Dr. Bhadragiri Vageesh Padiyar
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 doctor,
I swallowed a 600 mg NAC supplement nine hours ago. It went down the wrong pipe, and I could not cough it out. I had choked twice, which was scary, and my mother made me sit down and calm down and take sips of water. I did this, then tried burping and choking it up, and only a tiny bit came back up. So things calmed down a bit. But it is now 9 hours later, and if I breathe in deep with my throat, I feel a little of the hoarse rasp noise, and if I breathe out heavy with my throat, I think more of the hoarse rasp. I am coughing a lot, not choking, but because of this sensation of raspiness in my breathing and feeling throat. Sometimes the wheezing makes noise and feels right down to my stomach's bottom or around there. I am scared that I am going to die. I consulted doctors; they said this does not seem severe based on symptoms. It had been 9 hours still had a constant sensation of needing to cough, and nothing happened. I still feel its feeling and that rasp if I do a heavy inhale or exhale. I am scared this will kill me or never pass, shocked it will enter my lungs and cause havoc. I am trying to be positive and calm. I decided to go to the doctor for hours; he just looked at the back of my throat with a torch. Then I used a tool below my chest, and in the middle, I was told to swallow water and said all was fine. He tells me he feels the raspiness and coughing is due to the throat being irritated after that. Sometimes I still taste it a bit. I am scared it is trapped there or entering my windpipe and lungs. I came home and was very shaky and felt weak and nauseous. Also, when laying down trying to sleep, I sometimes get random noises and clicks from my breathing in the throat and chest area. I hope this passes.
Hello,
Welcome to icliniq.com.
There is nothing that you need to be worried. A tablet cannot enter the windpipe and remain there without creating choking cough-like symptoms until it is ejected. Eventually, it has to enter the food pipe, and during the process, it slowly disintegrates, and even if you throw up, you will get bits and pieces. There is an issue of anxiety neurosis, which has created so much panic as far as this problem is concerned. Another factor causing it could be GERD with LPR (gastroesophageal reflux with laryngopharyngeal reflux). Even though you might be asymptomatic or never have gastric issues in between, the inflammation in the throat often exists in the hidden form and can resurface when adequate care is not taken. In addition, the stomach usually has cells that release hydrochloric acid, thus keeping the gastric environment acidic. Your entire mucosal lining from the mouth, throat, and food pipe is not meant to handle anything acidic. However, the throat is the most sensitive of the three structures due to its rich nerve supply. If your mouth, throat, or food pipe chronically comes in contact with acidic contents in a given situation. Still, once this compensation wears out, you start developing the symptoms you have mentioned. Please try to follow the following advice: 1. Maintain a strict diet, eating on time. 2. Avoid eating spicy, oily, and cold drinks. 3. Keep a gap of 2 hours between meals and go to bed after two hours of taking food. 4. Do not overeat; instead, keep your stomach half empty and have regular intermittent light food like fresh-cut fruits in between main meals. 5. Saltwater gargling at least ten times a day for fifteen days 6. Avoid alcohol and smoking as it can trigger reflux. 7. Try to maintain a left lateral position while sleeping to reduce the chance of reflux. Please take the following medications. 1.Tablet Pan 40 mg (Pantoprazole) once in the morning before breakfast for one month. 2. Syrup Mucaine gel (Magnesium hydroxide) one tablespoon three times a day twenty minutes before meals for one month. Please ensure you follow the precautionary measures as much as possible. Also, kindly understand that it takes around six weeks for things to normalize and symptoms to subside. It would help if you worried about absolutely nothing as this is a treatable entity, and things will be fine.
Patient's Query
Hello doctor,
Thanks for your suggestion. I decided to call a paramedic because of my anxiety about this situation. He said my heart rate was higher, and my blood sugar was standard. He then checked my back asked me to breathe; listening to my breathing, he said my right lung was making a crackling sound. For this reason, he advised me to check it with a chest x-ray. If the product is stuck in the throat, other tubes, windpipe, or lung, he believes I should have got an infection. I still cough a bit and do not feel good since this accident. Most of the product was stuck somewhere, and it burnt my throat at the time, and then I also suffered from extreme teeth and face ache after that incident. But I still get raspy hoarse when breathing and it makes me cough sometimes and more. Kindly help.
Hello,
Welcome back to icliniq.com.
Yes, there is nothing that you need to be worried. As mentioned earlier, I am sure that it is doubtful that a tablet gets stuck in the upper digestive tract. I would not consider an infection unless there is a high-grade fever associated with your issue. Nausea and bloating (if present) would not be present as a part of the reflux. You might be having some dryness in the throat, foreign body sensation, heaviness, and sometimes little pain. Above mentioned medications and some lifestyle changes should benefit you with time, and your symptoms should undoubtedly subside. It is prevalent to have medications go in the wrong passage and patients having similar symptoms that you are facing. They should all subside slowly, and you will be fine. If you encounter any issues, please let me know.
