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Q. I have sore tonsils and difficulty swallowing with laryngopharyngeal reflux. Please help.

Answered by
Dr. Ajeet Kumar Lohana
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 06, 2021

Hello doctor,

I had soreness on my left tonsil that started two months back. Three weeks later, I went to an ENT. He put me on Prednisone 40 mg. I took it for a few days, but it was not helping. I again went to the ENT next week, and he put a camera into my nose to see my throat and said no issues except for some irritation around my food pipe. He reported I might have laryngopharyngeal reflux, put me on Protonix, and set an appointment eight weeks later. Two days after being on Protonix, I developed the most severe reflux I have ever had. I do not have a history of GI issues or reflux. But this started, and the symptoms were intense. Meanwhile, the tonsil pain disappeared. I had to change my diet to eating almost nothing for this to occur. Slowly, I began to reintroduce food over the week, but I developed the feeling of lumping in my throat. Every time with laryngopharyngeal reflux, it is very uncomfortable for me to swallow and feels almost like squeezing around my throat. At rest, I can feel it sometimes more intensely. I have a very difficult time sleeping, and I eat almost nothing at this point because I am afraid to make it worse. I do not have any burning in the chest or other symptoms of reflux. Just the lump in my throat and uncomfortable swallowing. Please help.

#

Hello,

Welcome to icliniq.com.

Well, I can understand that you must be very anxious and upset about your ongoing symptoms. To tell somebody or to diagnose that you have laryngopharyngeal reflux, one should undergo a PH metry testing. In this, a probe (acid monitoring probe) in the lower part of the food pipe (esophagus) and recording of acid changes are documented by a meter worn over the neck or hip.

Since you do not have any symptoms suggestive of even esophageal reflux, such as heartburn, acid regurgitation, or any prior symptoms of that kind, it is difficult to say that you have gastroesophageal reflux disease (GERD).

The continuous pain in the throat and difficulty in swallowing seems to be arising from the tonsils themselves. And this may have worsened since it has started. So it is merely tonsillitis, or pharyngitis, both are kind of upper respiratory problem and does not seem to be GERD related.

Rather than putting you on some acid suppressant medications such as Protonix, I suggest you treat this tonsillitis and pharyngitis since both can occur simultaneously due to an infection by a flu virus or seasonal changes.

I suggest you follow the following regimen for five to seven days.

1. Capsule Augmentin (Amoxicillin+ Clavulanic acid) 1 gm twice daily for five days.

2. Tablet Fexofenadine 120 mg daily at night.

3. Do Dispirin gargles or some tepid water gargles at least thrice daily.

4. Avoid cold drinks and cold water.

5. Take some hot liquids such as coffee, tea, or lime water.

You can now continue Protonix for a few days more. Then you can stop it.


The Probable causes:

Upper respiratory infection.

Regarding follow up:

Follow up if you do not feel good in the next 48 hours.


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