Throat / Mouth

A. Tonsil and adenoid enlargement or infection

iStock_000023931445_MediumCauses:

Tonsils and adenoid enlargements in children may have intrinsic, unknown or infective origins.

Importance:

Adenoid and tonsil enlargement may result in blocked breathing passages, and snoring, which may be associated with reduced oxygen delivery to the brain and vital organs. It is more common in children between 2-10 years of age. Long term, it may contribute to reduced attention span and learning, poor growth and weight control, reduced mandibular growth and poor dentition. Recurrent tonsillitis could be associated with sore throats, fevers, poor feeding, antibiotic resistance and absence from school/ work. Adenoid hypertrophy and adenoiditis may also predispose to chronic glue ears.

Photo 33 adenoid xrayInvestigations offered:

Examination in the clinic may include flexible nose endoscopy. X-ray may be needed for children who are unable to cooperate. 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.

 

B.  Unclear speech

Causes:

Can be due to tongue tie, oromotor poor coordination, wrong learning of speech, very large tonsils, cleft palate, submucous cleft, soft palate insufficiency/ weakness, disproportionate craniofacial structures, poor lateral pharyngeal wall tone, neurological disorders.

Investigations offered:

  • Examination of oral cavity with good headlight
  • Flexible nasoendoscopy with patient speaking
  • Work with a speech therapist/paediatrician/ plastic surgeon/ dental colleagues for multidisciplinary evaluation

Treatment offered:

  • Tongue tie release if severe
  • Speech therapy
  • Repair of submucous cleft, tonsillectomy, pharyngeal flap, sphincteroplasty as needed

 

C.  Gastric acid reflux into larynx

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. Mild cases are sometimes common in children before the age of 1 year old. In more complex laryngeal and tracheal airway anomalies, often an associated condition worsening the airway pathology. Obesity, coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen. 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. It also worsens airway swelling in larynx and pharynx in young children. Children may have recurrent vomiting, crying, irritability and food refusals at meal times, with poor weight gain.

Investigations:

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

Treatment:

  • Avoid feeding lying down or near bed time
  • Dietary and lifestyle modification: reduce weight, smoking, chocolate, peppermint, fried/ fatty foods, coffee and alcohol
  • Medication for reflux
  • Surgery if the hiatal hernia is strangulated or there is severe reflux