Patient's Query
Hello doctor,
I underwent a chest x-ray which came back normal. But I am still worried. I did four blood tests, and the white blood cells were slightly elevated with inflammation. It only began when choking on the 600 mg NAC supplement by accident. The doctor suggested that I might have had some chest infection before. He advised tablet Doxycycline 200 mg then 100 mg for four days. I cannot take this antibiotic as it is ototoxic, and besides, the common side effect is tinnitus. Three months ago, I suffered a horrible acoustic trauma causing catastrophic tinnitus and severe hyperacusis. I am slowly healing, and there is no way I can risk my tinnitus worsening. Unfortunately, I am allergic to penicillin. I am trying to call my doctor today to ask for advice. I am worried I will die if I try to heal naturally as I suspect it is Aspirin-induced pneumonia. I lay on my side, and the awful hoarse rasp noises are so noisy, and the sensations are horrible, making me cough. I slept, and I woke up in near silence about my tinnitus. I would fall apart. I am slowly trying to heal my fragile ears. I have suffered terrible anxiety since this situation. My chest and stomach feel some tightness and pressure or slight pain, and I get cold a bit in my chest. My temperature was average. Also, when I yawn, it hurts, and when I try to burp, it feels like I can no longer burp like there is a heavy block feeling, and I am forcing it. I am so frightened this is permanent damage. I am unsure if the product is still there as I still have hoarseness. The chest x-ray does not show anything, but it is early days and may not pick it up, and then all the doctors are confused why an infection happens this soon. I also did an ECG for my chest, which came normal. But regarding this situation, I am increasingly worried; the symptoms are still there. If this is aspirin-induced pneumonia, I am terrified that I will need an antibiotic that does not have tinnitus or inner ear issues as side effects, no penicillin, and no ototoxic medicines. Kindly share your suggestions.
Hello,
Welcome back to icliniq.com.
As previously mentioned, I would not advise any antibiotics. Doxycycline is tetracycline that causes tolerance issues and possibly is given since you are allergic to the penicillin group of drugs. However, I do not see any reason for which you need to be taking any antibiotics for your problem. The wheezes or some noisy breathing should settle on their own, and there is no need to take antibiotics for that. Your vital parameters look all ok to me. Do not worry about the note made on the ECG as tachycardia, and it has no relevance as long as the rhythm and pattern seen in all leads of the ECG are normal. In pneumonia, you will have severe dyspnoea, your heart rate will be above 120, and your temperature will be almost above 100 degrees Fahrenheit, and I am sure that it is not there. I suggest you consider some meditation and yoga exercises that should keep the anxiety neurosis under control. I would also suggest you include good physical activity in your daily routine. It would give a lot of benefits by releasing endorphins into circulation and will significantly reduce panic attacks. Please follow all instructions and try practicing meditation and some yogas, especially breathing exercises. It will help you feel better gradually.
Patient's Query
Hello doctor,
Thanks for getting back to me. I am sorry for being anxious about all of this; it was just so unexpected and some simple mistake that caused so much trouble for me. I believe it entered my lungs a bit due to symptoms. So the only thing that makes me think about this aspirin pneumonia is that all my symptoms match; when the paramedic came, the heart rate was over 120, mostly around 140, and he heard cracking in the lungs. Is there any medicine that could help me that is entirely safe without any side effects on the ears? My ears are very slowly healing after severe acoustic trauma. I could not live well if this spiked due to ototoxicity or anything else, but I want to protect my health and breathing. I am sharing my ECG report (attachment removed to protect the patient's identity). I am also practicing exercises as per your suggestions. I appreciate your patience, support, and help in all this.
Hello,
Welcome back to icliniq.com.
The symptoms of aspiration pneumonia should include persistent fever and hypoxia with oxygen saturation of less than 85% in room air. If your oxygen saturation is normal and you do not have a fever, it is doubtful that you have pneumonia. Tetracyclines are known to be ototoxic, but ototoxicity is when medications are taken for months together. I would not consider doxycycline as you do not have any symptoms of pneumonia. Having heaviness in the chest region can be due to reflux, and reflux can get accentuated with panic attacks. I have not received the ECG, but if the primary care physician has informed you that there is absolutely nothing to worry about, you can let it be. But, again, this has nothing to do with the heart. I hope this answers your query. Warm regards.
Patient's Query
Hello doctor,
I tried to remain calm. I decided to take the doxycycline. I hope it does not cause any issues, but I want to overcome this. Also, when I try to burp, I can not and am forcing pressure and feeling lumpy. Yesterday I noticed more blurring of my eyes and still. I hope any infection is not causing issues here like optic neuritis. It scares me because my vision has suddenly changed since my acoustic trauma. I have undergone several eye tests, and now the good eye is noticeably more blurred. I am worried about the product in the lung or scarring, oxygen issues. I visited a pulmonologist this afternoon; he wanted to listen to my chest and lungs, then said he could recommend a CT. I hope this all passes one day. My mother said that my cheeks were rosy and slightly warm temp before the medicine, so I took some paracetamol. I am on the Doxycycline antibiotics, and I took two tablets yesterday of 200 mg and 100 mg one tablet for the next four days. I also took this because my white blood cells are higher, and inflammation indicates the body fights infection. I have never experienced anything like this; I hope it heals fully. The NAC burnt my throat so much. My vision is more blurred, and I worry it will cause bad things for me. I still feel I can not burp and the hoarseness. I hope this heals. Sorry for my anxiety with all of this.
Hello,
Welcome back to icliniq.com.
I can understand your concern. You can start doxycycline, but please complete the entire course. Severe acid reflux is causing you difficulty, and this issue should resolve slowly. It is very unlikely that you have optic neuritis, as this condition is usually not commonly seen. If normal, it could be due to some ongoing irritation to the cornea. Please avoid taking unnecessary paracetamol as it can further increase your reflux symptoms. Also, avoid NSAIDs group of drugs as much as possible. Ototoxicity with doxycycline is more common when medications are taken for a longer duration. It is implausible that any permanent damage happens to your lungs, but your symptoms might take a while before you feel better. I would urge you to spend at least two hours of the day doing some strenuous exercise and meditation or pranayama. The more you sit at home, the more you get paranoid about your symptoms, and only negative thoughts will keep creeping up. I am sure you will be fine in some time, and there is nothing that you need to be worried. Do let me know regarding any further queries.
