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Q. What is the reason for the feeling of windpipe compression in a pregnant patient?

Answered by
Dr. Shyam Kalyan N
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Nov 10, 2018

Hello doctor,

I have had some problems with swallowing for about a year. At first, it was happening with solid food and only from time to time. Then it started to appear more often. I have seen GP about that and they advised me to see a psychologist in case it was due to anxiety because it was not happening all the time. I have seen a psychologist for 10 sessions and he said I do not have more anxiety as other normal people out there and advised to search the solution of my problem in my physical health. My GP did not see anything major and did not give me a referral to any specialist. I have seen a dentist and he commented, I have dry mouth, but we did not go further from it.

After six months, I started to have problems with swallowing saliva. I have been in the hospital due to very high pulse for an unknown reason. They did a CT scan of my chest and said they have seen some mass in the neck and advised to see an endocrinologist in case it is a multi-nodular goiter. I have seen an endocrinologist and had an ultrasound. All was good with thyroid. I also was checked for Sjogren syndrome and rheumatoid arthritis. I do not have them. I discovered a lumpish mass in my neck, under the right jaw. Endocrinologist touched the lump and commented it may be something wrong with the salivary gland. I noticed that the color inside of my cheeks and roof of my mouth changed to yellowish, and my palate was whitish. I do not have any soreness, just a bit of feeling that soft palate and tongue are a bit swollen. I have seen a few GPs about that, they all said I am fine. Only one GP said it can be laryngitis and the lump is swollen lymph node so they prescribed me antibiotics. I did not have any reaction. Then, they gave me Erythromycin 400 mg four times a day for two weeks. I noticed lump got a bit smaller but that was it, the color in my mouth did not get back to its pale pinkish normal color. I also had an ultrasound of soft tissue, they said I do not have lymphadenitis and did not say anything about salivary gland.

Yesterday, I noticed at the end of the day blood vessels under my tongue got swollen and looked blackish. I thought maybe it is because of my blood thinner. In the morning it looked normal, but today the same happened. I am four months pregnant at the moment and doctors do not want to give me any referrals to specialists. I was asking about a referral to ENT, but they said all procedures are going to be invasive and you do not want to have any problems with your baby. I have a feeling that something is compressing my windpipe and at night, I wake up coughing as I am not able to breathe. I have also got some tickling in my throat so have to cough often and my voice is hoarse and gets tired quickly. My main concern is if it is something serious and will those problems harm the baby in any way?

#

Hello,

Welcome to icliniq.com.

We are happy to help you. I understand your situation and the worries the problem might be causing to you, that too when you are pregnant.

With the symptoms you have described, and with the doctor's repeated reassurances to you, I feel there may not be any super significant physical finding that they might have missed. That being said, there is nothing wrong in getting a proper specialist referral from the GP. I do not understand why the GP is reluctant to do that. If you were to come to me, I will do a nasal endoscopy in OPD (office) and do a flexible fiberoptics laryngoscopy also in the office. These two require no special medication except for decongestion of the nose and local spray into throat and passing of endoscopes. These will rule out sinusitis, DNS (deviated nasal septum), nasal disease and also laryngeal problems, say growth, vocal cord changes, movement of vocal cords, pyriform fossae, etc.

I do not anticipate anything in these areas, but these two tests will conclusively rule out any issue there. Maximum what I expect is some allergy and allergic post nasal drip. This will get alright with some nasal sprays which will not get absorbed into the bloodstream and will not cause any issue to the baby. Looking at the pictures (attachment removed to protect patient identity), regarding the undersurface, it Is normal to have that color. The veins underneath look so. The color of the palate and posterior pharyngeal wall do appear mild pale and bluish. We need to rule out anemia in you and also allergy. Allergy and nasal discharge and post nasal drip can cause these discolorations. Reflux can also be spotted in laryngoscopy, however, the Ranitidine should solve the matter nevertheless.

What I want to know is the exact duration and chronology of all your problems. How many weeks pregnant are you? Has hemoglobin been checked? Are your scans normal? Why the Aspirin and blood thinner? Can you show me the relevant prescription? Any past history of sinus disease or nose block or post nasal drip or allergy? Sneezing, running nose, reduced sense of smell, itching, watering of eyes, etc.? Do revert back to me with relevant details. You should feel better soon. Do not worry.

