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Medical Forum / Diseases and Disorders / Sinusitis / April 2006Arynetoid erythema
Dr. Grossan and of course, anyone with advice, please help me here. I have been irrigating for 7 months now and gargle multiple times a day. The irrigating helps a lot with but has not eliminated my PND. The frustration though is the bad breath that I can't seem to get rid of. The pattern is that I do not have bad breath constantly. It seems to come out every now and then when I'm speaking. Since I've been gargling religiously and have not reached a resolution, I'm beginning to rethink my strategy. While undergoing an endoscopy, the GI doctor noted that I had arynetoid erythema. Could the bad breath be from this problem rather than PND and my tonsils? My ENT thinks the erythema is proof of LPR. I'm awaiting my double PH probe test. Yes, I have seen the dentist and he said the bad breath is not a dental hygiene issue. Thanks. What you have is a redness in the cartilage at the back of the true vocal cords (arytenoid erythema). One possible cause of this is common acid reflux due to many, usually simple to treat, different problems. Acid reflux can cause bad breath. Let them do the test but also consider asking about the possibility of being tested for acid reflux. A barium swallow study may also show the acid reflux. The PH test should show any acidic conditions as well. I would assume that if you had an upper GI endoscopy (you didn't mention the specific endoscopy procedure performed) that they actually did not scope your tonsils. It is also common to have pits in the tonsils that collect food and cause bad breath. The ENT pharyngeal scope is really what is used to get a good look at the tonsils. Tonsiliths, aka tonsil stones can be very hard to get out and gargling may not shake them loose. My endoscopy came out fine. The GI did not see any problems with my esophagus. I did the PH test last week and will get my results in May. Prior to the test, I was on 80mg of Protonix, I had to stop the medication one week prior to the test. I have not resumed the meds because I notice that I don't feel that much worse without Protonix. Actually, the only pro about taking the medication is that my throat was slightly better (never healed it though) and the cons were a multitude of annoying side effects, like bloating, weird crappy taste in my mouth,etc. And the bad breath was just as much a problem while on Protonix. Is it possible the erythema is due to anything besides acid reflux? Is the bad breath from actual acid reflux coming up? For example, the random times I have bad breath when I speak is that when I'm actually refluxing? Or is it from the effects of the acid on my arynetoids? My ENT said my tonsils are tiny and are not likely the problem. I have read a lot about tonsiliths and thought that was my problem, but I have to see a stone come out. Yet, I keep on gargling. You could have acid reflux during the night at not even know. I take one pepcid AC with the last meal of the night, at least two hours before laying down, and have the entire head of the bed raised about 4 inches to help prevent night time reflux problems. This reflux control works in three ways. No food right before bedtime due to hiatel hernia, pepcid AC to reduce stomach acid quantity at night, laying on a complete incline lets gravity do some of the work to help keep any acid from coming up. After a couple of nights of having the feet at the head of the bed on 4X4 blocks I didn't notice the incline of the bed any longer when sleeping. Protonix complicated my marginally high BP issues, so I went to Pepcid AC OTC which so far has not raised my BP like the protonix did. Keep on the PND problem as well. You may still need to find and reduce your exposure to an allergen. One thing I learned the hard way with allergies, is replace the pillow often with a new one, use white bleached linens only, and carefully select any bedding material. Plus no indoor pets of any kind!!!! On 4/16/06 10:04 AM, in article 1145207053.465993.101090@t31g2000cwb.googlegroups.com, "dkuhajda@locl.net" > It is also common to have pits in the > tonsils that collect food and cause bad breath. The ENT pharyngeal > scope is really what is used to get a good look at the tonsils. > Tonsiliths, aka tonsil stones can be very hard to get out and gargling > may not shake them loose. It is important to realize that