Patient's Query
Hello doctor,
I have an update, and please advise me and reassure me because I feel scared right now. I visited a pulmonary doctor, and he said that my right lung was crackly and that the capsule went into the lung. He said he wanted to get a CT scan and bronchoscopy. I am scared that if they sedate me, it will worsen my vision and tinnitus when I wake up. I am afraid I will go blind or deaf or have loud tinnitus. I am scared I will die. I still got a lumpy throat and a weird reflux sensation. Will this heal, or will it cause permanent damage?
Hello,
Welcome back to icliniq.com.
Bronchoscopy would be the test the pulmonologist would have advised. I would advise you to wait for some time. Some inflammation could be there, which should undoubtedly resolve in ten days. If the pulmonologist feels there is a necessity to do the bronchoscopy. You need to worry about absolutely nothing as it is a very safe procedure, and you will be under local anesthesia with some sedation to reduce your anxiety. You will be fine, and I am sure your symptoms should subside slowly in time to come. No such patient has had any permanent damage, at least to my knowledge, unless he has been entirely moribund and comatose, causing aspiration. In such a scenario, medications are given by nasogastric tube to reduce the tendency for aspiration. However, in case of any pneumonia, the patient should present with some signs of inflammation, including persistent fever, hypoxia, dyspnoea, etc. Again, there is absolutely nothing that you need to worry about. You will be fine. I hope this answers your query. Please do let me know if there is anything that you need to know. Warm regards.
Patient's Query
Hello doctor,
Thank you for being here and reassuring me with all your knowledge, insight and advice, and general tips. I am still waiting. It just says CT scan. I hope this includes the thorax. Also, I am so anxious about this procedure, but I try to be calm. But my vision seems blurrier, and I am worried it affects me in other ways. I have undergone blood tests and a chest x-ray, which came back normal. However, the white blood cells were low, so I am advised to continue the antibiotics even if I am nervous about my tinnitus and ears. I am also very nauseous now. I am also worried about local anesthesia, as I tend to swallow. Why are the white blood cells low? Kindly share your suggestions.
Hello,
Welcome back to icliniq.com.
There could be some minor ulcerations due to choking, as a result of which your symptoms have become exaggerated due to previous, ongoing chronic reflux. But, as I said, the total count will come back to normal. If you can breathe normally and there is no constant cough, it's very unlikely that you have a foreign body in your airway. It would help if you had a healthy diet, not restricting yourself from too less calorie intake as too little food can again potentiate acid reflux. Ototoxicity is not usually seen with a short doxycycline duration, and I am sure it would not create such side effects for you. Please continue the antibiotic course and complete it. Do not worry too much, and I am certain things will be fine.
Patient's Query
Hello doctor,
Thanks for your patience and support, as always. I underwent a CT scan. The CT scan revealed that the product had entered the windpipe. He says it is mushed looking and disintegrating when looking at it. The doctor consulted with respiratory specialists and advised me not to remove it. He also told me that the scan was inflammation, likely explaining the symptoms. First, I get some random coughing fits, then the chesty discomfort feelings, and then I get hoarse, especially in certain positions. I also get weird GERD or acid reflux feelings like lumpy or lump in the throat, difficulty burping as I need to but cannot, heartburn, and some pain. Will this all subside? Because I remember when this incident happened to me, it burnt my throat and likely the windpipe so much it even hurt my teeth and face. The doctor told me it could take around three weeks to heal. I called up my lung specialist, who I saw the other day, asking about all this and the removal; he agreed with the hospital and said it is gelatine it will dissolve even in mucus in the lungs. He said I could lay flat too and breathe deeply inwards, then huff fast outwards to dislodge it, or it will dissolve naturally. I hope this is not causing me long-lasting damage either. I am fit and healthy otherwise. I worry about my tinnitus, but it did bring my white blood cells down. Does that mean there was an infection or bringing down the inflammation? I do not know why my vision seems more blurry since this incident. I am trying to remain positive, though. Kindly share your suggestions.
Hello,
Welcome back to icliniq.com.
There could have been a slight possibility of some tablet fragments entering the airway, causing some inflammation, thus leading to your symptoms. Now that you are on antibiotics and there is some evidence of inflammation in the airway, I suggest you complete the entire course, not worrying too much about the side effects. The feeling of heaviness in the throat and chest could be a mixture of symptoms due to the inflammation caused due to accidental entry of the tablet fragments into the airway and the previously ongoing reflux. Things should improve within two to three months, as this is the normal duration it takes for reflux symptoms to resolve. It would help if you were patient for the symptoms to come down and follow all the precautionary measures mentioned, failing which symptoms will persist and worsen your situation. It is unlikely to have any permanent damage as this is not often seen nor reported in the literature. I am sure things will improve with time, and there is nothing that you need to worry. I hope this answers your query.
