Tonsils and adenoids are masses of tissue that are similar to
the lymph nodes or "glands" found in the neck, groin,
and armpits. Tonsils are the two masses on the back of the throat.
Adenoids are high in the throat behind the nose and the roof
of the mouth (soft palate) and are not visible through the mouth
without special instruments.
Tonsils and adenoids are near the entrance to
the breathing passages where they can catch incoming germs,
which cause infections. They "sample" bacteria and
viruses and can become infected themselves. Scientists believe
they work as part of the body's immune system by filtering germs
that attempt to invade the body, and that they help to develop
antibodies to germs.
This happens primarily during the first
few years of life, becoming less important as we get older.
Children who must have their tonsils and adenoids removed suffer
no loss in their resistance.
What affects tonsils and adenoids?
The most common problems affecting the tonsils
and adenoids are recurrent infections (throat or ear) and significant
enlargement or obstruction that causes breathing and swallowing
problems.
Abscesses around the tonsils, chronic tonsillitis,
and infections of small pockets within the tonsils that produce
foul-smelling, cheese-like formations can also affect the tonsils
and adenoids, making them sore and swollen. Tumors are rare,
but can grow on the tonsils.
When should I see my doctor?
You should see your doctor when you or your
child suffer the common symptoms of infected or enlarged tonsils
or adenoids.
The Exam
The primary methods used to check tonsils and
adenoids are:
Medical history Physical examination
Throat cultures/Strep
tests X-rays Blood tests
What should I expect at the exam?
Your physician will ask about problems of the
ear, nose, and throat and examine the head and neck. He or she
will use a small mirror or a flexible lighted instrument to
see these areas.
Cultures/strep tests are important in diagnosing
certain infections in the throat, especially "strep"
throat.
X-rays are sometimes helpful in determining
the size and shape of the adenoids. Blood tests can determine
problems such as mononucleosis.
How are tonsil and adenoid diseases
treated?
Bacterial infections of the tonsils, especially
those caused by streptococcus, are first treated with antibiotics.
Sometimes, removal of the tonsils and/or adenoids may be recommended.
The two primary reasons for tonsil and/or adenoid removal are
(1) recurrent infection despite antibiotic therapy and (2) difficulty
breathing due to enlarged tonsils and/or adenoids.
Such obstruction to breathing causes snoring
and disturbed sleep that leads to daytime sleepiness in adults
and behavioral problems in children. Some orthodontists believe
chronic mouth breathing from large tonsils and adenoids causes
malformations of the face and improper alignment of the teeth.
Chronic infection can affect other areas such
as the eustachian tube - the passage between the back of the
nose and the inside of the ear. This can lead to frequent ear
infections and potential hearing loss.
Recent studies indicate adenoidectomy may be
a beneficial treatment for some children with chronic earaches
accompanied by fluid in the middle ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor
may be another reason for removing the tonsils and adenoids.
In some patients, especially those with infectious
mononucleosis, severe enlargement may obstruct the airway. For
those patients, treatment with steroids (e.g., cortisone) is
sometimes helpful.
Tonsillitis and its symptoms
Tonsillitis is an infection in one or both tonsils.
One sign is swelling of the tonsils. Other signs or symptoms
are:
Redder than normal tonsils A white or yellow
coating on the tonsils A slight voice
change due to swelling Sore throat
Uncomfortable
or painful swallowing Swollen lymph
nodes (glands) in the neck Fever Bad breath
Enlarged adenoids and their symptoms
If you or your child's adenoids are enlarged,
it may be hard to breathe through the nose.
Other signs of constant enlargement
are:
Breathing through the mouth instead of the nose most of the
time Nose sounds
"blocked" when the person speaks Noisy breathing
during the day Recurrent ear
infections Snoring at night
Breathing stops
for a few seconds at night during snoring or loud breathing
(sleep apnea)
Surgery
Your child
Talk to your child about his/her feelings and
provide strong reassurance and support throughout the process.
Encourage the idea that the procedure will make him/her healthier.
Be with your child as much as possible before and after the
surgery. Tell him/her to expect a sore throat after surgery.
Reassure your child that the operation does not remove any important
parts of the body, and that he/she will not look any different
afterward. If your child has a friend who has had this surgery,
it may be helpful to talk about it with that friend.
Adults and children
For at least two weeks before any surgery, the
patient should refrain from taking aspirin or other medications
containing aspirin. (WARNING: Children should never be given
aspirin because of the risk of developing Reye's syndrome).
If the patient or patient's family has had any
problems with anesthesia, the surgeon should be informed. If
the patient is taking any other medications, has sickle cell
anemia, has a bleeding disorder, is pregnant, has concerns about
the transfusion of blood, or has used steroids in the past year,
the surgeon should be informed.
A blood test and possibly a urine test may be required prior
to surgery.
Generally, after midnight prior to the operation, nothing (chewing
gum, mouthwashes, throat lozenges, toothpaste, water) may be
taken by mouth. Anything in the stomach may be vomited when
anesthesia is induced, and this is dangerous.
When the patient arrives at the hospital or surgery center,
the anesthesiologist or nursing staff may meet with the patient
and family to review the patient's history. The patient will
then be taken to the operating room and given an anesthetic.
Intravenous fluids are usually given during and after surgery.
After the operation, the patient will be taken
to the recovery area. Recovery room staff will observe the patient
until discharged. Every patient is special, and recovery times
vary for each individual. Many patients are released after 2-10
hours. Others are kept overnight. Intensive care may be needed
for select cases.
