopy to rule out any pathology in the esophagus. Try to calm yourself as much as possible and eliminate anxiety from your lifestyle by careful observation of anxious thoughts. You should continue tab Omeprazole once or twice a day on an empty stomach for 2 to 3 weeks along with lifestyle modifications related to LPR and visit ENT to rule out any pathology in the upper respiratory or upper oesophageal area.

I hope this has helped you. Thank you.

Patient's Query

Hello doctor,

I did not suspect an acid reflux issue previously as I have no heartburn. I forgot to add that I am awaiting pulmonary function tests ie spirometry and reversibility as months ago I had sensations of air hunger despite respiratory rate and oxygen sats being normal. However, this symptom appeared to be a result of anxiety and has mostly resolved now. I also requested the tests as I have a family history of asthma and I read that having rhinitis or polyps can increase the risk. I think at the moment the chest tightness and episodes of difficulty breathing are making me very anxious, even though I was not short of breath my breathing sounded very raspy and my upper chest appeared to tighten. I felt anxious at work and ended up leaving. During the episodes, salbutamol did not seem to help. How worried should I be about the LRP constricting the airways to a dangerous level?

Hello,

Welcome back to icliniq.com.

PFT was normal in spite of your having a sensation of hunger for air which clearly reflects your anxiety as an underlying cause. Also, LPR does not go to the level of the lung, it just irritates the upper airway that is larynx and vocal cords if it is uncontrolled and severe. This is the reason why the patient complains of voice hoarseness during the chronic duration of LPR. So I request you to be aware of anxious thoughts rather than reacting to anxious thoughts. Just being watchful rather than reacting to it would lower anxiety levels. Also, anxiety slowly and slowly affects other dimensions of living so better check it.

I hope this has helped you. Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

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