Patient's Query
Hello doctor,
I visited the lung specialist privately again to check things over as I have been anxious. He has been reassuring and said he would listen to my breathing. He also requested my CT scan from the hospital. Another thing is that I have not been feeling too great. My mother says I sometimes feel hot with a puffy nose for a while and rosy cheeks. I think this blood pressure or sensation around my head or face or heaviness. Anyway, I took the Doxycycline and Vibramycin antibiotics as they brought the white blood cells down. But I am a little worried as my ears lately feel more sensitive, slightly clogged with pulse sensation and muffled somewhat hearing. Or more so dull hearing on some sounds. I had a tiny bit of this before taking the product in one ear, so I am unsure. My nose feels stuffy, but it has times when it does not. I feel like my face feels inflamed, slightly numb, and sensitive. It feels a bit flat if I touch my hair, rub my jeans, walk, or close my bedroom door. I had this before after noise trauma, and it all subsided, but I am just hoping the meds haven't caused permanent damage. I am trying to be calm. Kindly share your suggestions.
Hello,
Welcome back to icliniq.com.
You can start nasal decongestant drops three drops five to six times a day for the next week. This should ease the congestion in the nose. Avoid exposure to dust as well. Some stress itself can be the reason for having a stuffy nose. So I would advise you not to panic too much. Tinnitus could be due to a stuffy nose and should resolve slowly with time. Please complete the course of the antibiotic and do not worry too much about its side effects. If your anxiety levels are high, I suggest starting an anxiolytic at night. We usually prefer giving Alprazolam 0.5 mg once at night for ten days. I hope this answers your query. Warm regards.
Patient's Query
Hi doctor,
I saw the pulmonologist again today and he said that he is happy with my breathing. He feels that it moved too, meaning disintegrating. He heard and said that the wheezing sounds are more in front now and only slightly there in the lower part at the back. He has prescribed me today the tablet Prednisone 30 mg to take once a day and then the same Doxycycline tablet, which I really do not want to take again because I think it is affecting my hearing. Prednisolone tablet is supposed to be good and restore hearing though, but I have got this same Doxycycline tablet on top of it. He said that it is required to avoid scarring or infection. He also said that the supplement will dissolve, and asked me to try to do huffing to dislodge it and steaming too. Please tell me, would it dissolve on its own? I am scared of living with all these symptoms and conditions. Also, I am worried about reactions to the steroid. I really do not want to be on antibiotics because my hearing does not feel right. I feel stuck at the moment. My ears feel flat, the nose is not always blocked but sometimes. I noticed this slightly before taking the medicines but worried the medicines are ruining my ears. I am so scared of being on these two medicines for the next seven days and I am also concerned about my hearing. Hearing seems flat, if I take a deep breath from my nose my ear feels more blocked. What are your thoughts?
Hi,
Welcome back to icliniq.com.
Yes, steroids are of good benefit here. However, the dosage given to you is slightly on the lower side. Here, I would have prescribed the patient a slightly higher dosage, so I would definitely suggest you take it. Do not worry too much about the side effects. Low-dose steroids do work wonders in reducing scaring and cutting down inflammation. However, you should remember that it can mildly potentiate acid reflux to a certain extent. Medications given have nothing to do with the ears and there is nothing that you need to be too worried about. Steam inhalations and some nasal decongestant sprays should bring down the nasal stuffiness and thereby, also bring down the blocked feeling in the ear as well. Please start the steroids with no second thoughts and please do finish the course of antibiotics given as well. Your hearing will slowly come back to normal with time. It is healing and has nothing to do with antibiotics or steroids. Hope this answers your query. Warm regards.
Patient's Query
Hi doctor,
Thanks for coming back to me with this. Sorry, it has been a long time, but I do appreciate it. With steroid dosage, how much do you recommend? My doctor says nothing about tapering the dose which I know is supposed to happen with prednisolone tablets. And he says to do the huffing laying down. Breath in deep then strong huffs out. Sometimes my nose does not feel blocked which makes me worried if this is hearing loss. I also have this weird pulsing feeling or pressure in the ears. Sometimes the ringing is louder. I can handle some ringing just not hearing loss, flatness, or pressure feeling. Really hoping this all subsides. I do not want scarring or infections so, I will take the medicines at least once to see how it is for me. The pulmonologist says to try to dislodge it with huffing exercise and to see him next week to check the breathing again. I do not want any long-term medicines. The respiratory team at the hospital says it can take two to three weeks to dissolve fully and heal. How long do you think this takes? I put the NAC capsule in a little bit of water and it is almost two days and still not dissolving, it stuck to one side and the gelatin is rising up swelling but not yet dissolving. My lung or windpipe does not have water so will it take longer? I feel I cannot hear as well quieter sounds, either it is more muffled and I feel I cannot hear things away anymore from far. Warmest regards.
Hi,
Welcome back to icliniq.com.
If a low dosage of Prednisolone is started, say 30 mg, we do not taper. Tapering is required when slightly higher doses are given. Do not worry about the toxicity, it is meant for medications that are taken for very long durations and not otherwise. It has nothing to do with the eustachian tube catarrh symptoms that you facing. The feeling of stuffiness in the nose can be cut down with good steaming, doing it at least more than three to four times a day, and each session not more than five to six minutes. There is no need to add anything to the steam. Nasal decongestants will also bring some benefit in bringing down the feeling of blockage and heaviness in the ear. This will bring down tinnitus as well. No matter what you do. The small microscopic fragments which have accidentally entered your airway will get dissolved and the inflammation will subside in 10 to 14 days. Huffing will not be helping to any major extent as they would not have dissolved by now and all that is required is to bring down the inflammation which happens in 10 to 14 days' time. Do not worry too much about the muffled sounds in the ear. It should certainly come down with time. Hope that answers your query. Warm regards.