Your ENT specialist will provide you with the
details of pre-operative and postoperative care and answer any
questions you may have.
After surgery
There are several postoperative symptoms that
may arise. These include (but are not limited to) swallowing
problems, vomiting, fever, throat pain, and ear pain. Occasionally,
bleeding may occur after surgery. If the patient has any bleeding,
your surgeon should be notified immediately.
Any questions or concerns you have should be
discussed openly with your surgeon, who is there to assist you.
The American Cancer Society estimates that approximately 38,000
new cases of head and neck cancer were diagnosed in the United
States in 2002; about 9,000 of these were in the larynx (voice
box).Experts anticipate similar statistics for 2003.
An estimated 3,700 people died of laryngeal
cancer in 2002 representing approximately two thirds of one
percent of all cancer deaths in this country.Even for disease
survivors, the consequences of laryngeal cancer are often severe.Laryngeal
cancer is a preventable disease because the risk factors are
associated with modifiable behaviors.
The causes of laryngeal cancer
Development of this deadly disease is a process
which involves many factors, but approximately 90 percent of
head and neck cancers occur after exposure to known carcinogens
(cancer causing substances) causing a type of the disease calledsquamous
cell carcinoma (SCCA).
Smoking: More than 95 percent with laryngeal
SCCA are smokers.Smoking contributes to cancer by causing mutations
or changes in genes, impairing clearance of carcinogens from
the respiratory tract, and decreasing the body’s immune response.Tobacco
use is measured in pack-years, where one pack per day for one
year is one pack-year (or one pack per day for two years, or
two packs per day for one year, equals two pack-years).Depending
upon the number of pack-years smoked, studies have reported
that smokers are about five to 35 times more likely to develop
laryngeal cancer than nonsmokers.Other research findings indicate
that the duration of tobacco exposure is probably more important
overall to the cancer causing effect than the intensity of the
exposure.
Alcohol: This acts as a promoter of the cancer
causing process making it another important risk factor for
laryngeal cancer. The major clinical significance of alcohol
is that it enhances the harmful effects of tobacco at a magnitude
that is more than just additive.Essentially, people who smoke
and drink alcohol have a combined risk that is greater than
the sum of the individual risks.The American Cancer Society
recommends that those who drink alcoholic beverages should limit
the amount, and one drink per day is considered a limited alcohol
exposure.
Other risk factors:
Certain viruses, such as human papilloma virus (HPV), acid reflux,
and occupational exposure to asbestos likely contribute to causing
laryngeal cancer.Vitamin A and beta-carotene may play a protective
role in the disease process.
Signs and symptoms of laryngeal cancer
include:
Progressive
or persistent hoarseness Difficulty swallowing
Persistent sore
throat or pain with swallowing Difficulty breathing
Pain in the
ear Lump in the
neck
Anyone with these signs or symptoms, and having
risks for laryngeal cancer, should be evaluated by an otolaryngologist
(ear, nose, and throat specialist).The primary treatment options
include surgery, radiation therapy, chemotherapy, or a combination
of these treatments.
Remember that this is a preventable disease
in the vast majority of cases, because the main risk factors
are associated with modifiable behaviors.Do not smoke and do
not abuse alcohol.
Hoarseness or roughness in your voice is often
caused by a medical problem.Contact an otolaryngologist—head
and neck surgeon if you have any sustained changes to your voice.
The glands are found in and around your mouth
and throat. We call the major salivary glands the parotid, submandibular,
and sublingual glands.
They all secrete saliva into your mouth, the
parotid through tubes that drain saliva, called salivary ducts,
near your upper teeth, submandibular under your tongue, and
the sublingual through many ducts in the floor of your mouth.
Besides these glands, there are many tiny glands
called minor salivary glands located in your lips, inner cheek
area (buccal mucosa), and extensively in other linings of your
mouth and throat. Salivary glands produce the saliva used to
moisten your mouth, initiate digestion, and help protect your
teeth from decay.
As a good health measure, it is important to
drink lots of liquids daily. Dehydration is a risk factor for
salivary gland disease.
What Causes Gland Problems?
Salivary gland problems that cause clinical symptoms include:
Obstruction Obstruction
to the flow of saliva most commonly occurs in the parotid and
submandibular glands, usually because stones have formed. Symptoms
typically occur when eating. Saliva production starts to flow,
but cannot exit the ductal system, leading to swelling of the
involved gland and significant pain, sometimes with an infection.
Unless stones totally obstruct saliva flow,
the major glands will swell during eating and then gradually
subside after eating, only to enlarge again at the next meal.
Infection can develop in the pool of blocked saliva, leading
to more severe pain and swelling in the glands. If untreated
for a long time, the glands may become abscessed.
It is possible for the duct system of the major
salivary glands that connects the glands to the mouth to be
abnormal. These ducts can develop small constrictions, which
decrease salivary flow, leading to infection and obstructive
symptoms.
Infection The most common
salivary gland infection in children is mumps, which involves
the parotid glands. While this is most common in children who
have not been immunized, it can occur in adults. However, if
an adult has swelling in the area of the parotid gland only
on one side, it is more likely due to an obstruction or a tumor.
Infections also occur because of ductal obstruction
or sluggish flow of saliva because the mouth has abundant bacteria.
You may have a secondary infection of salivary
glands from nearby lymph nodes. These lymph nodes are the structures
in the upper neck that often become tender during a common sore
throat. In fact, many of these lymph nodes are actually located
on, within, and deep in the substance of the parotid gland or
near the submandibular glands. When these lymph nodes enlarge
through infection, you may have a red, painful swelling in the
area of the parotid or submandibular glands. Lymph nodes also
enlarge due to tumors and inflammation.
