DR MARTIN SCURR answers your health questions

One side of my back is tender, at the mouth’s entrance into my throat. The pain is sore and it affects my eating habits. I’ve had numerous tests and tried a steroid mouthwash. What can I do other than take steroid mouthwashes?

Mrs J. Farmer, via email.

These symptoms could be indicative of glossopharyngeal neurogia. This is characterized by sudden, severe, and often excruciating pain in the throat. It’s located near the tonsils.

However, generally, the only side that is affected, as it was in your particular case, is affected. You may feel a sharp, short-lasting pain or a dull, constant ache.

Spitting, coughing and yawning can trigger the symptoms. Some patients may also touch the area of pain. Patients may experience weight loss when they have difficulty eating due to the discomfort caused by the swallowing pain.

The brain receives information through the glossopharyngeal neuron. It carries it from the tonsils, tongue, throat and middle ear. Pain such as you describe is caused when this nerve becomes irritated in some way — perhaps by a blood vessel pressing on it.

In most cases, the pain is limited to one side of your throat. You may feel a sharp, short-lasting pain or a dull, constant ache.

This is the most probable diagnosis considering that many investigations including a MRI scan, dental X-rays and a long letter have not found any issue. This is why I would recommend that your GP refers you to a neurologist.

This is a common condition that can usually be treated successfully with medication.

Carbamazepine is often the first choice treatment for severe facial pain caused by nerve pressure. Although the drug can interfere with pain signals being transmitted through the nerve, it may need to be used long-term. Gabapentin — a drug used for epilepsy and nerve pain — is another option, and works in a similar way.

If these don’t work, microvascular decompression surgery may be offered.

Both my sons (aged 42 and 45) have been diagnosed with low platelets. Are they safe to receive the AstraZeneca or Covid vaccine? My husband was diagnosed a few years ago with low iron, but was told he wasn’t anaemic. This is possible?

Carol Frankland and Clitheroe Lancs.

The smallest blood cells, platelets, are vital components of the blood clotting system. They bind together blood cells and aid in healing.

Your sons may have low levels of platelets. It can result in bleeding, bruising, and even scarring from your gums, nose, and intestinal tract.

A platelet count below the lower limit of normal (less than 150,000 platelets per microlitre of blood) is known as thrombocytopenia and can lead to spontaneous bleeding and — paradoxically — clotting.

There are many causes of this condition, such as medications like penicillin and non-steroidal Anti-Inflammatories (used for ulcers), as well as cancers like kidney disease, leukemia, and excess alcohol consumption.

Developing thrombocytopenia has — in rare cases — been linked to the Covid-19 vaccine. But this is extremely rare. [File photo]

Occasionally, thrombocytopenia is not due to one of the above triggers, but is an inherited condition — an autoimmune disease where platelets are mistakenly destroyed by antibodies (which seek to fight foreign cells in the body and fend off disease). This is likely to be the case with your sons as they’re both otherwise in good health.

Those with this type of inherited low platelets have a lower bleeding risk than people with other causes for the condition, although spontaneous bleeding is still a worry because it can cause severe blood loss in some circumstances — even a tooth removal or other minor injury.

Developing thrombocytopenia has — in rare cases — been linked to the Covid-19 vaccine. This however is extremely uncommon.

I imagine your concern is that the jab might lower your sons’ platelet counts further. But the current medical advice is that thrombocytopenia should not stop anyone from getting the AstraZeneca vaccine (which has seen the highest incidence of this rare side-effect, although it’s worth noting that the other vaccines have also caused bleeding and clotting).

Discuss with your doctor whether or not the AstraZeneca jab will be appropriate for your sons. However given the wide range of vaccines that are available in the UK it is likely to be recommended to choose from the Moderna and Pfizer.

Your husband’s previous iron levels are probably not relevant as he was not anaemic.