Patient's Query
Hi doctor,
Thanks for your response. It has been eight days since this incident. I am trying so hard to stay calm. I do not want to be on this medication much longer either. I still feel the same and I am petrified that it is never going to dissolve. I did deep breathing in and huffed fast out. Now, if I breathe in deep through my mouth I hear a more hoarsing voice. I am so scared. Also, two days back I had put the NAC capsule in a little pot of water and it is still not dissolving. The plastic part of the capsule is swollen and risen up, but it is not dissolving. And that is still inside me, I am scared it will not ever dissolve and that the grains of the product are still there. I just do not feel comfortable at all. Is the product definitely gelatin? Is it definitely going to completely dissolve and fade into nothing? How can it do that if not reached the stomach? Sorry for the questions. Also, since I started huffing I got more hoarsing. Scared, I am making it worse but the doctor said it is fine to try to dislodge it. My vision seems a bit more blurry too, hoping there is no damage from medicines. It was a bit more blurry and also cloudy before the medicines after this incident. What if it is not gelatine? The product in the little water I watch daily is still swelling but there are no signs of the plastic or gelatine dissolving. Scared, it is just moving and causing more damage. Will this settle down? More coughing and raspiness now and I am scared if I am going to die or if it gets worse. Thanks for all your support.
Hi,
Welcome back to icliniq.com.
There is no way that a small part of it in the lung cannot get dissolved, it has to. Now, the issue that you are facing is purely due to reflux, and symptoms will only come down after one to two months time. Till then some feeling of obstruction will persist in the throat. I hope you have started medications for reflux as they are very important to treat the problem that you are facing. It is going to take some time. Follow all the advice given for the reflux as they are extremely important. Panicking and getting anxious will only increase the reflux and increase the duration of the healing time. Do let me know regarding any other queries that you might have. There is absolutely nothing that you need to worry about. Warm regards.
Patient's Query
Hi doctor,
Thank you for all your help regarding the situation with the NAC capsule. I have attached some different files for you. The first is from the pulmonologist notes. I am due to see him next week, as well as at the chest clinic at the general hospital this week. I really hope it fully dissolves soon, it has been three weeks now. I stopped the Doxycycline tablet, I was on it for nine days. I have been on Prednisone 30 mg tablet for around two weeks, for the last two days tapered it to 25 mg, and my specialist said that I can do this every four days dropping to 5 mg. This will mean I will likely be on this for a month. Is this safe and not ototoxic? I feel quite off, slightly light-headed, with some head pressure, and dullness on this steroid, but I follow his instructions and hope when I come off my body returns to normal. Do I need some healthy good medicines to restore my adrenal gland functions or immune system after being on a steroid when I come off? My symptoms sometimes feel better. I do still have some coughing. I did the huffing as he said and facial steaming. I noticed I cough up some mucous sometimes. Will this dissolve completely, and the grit from the NAC capsule too? Another question I have is regarding my ears. I have attached my most recent audiogram for you. This just tests up to 8 kHz. I am nervous because as I briefly mentioned before, I had an acoustic trauma for a few days around five months back. I suffered aural fullness, loud tinnitus, extreme hyperacusis, and nerve pain. This all settled to a calm tinnitus level that was fading and calming hyperacusis. For two months, I began using 35 dB inserted tight foam earplugs, and over the head earmuffs, ear defenders 37 dB suction the ears and tight, that you would see construction workers using. I noticed some muffling, and in one ear more than the other. But, I am worried about its further damage, or hearing damage from previous events happening slowly such as in my synapses. I hope I am wrong in this regard. I slept one night and my mother told me that three jets were right over the house shaking the house but I slept, so I could not defend myself. Just a few weeks ago, when the NAC incident happened I take a walk, with only the ear defenders, not the foam, and a modified loud car exhaust went by. Even in the protection, it vibrated my ears and face. I am in the healing process and worried about further damage constantly. My hearing test came as normal, up to 8 kHz. Although, I have not yet had an extended one such as up to 16 kHz or more, which I am thinking about. But I also know someone with perfect normal range thresholds up to 20 kHz, and yet when they did an ABR or BERA and OAE. The ABR was signifying auditory neuropathy or cochlear synapse damage, cochlear synaptopathy from noise traumas. I am very worried because for a month now, my ears feel some slight pressure or full, sound distortions a bit, and my hearing feels flat or dull. Yet it was crisp before. I am also experiencing more TTTS symptoms and all these symptoms together I noticed when overprotecting a month ago now, even before those little incidents. I really want to make a full remission and heal since my ears were doing so good but I am worried I am having nerve damage or inner ear damage that is progressing. I do hope I am wrong. Would a TEN (threshold equalizing test) show if there is any synapse damage between thresholds on normal audiograms? I really hope this is not going to make me deaf or worsen my situation. My tinnitus feels a bit worse lately, not extreme, but I feel electrical circuit and head pressure. I also feel slight pulsing. I never had this before and this is also there since the ear protection but I am worried this is due to damage. I also attached my recent ECG from the hospital for you, please let me know what you think. The ear flat hearing and dullness, pressure, TTTS, or distortion have been a month now. Warmest regards.
Hi,
Welcome back to icliniq.com.