Tumors Primary benign
and malignant salivary gland tumors usually show up as painless
enlargements of these glands. Tumors rarely involve more than
one gland and are detected as a growth in the parotid, submandibular
area, on the palate, floor of mouth, cheeks, or lips. An otolaryngologist-head
and neck surgeon should check these enlargements.
Malignant tumors of the major salivary glands
can grow quickly, may be painful, and can cause loss of movement
of part or all of the affected side of the face. These symptoms
should be immediately investigated.
Other Disorders
Salivary gland enlargement also occurs in autoimmune
diseases such as HIV and Sjögren's syndrome where the body's
immune system attacks the salivary glands causing significant
inflammation. Dry mouth or dry eyes are common. This may occur
with other systemic diseases such as rheumatoid arthritis. Diabetes
may cause enlargement of the salivary glands, especially the
parotid glands. Alcoholics may have salivary gland swelling,
usually on both sides.
How Does Your Doctor Make the Diagnosis?
Diagnosis of salivary gland disease depends on the careful taking
of your history, a physical examination, and laboratory tests.
If your doctor suspects an obstruction of the
major salivary glands, it may be necessary to anesthetize the
opening of the salivary ducts in the mouth, and probe and dilate
the duct to help an obstructive stone pass. Before these procedures,
dental x-rays may show where the calcified stones are located.
If a mass is found in the salivary gland, it
is helpful to obtain a CT scan or a MRI (magnetic resonance
imaging). Sometimes, a fine needle aspiration biopsy in the
doctor's office is helpful. Rarely, dye will be injected through
the parotid duct before an x-ray of the gland is taken (a sialogram).
A lip biopsy of minor salivary glands may be
needed to identify certain autoimmune diseases.
How Is Salivary Gland Disease Treated?
Treatment of salivary diseases falls into two categories: medical
and surgical. Selection of treatment depends on the nature of
the problem. If it is due to systemic diseases (diseases that
involve the whole body, not one isolated area), then the underlying
problem must be treated. This may require consulting with other
specialists. If the disease process relates to salivary gland
obstruction and subsequent infection, your doctor will recommend
increased fluid intake and may prescribe antibiotics. Sometimes
an instrument will be used to open blocked ducts.
If a mass has developed within the salivary
gland, removal of the mass may be recommended. Most masses in
the parotid gland area are benign (noncancerous). When surgery
is necessary, great care must be taken to avoid damage to the
facial nerve within this gland that moves the muscles face including
the mouth and eye. When malignant masses are in the parotid
gland, it may be possible to surgically remove them and preserve
most of the facial nerve. Radiation treatment is often recommended
after surgery. This is typically administered four to six weeks
after the surgical procedure to allow adequate healing before
irradiation.
The same general principles apply to masses
in the submandibular area or in the minor salivary glands within
the mouth and upper throat. Benign diseases are best treated
by conservative measures or surgery, whereas malignant diseases
may require surgery and postoperative irradiation. If the lump
in the vicinity of a salivary gland is a lymph node that has
become enlarged due to cancer from another site, then obviously
a different treatment plan will be needed. An otolaryngologist-head
and neck surgeon can effectively direct treatment.
Removal of a salivary gland does not produce
a dry mouth, called xerostomia. However, radiation therapy to
the mouth can cause the unpleasant symptoms associated with
reduced salivary flow. Your doctor can prescribe medication
or other conservative treatments that may reduce the dryness
in these instances.
Salivary gland diseases are due to many different
causes. These diseases are treated both medically and surgically.
Treatment is readily managed by an otolaryngologist--head and
neck surgeon with experience in this area.
Sore throat is a symptom of many medical disorders.
Infections cause the majority of sore throats and are contagious.
Infections are caused either by viruses such as the flu, the
common cold, mononucleosis, or by bacteria such as strep, mycoplasma,
or hemophilus.
While bacteria respond to antibiotic treatment,
viruses do not.
Viruses: Most viral sore throats
accompany flu or colds along with a stuffy, runny nose, sneezing,
and generalized aches and pains. These viruses are highly contagious
and spread quickly, especially in winter. The body builds antibodies
that destroy the virus, a process that takes about a week.
Sore throats accompany other viral infections
such as measles, chicken pox, whooping cough, and croup. Canker
sores and fever blisters in the throat also can be very painful.
One viral infection takes much longer than a
week to be cured: infectious mononucleosis, or "mono."
This virus lodges in the lymph system, causing massive enlargement
of the tonsils, with white patches on their surface and swollen
glands in the neck, armpits, and groin. It creates a severely
sore throat and, sometimes, serious breathing difficulties.
It can affect the liver, leading to jaundice- yellow skin and
eyes. It also causes extreme fatigue that can last six weeks
or more.
"Mono," a severe illness in teenagers
but less severe in children, can he transmitted by saliva. So
it has been nicknamed the "kissing disease," but it
can also be transmitted from mouth-to-hand to hand-to-mouth
or by sharing of towels and eating utensils.
Bacteria: Strep throat is an
infection caused by a particular strain of streptococcus bacteria.
This infection can also damage the heart valves (rheumatic fever)
and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia,
sinusitis, and ear infections.
Because of these possible complications, a strep
throat should be treated with an antibiotic. Strep is not always
easy to detect by examination, and a throat culture may be needed.
