Throat

Our Otolaryngologists are experts in managing diseases of the throat, larynx (voice box) and the esophagus.  These include: sore throats, hoarseness, reflux and swallowing disorders

Sore Throats

Sore throat is a symptom of many medical disorders.

Infections cause the majority of sore throats and can be caused by viruses (such as the common cold, flu or mono) or by bacteria such as streptococcus.  Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections.  Strep throat should be treated with an antibiotic. Other bacteria can also cause severe sore throats that deserve antibiotic treatment.  Tonsillitis is an infection of the tonsils on each side of the back of the throat.  Infections in the nose and sinuses can also cause sore throats, because mucus from the nose drains into the throat and carries the infection with it.

Patients with nasal congestion, causing mouth breathing may suffer with a dry and sore throat. 

Other causes of sore throat include: tobacco smoke, straining your voice, reflux, allergies and certain head and neck tumors.

It is important to see one of our otolaryngologists when a sore throat is severe, lasts longer than the usual 5-7 day duration of a cold or flu, and is not associated with an avoidable allergy or irritation.  Other signs and symptoms to seek medical attention for include: difficulty breathing, difficulty swallowing or opening the mouth, earache, rash, fever (over 101°), blood in saliva or phlegm, frequently recurring sore throat, lump in neck or hoarseness lasting over two weeks.

Tonsils and Adenoids

Tonsils and adenoids are masses of tissue that are similar to lymph nodes.  Tonsils are the two masses in the back of the throat. Adenoids are high in the throat behind the nose and soft palate.  Tonsils and adenoids "sample" bacteria and viruses and help form antibodies and develop your immune system from birth until age 2.  Having your tonsils and adenoids removed will not affect your immunity or resistance.

The most common problems affecting the tonsils and adenoids are recurrent infections and enlargement that causes breathing and swallowing problems.

Tonsillitis is an infection in one or both tonsils. Signs or symptoms include: tonsil swelling, red tonsils, a white or yellow coating on the tonsils, voice change, sore throat, fever, bad breath, ear pain and swollen lymph nodes in the neck.

Abscesses around the tonsils (peritonsillar abscess), chronic tonsillitis, and infections of the small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen.

Bacterial infections of the tonsils are first treated with antibiotics. If recurrent infections continue despite antibiotic therapy, removal of the tonsils and/or adenoids may be recommended.  Another reason surgery may be recommended is if the tonsils and/or adenoids are enlarged and causing difficulty breathing, snoring or obstructive sleep apnea.  Surgery can be very effective in treating these problems.

Removal of the adenoids may be recommended in children who have recurrent ear infections or ear fluid and are receiving a second set of ear tubes.  This removes any possible obstruction to the eustachian tubes which drain the ear.  Adenoid removal may also be indicated in children who are mouth breathers and have nasal congestion despite medical treatment.

 

Gastroesophageal Reflux Disease (GERD) & Laryngopharyngeal Reflux (LPR)

Gastroesophageal reflux disease, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus.  This can cause a burning sensation known as heartburn and in some cases; the reflux can be silent with no symptoms of heartburn.  When the acid refluxes all the way up and into the back of the nose and throat, it is called laryngopharyngeal reflux (LPR).  Symptoms of LPR include: a bitter taste, a sensation of burning in the throat, sore throat, voice change, cough, feeling like something is stuck in throat and difficulty breathing.

GERD and LPR can be caused by a malfunctioning lower esophageal sphincter muscle or hiatal hernia but is mostly caused by lifestyle factors.  These can include diet (chocolate, citrus, fatty foods, spices), overeating, alcohol and tobacco use and pregnancy.

GERD can be diagnosed by our otolaryngologists and then treated. Most patients with GERD and LPR respond to a combination of lifestyle changes and medication.  Lifestyle changes include:

-avoid eating and drinking within two to three hours prior to bedtime
-do not drink alcohol
-eat small meals and slowly
-limit foods that cause reflux: caffeine, carbonated drinks, chocolate, peppermint, tomato and citrus foods, fatty and fried foods
-Lose weight
-Quit smoking

Medications used to treat reflux can be found over the counter.  Antacids, histamine blockers such as Zantac® and Pepcid®, proton pump inhibitors such as Prilosec®.  If over the counter medications fail, then prescription strength medications may be needed and possibly a consultation with a gastroenterologist.

 

Hoarseness


Hoarseness is a general term that describes a change in the voice.  The voice may sound breathy, raspy or there may be changes in volume.