It is good to hear from you. All the reports are absolutely normal (attachments removed to protect the patient's privacy) and there is absolutely nothing that you need to worry about. There is no hearing loss, and there is no need for any further hearing tests to be done. I do not see any hearing loss which requires an OAE /Bera. However, since you mentioned it, has it been done? If so, please do share the reports with me. There is no evidence about current existing acoustic trauma, and your symptoms of hyperacusis or intolerance to loud sounds have nothing to do with the loud sound exposure you had. I feel you should forget about that episode as there is no existing evidence for any damage. There is no need to get any further evaluation of the hearing done. OAE and Bera are meant for people who cannot hear and to ascertain the exact reason or exact level causing the hearing loss. There is an issue of anxiety neurosis/panic attack disorder for which I would want you to get a good psychiatry consultation. The anxiety neurosis itself can potentiate tinnitus, hyperacusis, fullness and thus causing some dizzy feeling and it is extremely important to get this thing treated with good counseling and medications. Furthermore, I would suggest and request you to stop using the internet for your issues as you will only complicate it further, wanting you to get unnecessary investigations that have no purpose nor any indication. As far as the aspiration episodes are concerned, your pulmonologist is quite happy about the improvement that has been there. Your symptoms are largely gastric related and now since you have been put on tapering steroids the inflammation would have definitely subsided. Tapering the steroids is to maintain the normal adrenocortical axis, so there is nothing extra you need to be doing for the adrenal gland. You can use earplugs for the hyperacusis but do not go to overuse them as they can further potentiate fullness and their long-term use is not recommended and advised. Hope this answers your query. Do let me know regarding any issue that you want to discuss. Warm regards.
Patient's Query
Hi doctor,
Thanks for your advice and patience. Yes, I am dealing with anxiety regarding all this. I know I had the acoustic trauma back around four months back, I just need to give myself patience and time. Sometimes the ringing seems louder which upsets me, as two months back it was getting much better and I worry. I hope I heal from this even if it is slow. I went to the general hospital chest clinic today as they had called me. The doctor there was not sure if they could do bronchoscopy but I do not want this right now and I am scared. I requested another CT scan which they want to do because they told me that on the other lung they noticed a nodule of 5 mm. I am really scared as to what is happening to me lately. I saw the CT scan and the product of NAC looked scattered rather than seeing it in one place. I asked her if she thinks that it will dissolve. She said that she do not know but everyone else before told me it would. Some days I feel better than others. I am scared this product scattered will not ever dissolve and I am going to be damaged. I wish I feel healthy again. I am scared this is going to develop into COPD. Also with ears, what about synapse issues? What test can I do to check for this and cochlear dead regions between thresholds that are not IHC or OHC?
Hi,
Welcome back to icliniq.com.
For your ears, I would not advise any testing to be done as your audiometry reports are normal. The tests that you have mentioned are not done as they do not have any meaning nor give any extra information regarding the hearing or integrity of the cochlear nerve and its connections to the auditory cortex. Your lung issue should resolve. There could be bouts of cough. Breathlessness on and off could be due to panic attacks or anxiety neurosis. COPD (chronic obstructive pulmonary disease) is very unlikely to be there out of the blue. Fragments of the capsule would have disintegrated by now. However, the nodule does not seem to have any direct correlation with the NAC capsule aspiration episode. I would not suggest you go for a bronchoscopy, not a CT (computed tomography) scan of the chest. Remember, that each CT scan exposes you to harmful radiation. So for the time being, just relax. Do not think too much about it. Give it some time, and maybe after two months, we can get a re-evaluation done with a plain x-ray which is more than sufficient to give good information regarding the nodule. Hope this answers your query. Do revert to me if there is anything I can help you with. Warm regards.
Patient's Query
Hi doctor,
I have a CT scheduled for next month again for the thorax. A letter came through so I will attend to it. I am writing because I am anxious the NAC product caused permanent damage or scarring to my voice box or windpipe. I constantly feel this lump and the need to clear it and cough and some slight burn. Lungs hurt more often than usual and chest here and there. I have always had good health and now I am worried this accidental aspiration has caused permanent damage. When the NAC product went down the windpipe it burnt so so much, now I am scared it has scarred me and left me with permanent coughing and clearing of the throat. When I breathe in with my nose I feel the air hit it too. It is going to be five weeks now. What is your thought? They may want to look into the lung and remove it. I am trying to stay strong during all this. I am just really concerned due to the symptoms. I also wake up feeling head and face pressure. Warm regards.
Hi,
Welcome back to icliniq.com.
According to me, your symptoms are chiefly due to reflux which has further got aggravated with the NAC accidental aspiration. There is definitely some inflammation in the throat causing your symptoms. These symptoms roughly take around two months to settle down. However, you can get your CT scan done as advised by the physician you are seeing. It is very unlikely to have any permanent damage to the upper aerodigestive tract with such aspirations. This is not something that we commonly come across nor is documented in the literature. However, it is always best to get the investigations done to rule out any finding which could be treated specifically. In the meantime, my advice would be to follow all antireflux measures very strictly and wait for at least two months for things to resolve. There is also an entity of anxiety that can cause psychological persistence of symptoms and this also has to be managed accordingly. For nasal stuffiness, you can do plain steam inhalations two to three times a day, as this will help you reduce the congestion in the nose. No extra medications are required for the stuffiness in the nose. On the whole, I would advise you not to worry too much as things should certainly resolve with time to come. Hope this answers your query. Do let me know once your CT reports are out so that we can discuss them. I can put some inputs for the same. Warm regards.