These tests, when positive, persuade the physician to prescribe
antibiotics. However, strep tests might not detect other bacteria
that also can cause severe sore throats that deserve antibiotic
treatment. For example, severe and chronic cases of tonsillitis
or tonsillar abscess may be culture negative. Similarly, negative
cultures are seen with diphtheria, and infections from oral
sexual contacts will escape detection by strep culture tests.
Tonsillitis is an infection of the lumpy tissues
on each side of the back of the throat.
In the first two to three years of childhood, these tissues
"catch" infections, sampling the child's environment
to help develop his immunities (antibodies). Healthy tonsils
do not remain infected. Frequent sore throats from tonsillitis
suggest the infection is not fully eliminated between episodes.
A medical study has shown that children who suffer from frequent
episodes of tonsillitis (such as three- to four- times each
year for several years) were healthier after their tonsils were
surgically removed.
Infections in the nose and sinuses also can
cause sore throats, because mucus from the nose drains down
into the throat and carries the infection with it.
The most dangerous throat infection is epiglottitis,
caused by bacteria that infect a portion of the larynx (voice
box) and cause swelling that closes the airway. This infection
is an emergency condition that requires prompt medical attention.
Suspect it when swallowing is extremely painful (causing drooling),
when speech is muffled, and when breathing becomes difficult.
A strep test may miss this infection.
Allergy: The same pollens and
molds that irritate the nose when they are inhaled also may
irritate the throat. Cat and dog danders and house dust are
common causes of sore throats for people with allergies to them.
Irritation: During the cold
winter months, dry heat may create a recurring, mild sore throat
with a parched feeling, especially in the mornings. This often
responds to humidification of bedroom air and increased liquid
intake. Patients with a chronic stuffy nose, causing mouth breathing,
also suffer with a dry throat. They need examination and treatment
of the nose.
Pollutants and chemicals in the air can irritate
the nose and throat, but the most common air pollutant is tobacco
smoke. Other irritants include smokeless tobacco, alcoholic
beverages, and spicy foods.
A person who strains his or her voice (yelling
at a sports event, for example) gets a sore throat not only
from muscle strain but also from the rough treatment of his
or her throat membranes.
Reflux: An occasional cause of morning sore
throat is regurgitation of stomach acids up into the back of
the throat. To avoid reflux, tilt your bedframe so that the
head is elevated four- to six- inches higher than the foot of
the bed. You might find antacids helpful. You should also avoid
eating within three hours of bedtime, and eliminate caffeine
and alcohol. If these tips fail, see your doctor.
Tumors: Tumors of the throat, tongue, and larynx
(voice box) are usually (but not always) associated with long-time
use of tobacco and alcohol. Sore throat and difficulty swallowing-sometimes
with pain radiating to the ear-may be symptoms of such a tumor.
More often the sore throat is so mild or so chronic that it
is hardly noticed. Other important symptoms include hoarseness,
a lump in the neck, unexplained weight loss, and/or spitting
up blood in the saliva or phlegm.
When Should I See a Doctor?
Whenever a sore throat is severe, persists longer
than the usual five- to seven- day duration of a cold or flu,
and is not associated with an avoidable allergy or irritation,
you should seek medical attention. The following signs and symptoms
should alert you to see your physician:
Severe and prolonged sore throat Difficulty breathing
Difficulty swallowing
Difficulty opening
the mouth Joint pain Earache Rash Fever (over
101°) Blood in saliva
or phlegm Frequently recurring
sore throat Lump in neck
Hoarseness lasting
over two weeks
When should I take antibiotics?
Antibiotics are drugs that kill or impair bacteria.
Penicillin or erythromycin (well-known antibiotics) are prescribed
when the physician suspects streptococcal or another bacterial
infection that responds to them. However, a number of bacterial
throat infections require other antibiotics instead. Antibiotics
do not cure viral infections, but viruses do lower the patient's
resistance to bacterial infections. When such a combined infection
occurs, antibiotics may be recommended. When an antibiotic is
prescribed, it should be taken as the physician directs for
the full course (usually 10 days). Otherwise the infection will
probably be suppressed rather than eliminated, and it can return.
Some children will experience recurrent infection despite antibiotic
treatment. When some of these are strep infections or are severe,
your child may require a tonsillectomy.
Should other family members be treated
or cultured?
When a strep test is positive, many experts
recommend treatment or culturing of other family members. Practice
good sanitary habits; avoid close physical contact, and sharing
of napkins, towels, and utensils with the infected person. Handwashing
makes good sense.
What if my throat culture is negative?
A strep culture tests only for the presence
of streptococcal infections. Many other infections, both bacterial
and viral, will yield negative cultures and sometimes so does
a streptococcal infection. Therefore, when your culture is negative,
your physician will base his/her decision for treatment on the
severity of your symptoms and the appearance of your throat
on examination.
How Can I Treat My Sore Throat?
A mild sore throat associated with cold or flu
symptoms can be made more comfortable with the following remedies:
Increase your liquid intake. Warm tea with
honey is a favorite home remedy. Use a steamer
or humidifier in your bedroom. Gargle with
warm salt water several times daily: ¼ tsp. salt to ½ cup water.
Take over-the-counter
pain relievers such as acetaminophen (Tylenol Sore Throat®,
Tempra®) or ibuprofen (Motrin IB®, Advil®).
Insight into causes, prevention, and when to see an
ENT
What Is It?
