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Sore Throat, Tongue, Ear one side
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mmeehan770 posted:
I'm a 25 year old male that has recently quit smoking, but otherwise have been completely healthy my whole life. I've been expieriencing soreness on the left side of my mouth/throat/tongue/ears for about four months now. It all started when I woke up one morning with sore jaw. A week or so later my tongue started to feel swollen and eventually sore on the back left side. My ear on the same side began to have a full feeling and began popping whenever I opened my mouth. Shortly after that, I noticed a very slightly swollen node on the same side under the TMJ. All of my pain seems to be isolated to the back left side of my throat/mouth and has not really gotten better or worse the last few months.

I've been to my dentist once, family doctor five times, and ENT doctor fours times. No one seems to be worried. I have taken 2 rounds of antibiotics, prednisone once, and have tried various allergy and heartburn medications to no avail. I just cannot seem to find answers or a cure for my problems. I'm extremely worried about cancer (especially on the tongue) even though my ENT has told me several times that there is no evidence for it. I have had a CT scan w/contrast that came back "unremarkable" for everything.

The only test(s) I can think of that I have not had are an endoscopy, various bloodwork, and biopsy. Neither the dentist, doctor, or ENT see anything that would even need a biopsy. I know I should probably get bloodwork done, but I don't have insurance right now and have already spent a fortune the last few months on doctor visits and the CT scan.

I know I'm not going to get a diagnosis over the internet, but I would like to hear an educated opinion. I'm especially worried about cancer. Please let me know where I should go from here.

Thank You
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Rod_Moser_PA_PhD responded:
What would it take for you to stop worrying about cancer? A negative CT scan would have really done that for most people, but for some reason....three medical professionals over TEN visits have not been able to convince. I am not sure that I can do it either.

Anyone who starts their posting about their smoking history, whether they say it or not, is worried that they have some sort of occult (hidden) cancer that has not been found...yet. Fear of an illness can be worse than the illness itself in many cases. I spend more time during the day convincing people that they DON'T have things, than with the people that DO have things.

You really get get a biopsy. What would they biopsy? Unless the CT showed a suspicious area, or an area of concern, there would be no justification to do this. A blind biopsy is worthless. The endoscopy would be helpful, however. There is nothing inappropriate for getting a direct visualization of the problem, even though...the CT was negative. You will need to decide if or when you take this next, expensive test. Did the ENT suggest it? As far as blood work is concerned, you would first need to have some diagnostic clues. Again, blind blood work is worthless...you need to know up front, what you are looking for. It is rare that a bank of blood tests, randomly chosen, would make a profound diagnosis that your doctor has not considered.

I am a fan of taking a diagnostic investigation to the end, however, at some point, you will reach the "end" -- no more tests, no more specialists to see. At this point, you may still have that lingering fear of an ominous diagnosis that probably does not exist. You and your doctors will need to decide, togetter, when this "end point" occurs. You are torturing yourself with the "what if's", but not rejoicing in the fact that ALL of your diagnostic tests have been negative. A negative CT, my friend, is EXCELLENT news.

You have quit smoking....clearly, the best move you have made so far.
 
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mmeehan770 responded:
I can't thank you enough for taking the time to answer my post Dr. Moser. I do understand your skepticism given the fact that the CT was negative and none of the medical professionals I've seen have noticed anything to be concerned about. However, this pain is real, has been going on for months, and I have yet to find a solution. I have never had anxiety about my health, but my past is not squeaky clean so I'm natrually thinking of the worst possible scenario. My ENT doc did not suggest an endoscopy. He did not think I needed the CT scan either. I'm not questioning his ability or knowledge - I actually really like him. I do feel that my age and lack of insurance could possibly play against me though.

Would you mind answering a few more questions? I would really appreciate it.

1. The pain is in the left back of my mouth/tongue/upper throat (both muscular and surface irritation) - not to mention the ear popping. What could an endoscopy find that a CT scan could not?

2. I do have a noticable node (not visually, but you can feel it) in my neck located under my jaw at the same side of my pain. Even my doc has noticed it and it cannot be felt on the opposite side. Why would a node that can be felt, not show up visually on the CT scan? Or be something to worry about?

3. My ENT did suggest some possible bloodwork (although not urgent) such as CBC w Diff w Plt - Sed Rate, Westergren - Antinuclear Antibodies - Rhumatoid Arthrtus Factor. These could at least rule some things out right? - Just to add, I do not believe I'm at risk for any STD. I have been in a monogomous heterosexual relationship for years and although it's not impossible - it's not likely.

4. TMJ disorder could be part of the problem as I have always had an issue with jaw clinching. Could that cause a sore tongue and surface tissue sensativity?

5. ENT did suggest a consultation with an oral surgeon. In your opinion, Is that a logical next step?
 
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Rod_Moser_PA_PhD responded:
Your lack of insurance is an issue, but your willingness ot pay for your care is commendable. Your doctor may be trying to only do the bare minimum tests, knowing that you do not have a third-party payer picking up most of the tab.

1. An endoscopy is an important visual exam to augment the information obtained on the CT scan or other imaging studies, like an MRI. If your pain is located in an area that can not easily be seen, then scoping this area is important. Unless you look, you don't see...

2. Lymph nodes do not excite medical provider very much unless they are hard, fixed, or medical suspicious. Suspicious nodes are usually spotted on the CT scan or be skilled fingers during an exam. Lymph nodes enlarge or react to inflammation or infection in their immediate neighborhood, or to systemic disease. Finding the REASON for the lymph node reaction is important, not just the simple presence of a node that may even be normal.

3. If the usual and customary reasons have been ruled out....if some of the serious diseases (like a cancer, lymphoma) have been ruled out, and you still do not have a definitive diagnosis, then you need to keep looking and keep overturning those "stones". Blood work can offer some important information about systemic diseases, or active disease processes.

4. Sure, you can have TMJ, especially if you are prone to bruxism (grinding your teeth or jaw clinching), but that does not mean you do not have other things, too.

5. An oral surgeon...one who specializes in TMJ disorders...can offer a good opinion if you have a problem in this area. Again, this does not mean that TMJ is your only problem.
 
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Pulseezar replied to mmeehan770's response:
I'm having quite literally the same symptoms under the same conditions, and have also been to several ENT's and doctors. Nobody seems to be worried about anything in my case either, but I am! I know it's been years since this thread was updated, but did you ever figure anything more out, or find a solution?
 
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Purple74 replied to Pulseezar's response:
I also am having a nearly identical situation. Wish I could get relief, or at least answers.


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