Dr. Akshay. B. K.
Otolaryngology (E.N.T)
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello,
I am a 37-year-old female. suffering from chronic rhinosinusitis with polyps and currently taking nasal steroid drops, an oral antihistamine, vitamin D capsules, and Omeprazole
I have had a history of rhinitis or polyps for the past 14 years, it is treated with daily nasal steroids drops if severe and an antihistamine though all allergy tests have been negative.
About two months ago (after a period of anxiety ) I had been using the steroid drops and started to experience an odd intense tingle in my lower throat below the Adam's apple. This was followed by difficulty in breathing, closed off feeling at the throat (as though I was breathing through a pipe) and I heard a whistling noise through my mouth at night. At times my chest felt tight which made me panic. The symptoms of restricted throat breathing tend to occur on and off during the day.
My physician said it could be reflux and prescribed Omeprazole and a Salbutamol inhaler. The Omeprazole seemed to help a little as compared with Salbutamol. I had an ENT consultation. Nasoendoscopy was done and it was clear. A barium swallow test showed slight dysmotility which was not a reason to be concerned about. I was told that my throat issues were likely anxiety and globus. My symptoms are getting a little better now but are still present.
I happened to have a spirometry appointment today which I was told was normal or above average apart from one thing that it showed some upper airway obstruction. He showed me the abnormal curve. The pulmonologist said that he would have recommended a camera down my throat but as I have had one it could be that I had my tongue in the way, inflammation, or unusual anatomy.
I have an eight-week wait to see the physician for a follow-up and have started to worry again. As the area where I have symptoms and feel as though my breathing is restricted (Adam's apple or upper trachea) is where the test showed an obstruction. I am wondering when the ENT doctor said that he could not see anything on nasendoscopy would he have been able to see the whole throat below the Adam's apple? What are the most likely causes for upper airway obstruction on respiratory, how worried should I be? Also, I am awaiting blood test results due to a revent intermittent livedo reticularis and a slight cramp in my left hand. Kindly suggest.
Thank you.
Hello,
Welcome to icliniq.com.
I can understand your concern.
Chronic rhinosinusitis with nasal polyposis can lead to upper airway obstruction that can start from the nose itself although you are on steroid drops, there will be minimal polyposis in the nose which could have been picked up as upper airway obstruction, or a deviated nasal septum or a narrow internal nasal valve. Having a thick tongue, and enlarged tonsils, would also give the same result.
These are some of the reasons for upper airway obstruction. There is no need to worry as long as your oxygen saturation is maintained.
A nasendoscopy performed by your physician would have assessed your upper airway starting from the nose to your vocal cords (level of adam's apple). I feel it is just a coincidental finding that the spirometer has picked up something. Get blood investigations done as decreased calcium and electrolytes in blood could cause cramps in the hands.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I was worried as the spirometry was being done for reassurance purposes for any other issue (sensations of air hunger following covid infection). I had to wait many months for the spirometry test and in the meantime I developed the symptoms I mentioned above (tingling below Adam's apple, and tight breathing). This is why I am worried about the test showing upper airway obstruction.
I had a clip on my nose during the spirometry test, would this affect the results? Do you not think it could be an obstruction or lesion in the trachea? As sometimes I feel I am getting less air through my throat or upper chest. I also wanted to ask about my rhinitis. As the polyps tend to be small, it is the inflammation and congestion leading to the blocked nose that tends to bother me. Apart from steroids are there any other ways I can reduce the inflammation naturally? Although allergy tests have been negative my blood eosinophil levels are quite high. Are there any lifestyle factors that could reduce these symptoms?
Kindly suggest.
Thank you.
Hello,
Welcome back to icliniq.com.
It is not only the nasal polyps that can contribute to your airway resistance. There might be asymptomatic deviated nasal septum, enlarged turbinates, allergic rhinitis, or boggy mucosa. Many such asymptomatic things which may not be considered abnormal will be picked up by spirometry.
Regarding your trachea issue, we can rule out two things.
I suggest you follow the below-mentioned instructions:
Kindly consult a specialist, talk to them, and take medications with their consent.
Also, share the link to the video of the spirometry procedure to access it better.
I hope this information will help you.
Thank you.
Patient's Query
Hello,
Thank you for the reply.
I went for spirometry testing last week and the technician said that the results indicate upper airway obstruction which I am concerned about. I have to wait several weeks for my follow-up appointment but managed to obtain my results. Please review the attached file.
Thank you.
Hello,
Welcome back to icliniq.com.
I have gone through your reports (attachments have been removed to protect the patient's identity) and the results do not seem bad since you do not have stridor(noisy breathing) as of now. Although a respiratory physician would be the appropriate person to give an accurate opinion on the spirometry graph. I also suggest you get an endoscopy called flexible laryngoscopy of the larynx done.
I hope this information will help you.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I had nasendoscopy (which I was told was normal) and a barium swallow along with blood tests done to check inflammation. The throat symptoms have also improved. Do you think I still need to get a laryngoscope? I did not want to get those tests. Do you think a CT scan would be a good alternative? Kindly suggest.
Thank you.
Hello,
Glad to have you back at icliniq.com.
The nasendoscopy would have ruled out any problems in the nasal cavity and the nasopharynx (place behind your nose).
Barium swallow would have ruled out any obstruction in the esophagus and shows any abnormality related to swallowing disorders.
After the nasal cavity, an important area is the larynx which has been left out.
I would advise that CT (computed tomography) would not be of much help as it cannot comment on the movement of vocal cords.
Kindly undergo a video-directed laryngoscopy as it is a simple office-based procedure, and there is no need for any general anesthesia.
It gives a picture of your vocal cords and their movements, which is very important in your case.
I hope this information will help you.
Thank you.
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Otolaryngology (E.N.T)
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