Hoarseness is a general term that describes
abnormal voice changes. When hoarse, the voice may sound breathy,
raspy, strained, or there may be changes in volume (loudness)
or pitch (how high or low the voice is). The changes in sound
are usually due to disorders related to the vocal cords that
are the sound producing parts of the voice box (larynx). While
breathing, the vocal cords remain apart. When speaking or singing,
they come together, and as air leaves the lungs, they vibrate,
producing sound. Swelling or lumps on the vocal cords prevent
them from coming together properly and changes the way the cords
vibrate, which makes a change in the voice, altering quality,
volume, and pitch.
What Are the Causes?
Acute Laryngitis: There are many causes of hoarseness. Fortunately,
most are not serious and tend to go away in a short period of
time. The most common cause is acute laryngitis, which usually
occurs due to swelling from a common cold, upper respiratory
tract viral infection, or irritation caused by excessive voice
use such as screaming at a sporting event or rock concert.
Vocal Nodules: More prolonged hoarseness is
usually due to using your voice either too much, too loudly,
or improperly over extended periods of time. These habits can
lead to vocal nodules (singers’ nodes), which are callous-like
growths, or may lead to polyps of the vocal cords (more extensive
swelling). Both of these conditions are benign. Vocal nodules
are common in children and adults who raise their voice in work
or play.
Open Voice Box
Closed Voice Box
Gastroesophageal Reflux: A
common cause of hoarseness is gastro-esophageal reflux, when
stomach acid comes up the swallowing tube (esophagus) and irritates
the vocal cords. Many patients with reflux-related changes of
voice do not have symptoms of heartburn. Usually, the voice
is worse in the morning and improves during the day. These people
may have a sensation of a lump in their throat, mucus sticking
in their throat or an excessive desire to clear their throat.
Smoking: Smoking is another
cause of hoarseness. Since smoking is the major cause of throat
cancer, if smokers are hoarse, they should see an otolaryngologist.
Other Causes: Many unusual
causes for hoarseness include allergies, thyroid problems, neurological
disorders, trauma to the voice box, and occasionally, the normal
menstrual cycle.
Who Can Treat My Hoarseness?
Hoarseness due to a cold or flu may be evaluated
by family physicians, pediatricians, and internists (who have
learned how to examine the larynx). When hoarseness lasts longer
than two weeks or has no obvious cause it should be evaluated
by an otolaryngologist--head and neck surgeon (ear, nose and
throat doctor). Problems with the voice are best managed by
a team of professionals who know and understand how the voice
functions. These professionals are otolaryngologist--head and
neck surgeons, speech/language pathologists, and teachers of
singing, acting, or public speaking. Voice disorders have many
different characteristics that may give professionals a clue
to the cause.
How Is Hoarseness Evaluated?
An otolaryngologist will obtain a thorough history
of the hoarseness and your general health. Your doctor will
usually look at the vocal cords with either a mirror placed
in the back of your throat, or a very small, lighted flexible
tube (fiberoptic scope) may be passed through your nose in order
to view your vocal cords. Videotaping the examination or using
stroboscopy (slow motion assessment) may also help with the
analysis.
These procedures are not uncomfortable and are
well tolerated by most patients. In some cases, special tests
(known as acoustic analysis) designed to evaluate the voice,
may be recommended. These measure voice irregularities, how
the voice sounds, airflow, and other characteristics that are
helpful in establishing a diagnosis and guiding treatment
When should I see an otolaryngologist
(ENT doctor)?
Hoarseness lasting longer than two weeks especially if you smoke Pain not from
a cold or flu Coughing up
blood Difficulty swallowing Lump in the
neck Loss or severe
change in voice lasting longer than a few days
How Are Vocal Disorders Treated?
The treatment of hoarseness depends on the cause.
Most hoarseness can be treated by simply resting the voice or
modifying how it is used. The otolaryngologist may make some
recommendations about voice use behavior, refer the patient
to other voice team members, and in some instances recommend
surgery if a lesion, such as a polyp, is identified. Avoidance
of smoking or exposure to secondhand smoke (passive smoking)
is recommended to all patients. Drinking fluids and possibly
using medications to thin the mucus are also helpful.
Specialists in speech/language pathology (voice
therapists) are trained to assist patients in behavior modification
that may help eliminate some voice disorders. Patients who have
developed bad habits, such as smoking or overuse of their voice
by yelling and screaming, benefit most from this conservative
approach. The speech/language pathologist may teach patients
to alter their method of speech production to improve the sound
of the voice and to resolve problems, such as vocal nodules.
When a patients' problem is specifically related to singing,
a singing teacher may help improve the patients' singing techniques.
What can I Do to Prevent and Treat
Hoarseness?
If you smoke,
quit. Avoid agents
that dehydrate the body, such as alcohol and caffeine. Avoid secondhand
smoke. Drink plenty
of water. Humidify your
home. Watch your diet–avoid
spicy foods. Try not to use
your voice too long or too loudly. Use a microphone
if possible in situations where you need to project your voice.
Seek professional
voice training. Avoid speaking
or singing when your voice is injured or hoarse. Avoid speaking
or singing when your voice is injured or hoarse.
Voice problems usually are associated with hoarseness
(also known as roughness), instability, or problems with voice
endurance. If you are unsure if you have an unhealthy
voice, ask yourself the following:
Has your voice become hoarse or raspy?
Does your throat often feel raw, achy or strained?
Has it become an effort to talk?
Do you repeatedly clear your throat?
Do people regularly ask you if you have a cold when in fact
you do not?
Have you lost your ability to hit some high notes when singing?
Voice problems arise from a variety of sources
including voice overuse or misuse, cancer, infection, or injury.
