Why is there always a tickle in my throat?
I CONSTANTLY feel the need to cough to clear my throat. It is not particularly full of mucus but I always feel that there’s a little something there. I’m also very quick to lose my voice. The cough is more of a dryish cough rather than chesty, as if I half swallowed some food. I have tried honey and lemon, and Karvol capsules and things like that, and while they make a little difference, it still comes back. Other than this I am fit and healthy.
Terri Harrington, by email.
From your very clear description, I have little doubt t hat you are describing acid reflux from the stomach into the gullet or oesophagus. Although a common symptom is a burning feeling, often referred to as heartburn, not everyone experiences this; some patients just have a cough, or problems with the larynx, or a sensation of mucus in the throat (whether or not there is more mucus than the norm) or odd sensations when swallowing.
Yet even when there are no obvious symptoms, there may be identifiable damage to the lining of the oesophagus, where the cells lining it change and become precancerous, a condition known as Barrett’s oesophagus.
Acid r ef l ux is f r equently diagnosed on the basis of the symptoms you describe; doctors can then offer a trial of medication, using a drug that suppresses acid secretion in the stomach, typically one of the so-called proton pump inhibitors (PPIs), such as omeprazole or lansoprazole.
If the trial works for you and eradicates the symptoms (it may take a week or even three to have an effect) then the diagnosis BuT is proven.
if not, then a more formal diagnostic assessment is needed by referral to a gastroenterologist, with tests such as a barium swallow X-ray, where you swallow a liquid that shows up on the Xray a detailed picture of the oesophagus. This might, for example, reveal a hiatus hernia.
Another possible test i s an endoscopy (where a long flexible tube with a viewing instrument is i nserted down the throat to inspect the lining of the oesophagus: this can identify visible reflux, or the inflammation caused by it).
Acid reflux is caused by failure of the valve at the point where the oesophagus joins the stomach — normally this valve stops the stomach’s contents, including acid, moving back up the gullet.
But it can fail on account of factors such as obesity (excess weight means more pressure on it); smoking, alcohol, and fatty foods, which can all trigger reflux as they either promote extra acid secretion by the stomach or render the valve-like action at the bottom of t he oesophagus unreliable or incompetent.
However, before making major lifestyle changes, what you require is an exact diagnosis. Discuss the collection of symptoms in detail with your GP, asking the question: could this be acid reflux?
If that conclusion can be reached there is every chance that you will receive suitable medication that will, in time, ease the symptoms and give you the relief you need. IT APPEARS I may have a condition called phimosis, affecting the foreskin. I feel too embarrassed to visit my GP. What exactly is it and is there any treatment?
Name and address withheld. PHImoSIS is defined as a tight foreskin that cannot be retracted. The foreskin is a protective covering f or the head of the penis, protecting it as well as providing immunological protection, in other words protection from infection.
At birth the foreskin and penis are fused together, joined by ‘adhesions’ and the foreskin is not retractable, but gradually over the next few years the adhesions s eparate under developing hormonal influences. In little boys up to the age of about four, phimosis is normal though variable — some will be able to retract the foreskin earlier, or later, but by the age of ten more than half of boys have a fully retractable foreskin. And by the age of 17, studies suggest 95 per cent of foreskins are fully retractable.
In your letter you have not stated your age, but I am assuming you are an adult. The nonretractable foreskin is almost certainly due to a condition called balanitis xerotica obliterans (BXo) in which the foreskin has spontaneously thickened, lost elasticity, and so will not retract. THIS
is a type of scarring of the skin, the cause of which is not understood, and there is only one treatment, which is circumcision.
I must, therefore, suggest to you that you will need an expert opinion, and that requires referral to a consultant urologist.
If it is confirmed that you do have BXo then surgery will be necessary as without an operation you will have problems with passing urine due to the narrowed ( and i ncreasingly narrowing outlet) as well as problems with erection and intercourse.
The major issue for you is to conquer your embarrassment — which we all understand, and for which all practitioners have much sympathy.
Pluck up your courage and go to see your GP — if you explain what’s happened, you may not need to be examined there and then and you can be referred straight on to the expert promptly; it is less traumatic psychologically to see a doctor who does nothing else but deal with that part of the anatomy — even though for GPs it is also part of everyday life.