Monday, November 29, 2021

Throat maladies needing ENT intervention

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Respiratory tract infections extending to throat aches, pains and sore throats are common, but an ENT visit  is not needed many of the  times as  the cases are self-limiting. However, sore throats which are persistent and recurring multiple times can indicate a chronic condition which needs medical attention. In addition, symptoms such as a scratchy sensation, hoarseness and burning when swallowing may need a visit to a specialist.

Dr. Annabelle Leong is an experienced ENT surgeon who has over 18 years of experience. She treats both adult and paediatric ENT maladies at the ENT Clinic in Singapore. Here are some of the most common throat conditions which need intervention by specialist:

Foreign Objects in the Throat

A foreign object can be described as something which gets stuck in the throat, causing difficulty in breathing, swallowing or both. This foreign object which is accidentally ingested may lodge behind the tongue or in the oesophagus or at times in the windpipe or trachea. In Singapore, the ingestion of fish bones are more common among adults, especially individuals who consume fish soups. When fish bones get stuck it can cause a lot of pain and discomfort. Common places where it can get stuck include the tonsils and tongue base. The issue with fish bone removal is that it gets embedded deeply making it difficult to remove as one whole piece. At times the fish bones can even pierce the inner lining of the throat causing a perforation. This needs immediate attention as such perforations can lead to infections which can spread to the lungs causing complications. In children too, it is not uncommon to have instances where foreign objects such as coins, toys are ingested.  The diagnosis of such foreign bodies are done through a thorough examination of the head and neck. The ENT doctor would perform a laryngoscopy to identify the position of the foreign body. This procedure is performed in the operating room while the patient is asleep. It might even be necessary to have imaging tests such as an X-ray or a CT scan performed to locate the object facilitating its safe removal.

Persistent Sore Throats

Having a sore throat is not unusual, especially following a viral pharyngitis. Most of these sore throats generally resolve on their own. At times though, you would have to visit an ENT doctor especially if the sore throat is due to a bacterial infection where one would need antibiotic treatment. In addition, there could be other factors which trigger an individual to have a persistent sore throat. These include allergies. An allergy can occur when the immune system is hyperreactive to the normal harmless substances called allergens. Pollen, dust and foods are common allergens. When there is an allergy, the other observed symptoms apart from a sore throat include a runny nose and eyes, sneezing.

Apart from allergies, an acid reflux too can lead to a sore throat. Individuals who have persistent acid reflux often have persistent soreness in the throat too. An acid reflux which is generally called a heart burn, occurs when the lower esophageal sphincter is not able to close tightly. This causes the contents from the stomach to flow back into the oesophagus. With time, this acid can erode the oesophagus lining and that of the throat.

Tonsillitis

Throat pain and discomfort are present during tonsillitis. Tonsillitis occurs due to an infection in the tonsils and although it can occur at any age, it is more commonly diagnosed in children. Tonsillitis can be due to a viral or a bacterial infection.  Recurrent tonsillitis can greatly decrease the work productivity and it can lead to severe throat pain, stiff neck, neck tenderness and difficulty in swallowing.

Tonsil Abscess

A peritonsillar abscess causes a severe sore throat and it is due to a serious bacterial infection. This condition can occur when there is delayed treatment for tonsillitis, which causes pus filled pockets to form near one of the tonsils. This can lead to infection breaking out of the tonsils spreading it to the neighbouring tissues. On physical evaluation, the abscess which is present at the back of the throat may be visible. There could also be cases where it is hidden behind the tonsils. Symptoms of a tonsil abscess is more painful than tonsillitis and it includes a sore throat which causes more pain on one side, swelling, red and painful glands, ear pain, difficulty in opening of the mouth and swallowing.

Hoarseness in Voice

Hoarseness in voice or dysphonia is when the voice of a person becomes raspy or strained. The volume of the voice, as well as the pitch, can vary. This abnormal change in an individual’s voice is due to issues with the vocal chords or the larynx. Sound is produced when the vocal cords come together and vibrate in a special wave.  The reasons for hoarseness in voice can vary. Generally, it is due to an upper respiratory tract infection, which can fade, but on rare occasions, it could indicate something serious as well.

If there is a lump or a swelling in the vocal cords, then the pitch and volume of the voice can change. These swellings are usually vocal nodules which form bumps on the vocal cords and they are not cancerous. Professional singers go through this normally due to having a strained voice. Vocal nodules can cause the voice to crack or may cause one to sound raspy or hoarse. Apart from this, other factors which can lead to hoarseness in voice includes, acute laryngitis, acid reflux, smoking, neurological disorders.  In rare cases, it may be due to cancer in the voice box. It is important to have hoarseness in voice evaluated especially if it is lasting for more than three weeks

Persistent Cough

There could be dozens of conditions which can bring about a recurrent and lingering cough. The most common conditions are generally due to a postnasal drip, asthma, gastroesophageal reflux disease or a chronic bronchitis. If you are coughing repeatedly for more than two weeks then it is advisable to have an evaluation both by a chest physician and an ENT specialist. To evaluate the causes, the ENT doctor would perform imaging techniques such as an X-ray or a CT scan. If there is no apparent cause in the lower airways and lungs for the chronic cough, then a naso-endoscopy is performed to examine the voice box and throat. A persistent cough may even be due to a heavy flu too. However, it may be due to a postnasal drip caused by an allergy too which is irritating the voice box leading to a chronic cough. Acid reflux is another condition which causes chronic cough.

Thus, throat maladies can come in different forms. Dr. Annabelle as a trained throat specialist is well versed in evidenced based medicine and has up-to-date knowledge on the latest techniques and diagnosis methods used in ENT. She should be among your best choices as a throat specialist for your next ENT appointment.

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