Here are steps that can be taken to prevent voice problems and
maintain a healthy voice:
Drink water (stay well hydrated):
Keeping your body well hydrated by drinking plenty of water
each day (6-8 glasses) is essential to maintaining a healthy
voice. The vocal cords vibrate extremely fast even with the
most simple sound production; remaining hydrated through water
consumption optimizes the throat’s mucous production, aiding
vocal cord lubrication. To maintain sufficient hydration avoid
or moderate substances that cause dehydration. These include
alcohol and caffeinated beverages (coffee, tea, soda). And always
increase hydration when exercising.
Do not smoke:
It is well known that smoking leads to lung or throat cancer.
Primary and secondhand smoke that is breathed in passes by the
vocal cords causing significant irritation and swelling of the
vocal cords. This will permanently change voice quality, nature,
and capabilities.
Do not abuse or misuse your voice: Your voice
is not indestructible. In every day communication, be sure to
avoid habitual yelling, screaming, or cheering. Try not to talk
loudly in locations with significant background noise or noisy
environments. Be aware of your background noise—when it becomes
noisy, significant increases in voice volume occur naturally,
causing harm to your voice. If you feel like your throat is
dry, tired, or your voice is becoming hoarse, stop talking.
To reduce or minimize voice abuse or misuse
use non-vocal or visual cues to attract attention, especially
with children. Obtain a vocal amplification system if you routinely
need to use a “loud” voice especially in an outdoor setting.
Try not to speak in an unnatural pitch. Adopting an extremely
low pitch or high pitch can cause an injury to the vocal cords
with subsequent hoarseness and a variety of problems.
Minimize throat clearing: Clearing
your throat can be compared to slapping or slamming the vocal
cords together. Consequently, excessive throat clearing can
cause vocal cord injury and subsequent hoarseness. An alternative
to voice clearing is taking a small sip of water or simply swallowing
to clear the secretions from the throat and alleviate the need
for throat clearing or coughing. The most common reason for
excessive throat clearing is an unrecognized medical condition
causing one to clear their throat too much. Common causes of
chronic throat clearing include gastroesophageal reflux, laryngopharyngeal
reflux disease, sinus and/or allergic disease.
Moderate voice use when sick:
Reduce your vocal demands as much as possible when your voice
is hoarse due to excessive use or an upper respiratory infection
(cold). Singers should exhibit extra caution if one’s speaking
voice is hoarse because permanent and serious injury to the
vocal cords are more likely when the vocal cords are swollen
or irritated. It is important to “listen to what your voice
is telling you.”
Your voice is an extremely valuable resource
and is the most commonly used form of communication. Our voices
are invaluable for both our social interaction as well as for
most people’s occupation. Proper care and use of your voice
will give you the best chance for having a healthy voice for
your entire lifetime.
Hoarseness or roughness in your voice is often
caused by a medical problem. Contact an otolaryngologist—head
and neck surgeon if you have any sustained changes to your voice.
Most changes in the voice result from a medical
disorder. Failure to seek a physician’s care can lead to hoarseness
and more serious problems. They include:
Laryngitis
Laryngitis is a swelling of the vocal cords
usually due to an infection. A viral infection (a “cold”) of
the upper respiratory track is the most common cause for infection
of the voice box. When the vocal cords swell in size, they vibrate
differently, leading to hoarseness. The best treatment for this
condition is to rest or reduce your voice use and stay well
hydrated. Since most of these infections are caused by a virus,
antibiotics are not effective. It is important to be cautious
with your voice during an episode of laryngitis, because the
swelling of the vocal cords increases the risk for serious injury
such as blood in the vocal cords or formation of vocal cord
nodules, polyp, or cysts.
Vocal cord lesions
Benign noncancerous growths on the vocal cords
are caused by voice misuse or overuse and from trauma or injury
to the vocal cords. These lesions (“bumps”) on the vocal cord(s)
alter vocal cord vibration. This abnormal vibration results
in hoarseness and a chronic change in one’s voice quality, including
roughness, raspiness, and an increased effort to talk. The most
common vocal cord lesions include vocal nodules also known as
“singer’s nodes” or “nodes” which are similar to “calluses ”
of the vocal cords. They typically occur on both vocal cords
opposite each other. These lesions are usually treated with
voice rest and speech therapy (to improve the speaking technique
thus removing the trauma on the vocal cords). Vocal cord polyp(s)
or cyst(s) are other common vocal cord lesions caused by misuse,
overuse, or trauma to the vocal cords and frequently require
surgical removal after all nonsurgical treatment options (i.e.,
speech therapy) have failed.
Gastroesophageal reflux disease and
laryngopharyngeal reflux disease
Reflux (backflow of gastric contents) into the
throat of stomach acid can cause a variety of symptoms in the
esophagus (swallowing tube) as well as in the throat. Hoarseness
(chronic or intermittent), swallowing problems, a foreign body
sensation, or throat pain are common symptoms of gastric acid
irritation of the throat, called laryngopharyngeal reflux disease
(LPRD). LPRD is difficult to diagnose because approximately
half of the patients with this disorder have no heartburn symptoms
which traditionally accompany gastroesophageal reflux disease
(GERD).
Your gastric acid can flow up to the throat
at any time. The at-night aspect of LPRD is thought to be the
hardest to diagnose because there are usually no specific symptoms
while the reflux occurs. Consequently, patients will awake with
throat irritation, hoarseness, and throat discomfort without
knowing the cause. An examination of the throat by an otolaryngologist
will determine if stomach acid is causing irritation of the
throat and voice box.