Patient's Query
Hi doctor,
Thank you for your insight and help with this. I am due for the CT in two days. My GP also requested petrous bones and CT aortic arch and carotid both. Is this both for the inner ear? Will the contrast be fine for my tinnitus and no ototoxicity will be there? With the throat, I also feel pain in my lungs. Sometimes some chest pain or chest tightness particularly when lying down. I have coughed a lot over these past five weeks. I am just worried and pray no infection is there or that this eventually goes away. I am also still on the steroid Prednisone, initially on 30 mg for a couple of weeks then tapered to 5 mg every five days. I recently changed it to four days. I am due to take 5 mg tomorrow and for the next four days. I feel five weeks is a long time to be on the steroids. Since my vision is slightly blurrier, I feel quite lightheaded on the steroid. Is it normal, will all this pass, and what blood test can I take after the steroid? What should I ask GP for? I just want to feel and know I am normal after this. ACTH stimulation test? Also, when I breathe in with my nose I feel this rawness and 'too open'. I feel it and I am worried I have got scars or cuts as I still feel I need to cough and clear my throat. All the way down to almost my stomach area sometimes I feel pressure. I am really worried, this is going to linger since it has been five weeks now. If I need to undergo bronchoscopy, which anesthetic will not cause hearing loss/tinnitus/ototoxicity? CT showed a 5 mm nodule on the left lung where apparently the product did not enter. I had attached for you my ultra high-frequency hearing test also, the other week up to 16 kHz. There is a slope at the end that indicates mild hearing loss biggest at 25 decibels at 16 kHz. In the left ear, I noticed lately it rings more, even if it was from the noise blast. Is it possible that this can correct itself and go back up, even in the ultra-high frequencies? I know it has happened on the 8 kHz etc. It has been four and a half months now, so it is still acute. I have also attached a speech test report. Thanks so much.
Hi,
Welcome back to icliniq.com.
CT of your temporal bone includes the petrous bone to see the integrity of the eustachian tube, and the aortic arch to see for any anomalies which could be causing tinnitus. I do not suspect it to be there, so I am not sure why it has been specifically asked for. Contrast has nothing to do with ototoxicity or tinnitus. Your hearing tests done earlier do not show anything suggestive of ototoxicity. Dip in the 16k range is seen in most of the population and has no relation to the symptoms you are facing, except for the tinnitus. I would not consider any major hearing loss to be present here in both the tests that have been uploaded (attachments removed to protect the patient's privacy). There is no requirement for an ACTH stimulation test in your case. All your symptoms in the throat, chest, and stomach are purely due to acid reflux and should resolve in time to come if all precautionary measures have been followed. If you undergo bronchoscopy, the local anesthesia given will not be causing any tinnitus or ototoxicity. The nodule could be an old incidental finding which might have nothing to do with the NAC aspiration. We do not generally use the higher frequencies above 4k for normal conversation and hearing However, some insults at the higher frequency could be responsible for the ringing sound which is more prominent on left as compared to the right. On the whole, nothing major to worry about. I do not see anything major out there in the reports. There is nothing that you need to be too worried about. Hope this answers your query. Do let us know regarding anything more you would want to discuss. Warm regards.
Patient's Query
Hi doctor,
So the doctor said they would not do bronchoscopy due to a second CT scan showing the NAC capsule dissolving etc. They want me to do a checkup and for the left lung 5 mm nodule they do not know what it is said it could be a lymph node. I pray all this settles. What scares me is still coughing we have been discussing things before and I am very scared this is permanent or due to the acid product it burnt me going down I feel sometimes a sensation in the throat and a bit of chesty need to cough and constantly clearing throat and like u got mucus or something. I pray this is settled but what if this Incident has caused this permanent damage causing this permanent condition as it is almost two months now? Also sometimes feel I can still taste the drink I drank a while later on in my throat. Any suggestions or thoughts? Maybe as the product fully dissolves and I start to feel better this also subsides? I have never had this only after the incident and I am really concerned for my health now. I also recently had my thyroid checked out and all is normal no further actions are required Are there any tests to diagnose?
Hello,
Welcome back to icliniq.com.
Your symptoms are chiefly related to lPR and they have to be managed chiefly with good precautionary care and lifestyle changes. If you do not control the anxiety neurosis, the stress levels will always be on the higher side which will induce gastric or duodenal ulcerations creating more acid and thereby increasing the tendency and possibility of acid reflux. This is a treatable entity that requires good care and lifestyle changes. I would want to know in detail, what you have been following for the same so that I can correct and improvise a few things which should help you out. Regarding the NAC capsule incident, I am not too worried as it should not be of any major concern. If the pulmonologist has advised not to go for bronchoscopy, then it is most likely that things are much better than before. The majority of your symptoms are reflux-related and have to be treated in a specific manner failing which symptoms won't resolve for a very very long time.
Patient's Query
Hello doctor,
I have double pillows and never eat before bed and space it out also sometimes eat fruit between meals. I am scared that this will not stop the constant coughing lumpiness and clearing of my throat. Because this happened after the NAC capsule do you feel it will resolve? I am now worried because the product I felt it burn me I am worried it caused this as a permanent issue. Any food you suggest or safe ototoxic-free medication? Two months of this do you think I can get rid of it soon and if I start a medicine? Do you think the product caused an issue in my pipes or permanently burnt or scratched me?
Hello,
Welcome back to icliniq.com.