tonsiliths, white pits in the tonsils, squeezing stuff out of the tonsils is NOT A DISEASE. It is not a condition that needs treatment. It is perfectly physiological. The worry over this is strictly man-made, like making shyness a disease. Yes, sometimes the stuff can become stale and possibly odorous, but that is very very very rare. If you must, pulsatile irrigation where a pulsatile stream is directed at the tonsils so you won't gag, does remove the material. See www.hydromedonline.com re pulstile throat irrigation. But please THIS IS NOT A DISEASE. The only reason to "treat" it is that someone talks about it. Gee, there is so much else to think about, why make up unnecessary concerns? Murray Grossan, M.D. Www.grossan.com > Yes, sometimes the stuff can become stale and possibly odorous, but that is > very very very rare. So, it's unlikely my bad breath is from my tonsils then? > If you must, pulsatile irrigation where a pulsatile stream is directed at > the tonsils so you won't gag, does remove the material. See [quoted text clipped - 4 lines] > > Gee, there is so much else to think about, why make up unnecessary concerns? You're right, it's not a disease and I don't know why I have bad breath, but please understand that it's really affected my social life and so indirectly, has affected my self-esteem, etc. Yes, it's not a life-threatening condition, but I would love to be confident enough to have a face to face conversation with someone and not see them jerk back from me during mid-conversation. This has happened numerous times over the past 8 months and after awhile it's quite a bummer. On 4/16/06 9:15 AM, in article 1145204139.230560.134500@v46g2000cwv.googlegroups.com, "tdonline" <trinhd90@gmail.com> wrote: > Dr. Grossan and of course, anyone with advice, please help me here. I > have been irrigating for 7 months now and gargle multiple times a day. [quoted text clipped - 14 lines] > > Thanks. When you say irrigation, what type is this? Is it pulsatile? Posterior arytenoid edema is a sign of reflux. One reason for reflux treatment failure is that the starting dose is ofter too low. Most studies have shown that gargling is of no value except to increase visits to the doctor. Patient starts gargling on Monday , isn't better, then increases his frequency. The trauma of the gargling, he is in the doctor's office on Friday, now he is hoarse. Good for several visits that could have been avoided. Murray Grossan, M.D. Www.grossan.com S > When you say irrigation, what type is this? Is it pulsatile? I use your irrigator for nasal rinsing and gargle for the throat. I have used the pulsatile irrigator for the throat occassionally but still can't get over the gag reflex. It does feel "cleaner" in my throat when I use throat irrigator. If I can get myself to ignore the gagging, I would definitely do it more often. On 4/16/06 3:35 PM, in article 1145226938.764606.12100@i40g2000cwc.googlegroups.com, "tdonline" <trinhd90@gmail.com> wrote: >> When you say irrigation, what type is this? Is it pulsatile? > I use your irrigator for nasal rinsing and gargle for the throat. I > have used the pulsatile irrigator for the throat occassionally but > still can't get over the gag reflex. It does feel "cleaner" in my > throat when I use throat irrigator. If I can get myself to ignore the > gagging, I would definitely do it more often. The throat irrigator doesn't gag. You need to hold the tip exactly parallel to the tongue, lying on the tongue, on the right side first - not in the middle of the tongue. You aim the stream to just behind the last tooth. This way the stream doen't strike the back of your throat where you can get gagging. The throat irrigator doesn't gag, but do ;) Anyhow, I'm being a trooper and trying my best. I notice that when I spray my tonsils, my nose runs. Just curiosity, what's going on there? That was supposed to be "The throat irrigator doesn't gag, I but do ;) " On 4/18/06 6:21 AM, in article 1145366461.842360.221190@z34g2000cwc.googlegroups.com, "tdonline" <trinhd90@gmail.com> wrote: > The throat irrigator doesn't gag, but do ;) > > Anyhow, I'm being a trooper and trying my best. I notice that when I > spray my tonsils, my nose runs. Just curiosity, what's going on there? This is physiological. You are getting a nerve stimulation that brings more circulation to the throat. This same nerve affects the nose. |
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