Poor speaking technique
Improper or poor speaking technique is caused
from speaking at an abnormally or uncomfortable pitch, either
too high or too low, and leads to hoarseness and a variety of
other voice problems. Examples of this condition are when young
adult females, in a work environment, consciously or subconsciously
choose to speak at a lower than appropriate pitch and with a
heavy voice. Percussive speaking, a voice too loud or focusing
on the first syllable of each word, is another improper speaking
technique that may result in injury or trauma to the vocal cords
and muscles causing “vocal fatigue”.
Other factors leading to improper speaking technique
include insufficient or improper breathing while talking, specifically
breathing from the shoulders or neck area instead of from the
lower chest or abdominal area. The consequence of this practice
is increased tension in the throat and neck muscles, which can
cause hoarseness and a variety of symptoms, especially pain
and fatigue associated with talking. Voice problems can also
occur from using your voice in an unnatural position, such as
talking on the phone cradled to your shoulder. This requires
excessive tension in the neck and laryngeal muscles, which changes
the speaking technique and may result in a voice problem.
Vocal cord paralysis
Hoarseness and other problems can occur related
to problems between the nerves and muscles within the voice
box or larynx. The most common condition is a paralysis or weakness
of one or both vocal cords. Involvement of both vocal cords
is rare and is usually manifested by noisy breathing or difficulty
getting enough air while breathing or talking. However, one
vocal cord can become paralyzed or severely weakened (paresis)
after a viral infection of the throat, after surgery in the
neck or cheek, or for unknown reasons.
The immobile or paralyzed vocal cord typically
causes a soft, breathy, weak voice due to poor vocal cord closure.
Most paralyzed vocal cords will recover on their own within
several months. There is a possibility that the paralysis may
become permanent, which may require surgical treatment. Surgery
for unilateral vocal cord paralysis involves positioning of
the vocal cord to improve the vibration of the paralyzed vocal
cord with the non-paralyzed vocal cord. There are a variety
of surgical techniques used to reposition the vocal cord. Sometimes
speech therapy may be used before or after surgical treatment
of the paralyzed vocal cords or sometimes as the sole treatment.
Treatment choices depend on the nature of the vocal cord paralysis
as well as the patient’s voice demands.
Throat cancer
Throat cancer is a very serious condition requiring
immediate medical attention. When cancer attacks the vocal cords,
the voice changes in quality, assuming the characteristics of
chronic hoarseness, roughness, or raspiness. These symptoms
occur at an early stage in the development of the cancer. It
is important to remember that prompt attention to changes in
the voice facilitate early diagnosis thus early and successful
treatment of vocal cord cancer can be obtained.
Persistent hoarseness or change in the voice
for longer than two to four weeks in a smoker should prompt
evaluation by an otolaryngologist to determine if there is cancer
of the larynx (voice box). Different treatment options for this
cancer of the voice box include surgery, radiation therapy,
and/or chemotherapy. When vocal cord cancer is found early,
typically only surgery or radiation therapy is required, and
the cure rate is high (greater than 90 percent).
Hoarseness or roughness in your voice is often
caused by a medical problem. Contact an otolaryngologist—head
and neck surgeon if you have any sustained changes to your voice.
Difficulty in swallowing (dysphagia) 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. Difficulties
in swallowing rarely represent a more serious disease, such
as a tumor or a progressive neurological disorder. When the
difficulty does not clear up by itself in a short period of
time, you should see an otolaryngologist-head and neck surgeon.
How you swallow
People normally swallow hundreds of times a
day to eat solids, drink liquids, and swallow the normal saliva
and mucus that the body produces. The process of swallowing
has four stages:
1. The first is oral preparation, where food
or liquid is manipulated and chewed in
preparation for swallowing.
2. During the oral stage, the tongue propels the food or liquid
to the back of the mouth, starting the swallowing response.
3. The pharyngeal stage begins as food or liquid is quickly
passed through the pharynx, the canal that connects the mouth
with the esophagus, into the esophagus or swallowing tube.
4. In the final, esophageal stage, the food or liquid passes
through the esophagus into the stomach. Although the first and
second stages have some voluntary control, stages three and
four occur by themselves, without conscious input.
Although the first and second stages have some voluntary control,
stages three and four occur by themselves, without conscious
input.
What causes swallowing disorders?
Any interruption in the swallowing process can
cause difficulties. It 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. This
occurs when stomach acid moves up the esophagus to the pharynx,
causing discomfort. Other causes may include: stroke; progressive
neurologic disorder; the presence of a tracheostomy tube; a
paralyzed or unmoving vocal cord; a tumor in the mouth, throat,
or esophagus; or surgery in the head, neck, or esophageal areas.
Symptoms
Symptoms of swallowing disorders may
include:
drooling; a feeling that
food or liquid is sticking in the throat; discomfort in
the throat or chest (when gastroesophageal reflux is present);
a sensation
of a foreign body or "lump" in the throat; weight loss
and inadequate nutrition due to prolonged or more significant
problems with swallowing; and coughing or
choking caused by bits of food, liquid, or saliva not passing
easily during swallowing, and being sucked into the lungs.
Who evaluates and treats swallowing disorders?
When dysphagia is persistent and the cause is
not apparent, the otolaryngologist-head and neck surgeon will
discuss the history of your problem and examine your mouth and
throat. This may be done with the aid of mirrors or a small
tube (flexible laryngoscope), which provides vision of the back
of the tongue, throat, and larynx (voice box). If necessary,
an examination of the esophagus, stomach, and upper small intestine
(duodenum) may be carried out by the otolaryngologist or a gastroenterologist.
