Throat Diseases

Throat Diseases

TONSILLITIS

Tonsillitis is a common disease of children and young adults.
Presents with intense sore throat, which is often so sore that swallowing is painful, a condition called odynophagia. The tonsils can swell and cause difficulty swallowing, called dysphagia and may occasionally obstruct the airway.

Treated with course of antibiotics. Recurrent tonsillitis is often treated with a tonsillectomy.

HOARSENESS

Changes in voice are common complaints and often frightening to patients, for they are a well-known sign of cancer. The usual change is a roughness to the voice. Less common is a breathy sound to the voice.
Diagnosis is made by transnasal fiberoptic laryngoscopy or by examination of the larynx with a mirror placed at the back of the throat.

The four most common problems are laryngitis, GERD, post nasal drip, vocal cord nodules, vocal cord paralysis, and laryngeal cancer.

For left vocal cord paralysis without evidence of laryngeal or cervical disease, CT examination or MRI is indicated.

FOREIGN BODIES IN THE ESOPHAGUS

Esophageal foreign bodies are found in all age groups. They occur for two reasons. First, if a sharp, object such as a needle, fish bone, or chicken bone is swallowed, it can stick anywhere from the oropharynx to the lower esophageal sphincter. If a foreign body is swallowed and reaches the stomach, it is rare for it not to pass on through the rest of the gastrointestinal tract and be expelled. However, any foreign body stuck in the pharynx or esophagus must be removed, because it will not advance farther but, rather, will erode through the mucosa and cause a serious local infection.

A second cause of a foreign body is an inherent esophageal obstruction. This can be a tumor, cricopharyngeal muscle spasm, esophageal diverticulum, posterior mediastinal mass (either a tumor or a vascular anomaly), enlarged left atrium as in congestive heart failure, or some abnormality of the lower esophageal sphincter. These obstructions can block the passage of a normal-size food bolus but mostly involve a large bolus, such as a piece of meat. Symptoms vary, depending on location. Pain is often felt and is usually described as a sensation of something being stuck. The patient is unable to eat any additional food.

Diagnosis is by history and is confirmed by soft tissue X ray and a contrast swallow study. Occasionally a CT scan is required. Once the diagnosis is certain, the patient is anesthetized and the foreign body is located by esophagoscopy and removed .

VIRAL PHARYNGITIS

Most people have one or two colds annually. The majority of these are viral infections affecting the mucosa of the upper respiratory tract. Symptoms begin with a sore throat and can be mild or intense, depending in part on the virus and in part on the host. The pain and inflammation can also involve the larynx (laryngitis), the trachea (tracheitis), or the bronchi (bronchitis). Usually as the throat soreness disappears, the nose becomes congested. Initially, a clear rhinorrhea develops, but the discharge rapidly becomes purulent due to bacterial superinfection. Usually the paranasal sinuses are involved, and this is perceived as pain or pressure over the involved sinuses. Occasionally in adults, but frequently in children, the middle ear is also involved. At first the ear has a serous effusion, but this will often develop into a bacterial otitis media. Adults have low-grade fevers, and children tend to have higher temperatures. Breathing and swallowing are rarely compromised.

There is no specific therapy. Fluids & rest is advised. Antibiotics are not effective against the viral inflammation but may be useful prophylactically against the sequelae of the bacterial superinfection. Decongestants are useful to decrease the stuffy nose and sinus discomfort, and salt-water gargle may alleviate the sore throat.

PERITONSILLAR ABSCESS

A peritonsillar abscess is generally a mixed anaerobic infection of the space between the tonsil and the lateral pharyngeal wall. Its onset is rapid. Patients are febrile and show signs of toxicity. The pain, which is intense, is usually unilateral. Patients complain of dysphagia, may often drool, and may become dehydrated.

In early cases intravenous antibiotic & fluids is given.
If the IV and oral therapies fail to relieve the condition or should the infection progress and a presumptive diagnosis of peritonsillar abscess is made, a needle aspiration is recommended.

In advanced cases repeat aspirations may become necessary. Alternatively, incision and drainage may be warranted.

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