Hi doctor,

Thank you so much for your answer. Honestly, I do not understand why they would not give me this referral, I really appreciate they do not want to cause any harm to my baby, but I wanted to see ENT to make sure I do not have any infection which can be bad for the baby. I have had low iron a year ago, but recent iron studies are good. I also had some folate anemia six months ago, as I am homozygous for the C677T MTHFR mutation, but I am taking supplements for that. As it is considered also to be a blood clotting disorder, gynecologist prescribed to take Aspirin and Clexine throughout pregnancy ( I have had a few miscarriages before). I am 17 weeks pregnant and in the process of transitioning from private doctor to the public hospital at the moment. They would like to evaluate themselves if I need to take blood thinners any longer. I have an appointment with the doctor at the end of the month when I hope to get a new script as my last was taken at the chemist. So, unfortunately, I do not have any copy of the script at the moment.

First, a problem with swallowing happened about four years ago. But it was while eating solid food, so I do not know if it is even related. The dentist commented about dry mouth about three years ago, but at that stage, I did not feel it much. Last year, I had to see the dentist six times. He was not happy with my teeth, but I did not change anything about my oral hygiene routine. About six months ago, I felt that my mouth is really dry and I thought my difficulty in swallowing and teeth problems are because of that. Five months back, I had flu and there was a bit of post nasal drip for some time, but never before. Four months back I was at the hospital and they did CT scan with contrast for my chest. It was few days after I noticed this discoloration, I thought maybe it was some reaction on iodine contrast, asked my GP and they said I have a normal looking mouth. About two months back, I found a lump in my neck. Since I am pregnant, I have more saliva now, but still have difficulty swallowing, discoloration of an oral cavity and feel that it is a bit swollen there. I have some seasonal allergy, but it was always an itchy rash on my arm and stomach which was going quickly with 1 to 2 pills of Telfast. A week back I have had this rash again, GP said it is common in pregnancy and prescribed 1 % Hydrocortisone ointment, and the rash was gone in two days. I did not have any symptoms of sinus disease in the past, same as running nose, reduced sense of smell, watering of eyes. But yes, I have had more sneezing than usual for at least four months. And when I have had flu, I had a very dry nose, even a few nose bleeds due to that. My GP did not give me copies of ultrasounds, just said all is fine. I only have copies of my analyses for the hospital.

#

Hi,

Welcome back to icliniq.com.

A consultation with ENT and if needed nasal endoscopy and laryngoscopy will do no harm to you or the baby. Being an ENT specialist myself, I would like to rule out, reflux, sinusitis, mucosal congestion, polyps, laryngitis, mass in the larynx. Most probable among the above ones would be sinonasal disease causing dryness of mouth, silent post nasal drip and subsequent difficult swallow. Next I suspect reflux causing the symptoms.

Regarding the blood thinners and Aspirin, I leave it to the doctors and the specialists there. Since you are going to the public hospital and get a fresh consult, I understand that these will be taken care of. Is it possible that the new doctors can be convinced to get you an ENT consult? Is it possible there?

I will anyway give you some medicines which you can try to keep the problem down. First, nasal douching with plain saline. You get readymade salt sachets which you should mix in boiled room temperature water and then douche both nostrils. The douching is very helpful in cases where there is any nasal disease. After an hour of douching, take Fluticasone furoate 27.5 ug nasal spray. It is a steroid spray that acts locally in the nose with nil absorption into the bloodstream and thereby will not affect the baby. First inhale deeply and hold your breath, then take two puffs of the spray in each nasal cavity and then keep the breath held for another 15 seconds or more and then breathe out. Do not try to take the spray into the throat by deep inhaling or snorting or hawking.

For the reflux, Ranitidine should do. If it is safe during pregnancy (please confirm with the doctors there), take Montelukast (Singulair 10 mg) once daily for 3 or 4 days. If there is an infection, the mucosa gets swollen and red. Pain manifests along with fever and some malaise. In your case, it does not seem to be that. Revert back to me if you need any help. Be assured that you are not suffering anything serious and you and your baby will be totally fine.


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