Throat / Mouth

Tonsil problems

iStock_000023931445_MediumCauses:

Tonsil enlargement in adults may have intrinsic, unknown or infective origins.

Importance:

May result in blocked breathing passages, and snoring and obstructive sleep apnea. Recurrent tonsillitis could be associated with sore throats, fevers, poor feeding, antibiotic resistance and absence from work.

Investigations:

  • Oral cavity examination
  • Flexible nose endoscopy
  • Sleep study may be required – either home or hospital based for a night

Treatment offered:

  • Watchful waiting only if episodes are isolated, mild and without significant airway obstruction.
  • Fever, pain and antibiotic medications may be required.
  • Day surgery for tonsils removal may be required for chronic airway obstruction, severe or recurrent tonsillitis. Diathermy, radiofrequency and coblation methods are available.

 

Mouth Ulcers

Causes:

The exact cause is often unknown, and aggravated by stress, trauma, acidic fruits, braces or ill-fitting dentures. Poor health conditions need to be addressed – eg poor immune system, vitamin B-12, zinc, folic acid, iron deficiency and gastrointestinal tract disease like Crohn’s disease. Some pain killers, beta-blockers and chest pain medications may predispose.

Importance:

  • Painful, can be recurrent
  • Worrying if lasting longer than 3 weeks, or if sores are unusually large and spreading

Investigations offered:

  • Blood tests to exclude systemic causes
  • Biopsy to exclude systemic disorder and cancer in some cases

Treatment offered:

  • Minor ulcers around 2-8mm diameter may take 2 weeks to heal. Major ulcers which are larger and deeper take longer and can leave scars.
  • Antimicrobial mouth rinse, a corticosteroid ointment.
  • Good dental hygiene important

 

Laryngoesophageal Reflux

Photo 34 gastric acid reflux laryngitisCauses:

The ring of muscle between the esophagus and stomach is weak or relaxes abnormally. In Laryngoesophageal reflux disease (LERD), backflow of the acid from the stomach up into the voice box and laryngeal area causes irritation, phlegm and hoarseness in the throat. Obesity, pregnancy, coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen. Many otherwise healthy people age 50 and over have a small hiatal hernia.

Importance:

LERD may not be associated with gastric pain or heartburn sensation. More often, it is just chronic throat irritation worse after meals or sleep, or hoarseness of voice that prompts an evaluation. Long term however, there is a risk of cancer change in the esophageal and laryngeal and voice box mucosa if untreated.

Investigations:

  • Nasolaryngoendoscopy in the clinic
  • 24 hour double pH probe
  • Barium swallow/ meal
  • Evaluation by gastroenterology specialist

Treatment:

  • Dietary and lifestyle modification: reduce weight, smoking, chocolate, peppermint, fried/ fatty foods, coffee and alcohol
  • Avoid late meals near sleeping time
  • Medication for reflux
  • Surgery if hiatal hernia strangulated or severe reflux