Causes of hoarseness include:
Acute Laryngitisis the most common cause and occurs due to swelling from a cold, upper respiratory tract infection, or irritation caused by excessive voice use such as speaking loudly or screaming.

Vocal cord nodules can cause hoarseness and are caused by using your voice too much, too loudly, or improperly. This causes vocal cord nodules (singers’ nodes or screamer's nodules), which are callous-like growths. 

Gastroesophageal Reflux Disease (GERD) is a common cause of hoarseness.

Smoking is a major cause of throat cancer and if smokers are hoarse, they should see one of our otolaryngologists immediately.
 
When hoarseness lasts longer than two weeks or has no obvious cause, it should be evaluated.  The vocal cords are examined with a small fiberoptic scope in the office.

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. Avoidance of smoking and reflux treatment are also recommended.  Surgery may be needed in certain cases.

Salivary Glands

These glands are found in and around your mouth and throat.  The largest glands are in your face in front of your ears (parotid glands), under your jaw (submandibular glands) and under the tongue (sublingual glands).  They secrete saliva into your mouth that moistens your mouth, initiates digestion, and helps protect your teeth from decay.

Salivary gland problems that can occur include:

Obstruction to the flow of saliva usually because of stones or infection.  Symptoms occur when eating leading to swelling of the involved gland and pain.   Treatment involves antibiotics, warm compresses, increasing fluid intake and eating something sour to stimulate saliva production.  Occasionally, opening of the salivary ducts in the mouth may be needed to help an obstructive stone pass.

Tumors: benign and malignant tumors may show up as painless masses in the salivary glands.  If a mass is found, it is helpful to obtain a CT scan or an MRI for evaluation.  Sometimes, a fine needle aspiration biopsy in the office is helpful in diagnosis.   Removal of the mass may be recommended and most masses are benign (noncancerous).

 

Snoring and Obstructive Sleep Apnea (OSA)

The noisy sounds of snoring occur when there is an obstruction to the flow of air through the passages at the back of the nose and throat.  Snoring is more frequent in males and overweight persons, and it usually grows worse with age.   It disturbs sleeping patterns and deprives the snorer of appropriate rest.  When snoring is severe, it can cause serious, long-term health problems, including obstructive sleep apnea.

When loud snoring is interrupted by frequent episodes of totally obstructed breathing, it is known as obstructive sleep apnea (OSA).   Because the snorer does not get good rest, he may be sleepy during the day, which impairs job performance and makes him a hazardous driver or equipment operator. After many years with OSA, elevated blood pressure and heart enlargement may occur.

These patients should seek medical advice with one of our otolaryngologists to ensure that sleep apnea is not a problem. A thorough examination of the nose, mouth, throat, palate, and neck will be performed.  A sleep study may be necessary to determine how serious the snoring is and what effects it has on the snorer's health.

Treatment depends on the diagnosis.  An examination will reveal if the snoring is caused by nasal allergy, infection or deformity, by enlarged tonsils and adenoids or by redundant soft tissue in the soft palate and tongue.

Snoring and OSA may respond to various treatments:

  • Lose weight
  • Avoid tranquilizers, sleeping pills, alcohol and antihistamines before bedtime.
  • Establish regular sleeping patterns
  • Sleep on your side rather than your back.
  • Tilt the head of your bed upwards four inches.
  • Continuous positive airway pressure (CPAP) which is a nasal mask that delivers air pressure into the throat to treat OSA.
  • Surgery may be necessary to relieve obstruction (nasal or throat). 
    • Nasal procedures include straightening a deviated nasal septum (septoplasty), inferior turbinate reduction (BITR), sinus surgery (FESS) and removal of nasal polyps if they are present. 
    • Throat procedures include: surgery on the palate (Pillar implants®, stiffening the palate with Coblation® and Uvulopalatopharyngoplasty (UPPP) to remove redundant tissue), surgery on the tonsils and adenoids (T&A) may be needed if these structures are enlarged and obstructing. 

 

Swallowing Trouble (Dysphagia)

Difficulty swallowing is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. 

Any interruption in the swallowing process can cause difficulties. This may be due to simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux disease (GERD).  Other causes may include: stroke, neurologic disorder, a paralyzed or unmoving vocal cord, or a tumor in the mouth, throat, or esophagus.

Symptoms of swallowing disorders may include: drooling, feeling that food or liquid is sticking in the throat, discomfort in the throat or chest, a sensation of a foreign body or "lump" in the throat, coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing.

Once the cause is determined, swallowing disorders may be treated with; medication, swallowing therapy and possibly surgery.