The instructions that you actually need to follow for treatment for reflux are not being done completely and hence you are still having persistent symptoms. I will guide you regarding all the measures you need to take. You need to manage your time effectively and efficiently during the day. Keep a set schedule for everything that you need to do during the day and abide by it. 40 minutes of brisk walking will work wonders in bringing down the anxiety and will help bolster digestion as well. Have your breakfast within 3 hours of walking up. Avoid consumption of any bitter, sour, fermented caffeinated beverage on an empty stomach. Avoid tea and coffee as well. You can replace it with one glass of boiled warm water. Avoid spices in the diet, and keep more or less a bland diet. Saltwater gargles at least 5 to 6 times a day will also help reduce the inflammation in the throat. Do not go to bed immediately after food. Keep a gap of at least 2 hours. Maintain a left lateral position while sleeping. Take syrup Gaviscon 1 teaspoon in the morning and afternoon and evening 15 minutes after meals for the next 1 month 10. Take tablet Tums once or twice a day 30 minutes before food for the next 1 month. Take a tablet Pan D one tablet in the morning and evening 30 minutes before food for the next 1 month. Unless all these precautionary measures are followed there will be no improvement in your symptoms. The NAC aspiration has nothing to do with issues or if it did have some role to play, it would have just exaggerated and potentiated severe reflux giving rise to all the symptoms you facing.
Patient's Query
Hello doctor,
I have another question for you regarding the ears. Everything was fine when I was due to come home from holidays I noticed this thing happen. The plane is on the ground whilst people are standing up to board it. I wear inserted foam earplugs whilst boarding the plane and ear muffs due to my sound sensitivity and to avoid jet engine noise etc. I then removed it on the plane and only wore earmuffs for take off no earplugs and swallowed and was fine. As well it is very windy going up the stairs. But as swallowing they make some weird noise like they can't clear or pop and immediately clog again. And remember I am wearing inserted foam earplugs but this is to protect from jet noises for a few minutes only. It lasted a few minutes. I then enter the plane sit down and remove all hearing protection. I noticed the ear particularly the right one and the earplug were not inserted fully correctly some occlusion effect in space. But I fly okay wearing pelters and can pop ears. I flew on the 1st. Today is the 7th. And ever since on and off I've had some ear fullness and sometimes on both ears. Sometimes more so when I suddenly get up or bend or put pressure. The plane was on the ground but I did walk up a flight of stairs with strong wind and noticed ears closed a bit or became congested and I could not clear them as I had earplugs in. I was hoping to also fly again in a couple or few months but I am worried I have caused myself further damage by this simple thing I did lasting a few minutes. Symptoms since then are ear fullness that ebbs and flows randomly, more so if I bend or strain If someone has PLF do they have fullness constantly?
Hello,
Welcome back to icliniq.com.
There is absolutely nothing to worry about. There is no way of having a PLF suddenly out of the blue. It is not something we usually see as nature has taken its own steps to prevent such catastrophic situations from occurring. PLF is something we encounter during surgery and it is very unlikely to be seen without any major penetrating traumatic injury piercing random structures in the inner compartment. Again it is something we do not usually see. even in one such hypothetical situation happens, it will be characterized by severe onset of vertigo, sudden moderate to severe or sometimes profound sensorineural hearing loss which is not in your case. You have a clear-cut case of ETD causing pressure gradients in the middle ear compartment thus creating the symptoms you experiencing. There is nothing major you need to be doing. A decongestant tablet having Phenylephrine, Chlorpheniramine, and Paracetamol is to be taken once in the morning and evening after food for 10 days. Plain steam inhalation 3 to 4 times a day for 10 days should help in your case. Make sure you keep sipping on boiled warm water every 2 hours and salt water gargles at least 5 to 6 times a day for the next 3 weeks. Restrict consumption of spicy, cold, preserved undercooked food for the next 1 month.
I hope this helps.
Patient's Query
Hello doctor,
Sometimes I feel a little lightheaded but I had this before that could be stress induced. I have taken those decongestants before flying. When I flew the first time I was fine. On the second flight, I wore Peltor earmuffs and could pop and clear my ears fine. What scares me is I could not clear my ears because I had inserted foam earplugs and one was not inserted properly leaving some space or air. And I felt it more in that ear. Basically, I swallowed a few times and it made a noise as if it was trying to clear but could not because the foam was in the way. I am worried this give me trauma to my ears knowing I had sensitive middle ear muscles anyway due to my hyperacusis. I worry because of this and sometimes if I bend or strain I feel the fullness more but it mostly ebbs and flows. Could I have done any damage or given myself barotrauma that could manifest me to PLF? I pray this passes. I also since this event noticed a bit of just a bit of pulsatile tinnitus in the ears. And if I breathe in deeply in my nose and out they feel more blocked. Sometimes when chewing my food they feel blocked. This weird stuff started after that single event which is why I am worried it has done some damage. I will also not use earplugs but earmuffs when going upstairs.
Hello,
Welcome back to icliniq.com.
I just got back after a busy weekend. PLF is something I would not be considering in your case. In fact, most of the problem here is psychological and not due to any pathological cause per se except for the minor ETD that is there. ETD takes around 10 to 14 days to resolve and that is why you should be a little patient on that front. There is no damage, there is absolutely nothing to worry about. Yes, some stuffiness is going to be there and that will resolve in a few weeks time. Like I earlier said, you have a tendency to overthink, and obviously, the internet makes your scenario even worse. I would suggest not to think and frustrate yourself too much. You will be perfectly fine with the time to come.
I hope this helps.
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