These specialists may recommend X-rays of the swallowing mechanism,
called a barium swallow or upper G-I, which is done by a radiologist.
If special problems exist, a speech pathologist
may consult with the radiologist regarding a modified barium
swallow or videofluroscopy. These help to identify all four
stages of the swallowing process. Using different consistencies
of food and liquid, and having the patient swallow in various
positions, a speech pathologist will test the ability to swallow.
An exam by a neurologist may be necessary if the swallowing
disorder stems from the nervous system, perhaps due to stroke
or other neurologic disorders.
Possible Treatments
Many of these disorders can be treated with
medication. Drugs that slow stomach acid production, muscle
relaxants, and antacids are a few of the many medicines available.
Treatment is tailored to the particular cause of the swallowing
disorder.
Gastroesophageal reflux can
often be treated by changing eating and living habits - for
example:
eat a bland diet with smaller, more frequent meals; eliminate alcohol
and caffeine; reduce weight
and stress; avoid food within
three hours of bedtime; and elevate the
head of the bed at night.
If these don't help, antacids between meals and at bedtime may
provide relief.
Many swallowing disorders may be helped by direct
swallowing therapy. A speech pathologist can provide special
exercises for coordinating the swallowing muscles or restimulating
the nerves that trigger the swallow reflex. Patients may also
be taught simple ways to place food in the mouth or position
the body and head to help the swallow occur successfully.
Some patients with swallowing disorders have
difficulty feeding themselves. An occupational therapist can
aid the patient and family in feeding techniques. These techniques
make the patient as independent as possible. A dietician or
nutritional expert can determine the amount of food or liquid
necessary to sustain an individual and whether supplements are
necessary.
Once the cause is determined, swallowing disorders
may be treated with:
medication swallowing therapy
surgery
Surgery is used to treat certain problems. If a narrowing or
stricture exists, the area may need to be stretched or dilated.
If a muscle is too tight, it may need to be dilated or released
surgically. This procedure is called a myotomy and is performed
by an otolaryngologist-head and neck surgeon.
Many causes contribute to swallowing disorders.
If you have a persistent problem swallowing, see an otolaryngologist-head
and neck surgeon.
“Voice” is the sound made by vibration of the
vocal cords caused by air passing out through the larynx bringing
the cords closer together. Your voice is an extremely valuable
resource and is the most commonly used form of communication.
Our voice is invaluable for both our social interaction as well
as for most people’s occupation. Proper care and use of your
voice improves the likelihood of having a healthy voice for
your entire lifetime.
How do I know if I have a voice problem?
Voice problems occur with a change in the voice,
often described as hoarseness, roughness, or a raspy quality.
People with voice problems often complain about or notice changes
in pitch, loss of voice, loss of endurance, and sometimes a
sharp or dull pain associated with voice use. Other voice problems
may accompany a change in singing ability that is most notable
in the upper singing range. A more serious problem is indicated
by spitting up blood or when blood is present in the mucus.
These require prompt attention by an otolaryngologist
What is the most common cause of a change
in your voice?
Voice changes sometimes follow an upper respiratory
infection lasting up to two weeks. Typically the upper respiratory
infection or cold causes swelling of the vocal cords and changes
their vibration resulting in an abnormal voice. Reduced voice
use (voice rest) typically improves the voice after an upper
respiratory infection, cold, or bronchitis. If voice does not
return to its normal characteristics and capabilities within
two to four weeks after a cold, a medical evaluation by an ear,
nose, and throat specialist is recommended. A throat examination
after a change in the voice lasting longer than one month is
especially important for smokers. (Note: A change in voice is
one of the first and most important symptoms of throat cancer.
Early detection significantly increases the effectiveness of
treatment.)
Six tips to identify voice problems
Ask yourself the following questions
to determine if you have an unhealthy voice:
Has your voice become hoarse or raspy?
Does your throat often feel raw, achy, or strained?
Does talking require more effort?
Do you find yourself repeatedly clearing your throat?
Do people regularly ask you if you have a cold when in fact
you do not?
Have you lost your ability to hit some high notes when singing?
A wide range of problems can lead to changes
in your voice. Seek out a physician’s care when voice problems
persist.
Ear Nose &
Throat
Find answers to questions you may have
about common Ear, Nose and Throat ailments. read
more Allergy Information
Learn about indoor, outdoor allergies
and other helpful allergy advice here. read
more
Environmental
Control Allergies out of control?
Visit here to learn how to control your environment and beat
the allergy out of your home!
Air Quality Index Ozone is a
gas that is formed in the atmosphere when three atoms
of oxygen combine. Naturally occurring ozone is found
high in the stratosphere surrounding the earth and
in ground-level ambient air. read
more
Daily Pollen Count Here you will
find the daily pollen count and other helpful allergy
information for the Dallas Fort Worth Texas metroplex
area. read
more
972-394-4405 (fax)
Medical history 
throat.
In the first two to three years of childhood, these tissues
"catch" infections, sampling the child's environment
to help develop his immunities (antibodies). Healthy tonsils
do not remain infected. Frequent sore throats from tonsillitis
suggest the infection is not fully eliminated between episodes.
A medical study has shown that children who suffer from frequent
episodes of tonsillitis (such as three- to four- times each
year for several years) were healthier after their tonsils were
surgically removed.
in
preparation for swallowing. 
Pollen Count Archives
