Sorethroat

Sorethroat

Sore throat is one of the most common symptoms seen by an ENT surgeon. There are many causes of sore throat including infection, allergy and reflux disease. Generally, it is important to distinguish between sore throat with fever and sore throat without fever.

Sorethroat with fever is most commonly due to infection. Tonsillitis is caused by a bacterial infection of the tonsils (see Tonsillitis under Tonsils and Adenoids). It can also be due to a viral pharyngitis or laryngitis. This kind of sorethroat usually last one to two weeks and patients usually feel sufficiently ill to take time off school or work.

The causes of sorethroat without fever include postnasal drip, reflux of gastric acid secretions. Nasal secretions from allergy or sinus infection can trickle into the throat and cause irritation and pain. Gastric acid secretions can track up the esophagus and irritate the throat. Patients may also complain of a sour or bitter taste in the mouth and frequent hoarseness.

Treatment is targeted at the root cause of the problem. Antibiotics generally do not help unless a bacterial infection is the cause.

Hoarseness

Hoarseness refers to a change in quality of voice. Patients suffering from this problem have described it as rough, husky, squeaky, weak and breathy among others. The changes in sound quality usually result from conditions affecting vocal cords which is the sound producing part of the voice box. While breathing, the vocal cords stay apart but come together when phonation starts. Any condition that interrupts the smooth apposition of the vocal cords during this time leads to hoarseness.

Causes of Hoarseness include:

  1. Acute Infections – the commonest cause of hoarseness is a viral or bacterial infection of the larynx. This usually follows an upper respiratory tract infection made worse by shouting or excessive talking. Fortunately, the condition is self-limiting and supportive treatment is all that is required.
  2. Voice Abuse/ Overuse – excessive or improper use of the voice box can lead to prolonged hoarseness. Vocal cord nodules (Figure 1) form as a result of repeated trauma of the vocal cords from excessive voice use. As the nodules enlarge, more force is required to generate speech and this in turn results in worsening of the nodules. Vocal cord polyps are singular swellings on one vocal cord and usually results from a sudden shout.
  1. Smoking – smoking is another cause of hoarseness and is related to laryngeal cancer. All smokers who are hoarse should have an examination of their voice box.
  2. Smoking – smoking is another cause of hoarseness and is related to laryngeal cancer. All smokers who are hoarse should have an examination of their voice box.
  3. Functional Dysphonia – hoarseness without any obvious pathology is usually due to poor functioning of the larynx as a whole. This involves the movement and coordination of the laryngeal muscles.
  4. Others – many unusual causes of hoarseness include allergies, hormonal changes, neurological disorder and trauma.

When should I see an ENT specialist?

Patients should seek an ENT specialist opinion and assessment when

  1. hoarseness lasts more than 3 weeks. This is especially so in smokers.
  2. hoarseness is associated with
    1. blood-stained phlegm
    2. neck lump
    3. difficulty swallowing
    4. pain

Treatment

The management depends on the cause. Treatment options usually involve medical therapy for infections, reflux disease and allergies. Surgery may be necessary for nodules and polyps. Speech therapy is usually an important part of treatment in chronic hoarseness.

Globus Syndrome/ Sensation (Lump in the throat sensation)

Some patients experience a sensation of something stuck in the throat, a lump in the throat feeling, a blockage in the throat. Some patients even feel a difficulty breathing and a shortness of breath. However, examination of the throat with a nasopharyngoscope reveals a clear throat and no obvious mass or growth.

The cause is unknown but many theories have been put forward. This include

  1. Cricopharyngeal spasm – the cricopharyngeus muscle found at the top end of the esophagus and goes into spasm when there is failure of relaxation of swallowing muscles or premature closure during swallowing.
  2. Reflux Esophagitis – escape of gastric acid juices can track up the esophagus and irritate the throat causing the sensation. It can also cause cricopharyngeal spasm.
  3. Postnasal Drip – allergy resulting in excessive mucous production from the postnasal space can track down into the throat can cause globus sensation.
  4. Psychological – there is some degree of anxiety associated with this condition and patients present with a worry of a growth in the throat.

Diagnosis

The first and important step is to obtain an accurate history and perform a full examination to exclude significant disease such as tumor, neurological conditions. The diagnosis of Globus syndrome is dependent on 3 criteria:

  1. A sensation of something stuck in the throat, whether in the midline or one side of the throat.
  2. No true dysphagia (difficulty swallowing) with solids or liquids.
  3. No physical signs.

Treatment

Patients with symptoms of reflux disease should be treated with anti-reflux medications. Investigations such as barium swallow, rigid esphagoscopy under general anaesthesia will help exclude oropharyngeal and hypopharyngeal disease. Counseling and reassurance is an important part of treatment once exclusion of pathology is confirmed.