Hoarseness:

Hoarseness is a very common symptom and refers to any change in your normal voice. Hoarseness may occur with many respiratory conditions. More often than not, it does not represent a serious problem.

Any hoarseness that persists for more than two weeks, especially in individuals who are smokers or heavy alcohol drinkers should be evaluated.  Sometimes hoarseness may be a sign of cancer.  Please contact us for an appointment if you have persistent hoarseness.

Causes:

Acute Laryngitis:

This is the most common cause of hoarseness, and may occur as a result of the common cold or other respiratory infections, or from vocal strain.

Acid Reflux Disease:

This is a very common problem affecting as much as 60 percent of the population occasionally, and twenty to thirty percent chronically. When reflux comes up into the throat it creates irritation and inflammation that can cause many symptoms including hoarseness.

Vocal Abuse, Misuse, or Overuse:

Injury to the vocal cords can result from excessive or overuse of your voice. Examples are:

• Shouting and screaming
• Having to project your voice or speaking in noisy situations
• Overuse or misuse from performances
• Using inappropriate pitch (too high or too low) when speaking

Vocal cord nodules and polyps

Vocal hemorrhage

Smoking

Chronic throat clearing

Chronic cough

Use of inhalers such as those for asthma and COPD

Neurologic diseases

Thyroid disease:

Underactive thyroid can cause problems with the voice. Tumors and cancers of the thyroid can cause hoarseness by affecting the nerves that go to the vocal cords, and by direct pressure on the larynx and the windpipe.

Diagnosis:

• Complete ear, nose, and throat examination
• Fiberoptic laryngoscopy-a tiny light tube is passed into your throat to visualize the deeper part of your throat and voice box (larynx). This painless examination takes only two to three minutes and is done in the office with topical aesthesia.
• Lab tests
• X-rays and other imaging studies

Treatment:

Treatment of hoarseness will be tailored to the diagnosis. Most frequently, little more than voice rest will be required.

Medications may be very helpful for certain patients.  Medications to reduce swelling and inflammation and medications to reduce acid production are frequently prescribed.

Sometimes a surgical biopsy may be necessary if you have a persistent swelling or abnormality in your throat or voice box (larynx).

Speech therapy is also prescribed for many patients with persistent vocal problems.

Swallowing problems

Difficulty swallowing, known as dysphagia, affects all age groups, but is most common in the elderly population. Dysphagia can occur any time you get a sore throat, and usually resolves when the throat soreness is resolved.

Swallowing is a very complicated process with three main stages that starts as soon as you put food or liquid in your mouth. Something as simple as the production of saliva is an important part of the first stage of swallowing. Lack of saliva or reduced saliva can impair swallowing. Many muscles, nerves, and multiple areas in the brain are involved in the very complex process of getting liquids and foods from our mouth into our stomach.

Many older patients develop swallowing problems during a hospitalization for other serious medical problems. These medical problems are often not the direct cause of the swallowing problem, but an indirect result of the body’s weakness caused by the medical illness.

Swallowing problems can be associated with the use of multiple medications.

Not all swallowing problems are serious, but all swallowing problems that persist for more than a few weeks should be thoroughly evaluated.

Diagnosis:

• Complete ear, nose, and throat examination.
• Modified barium swallow:  This exam is considered the “Gold Standard” to diagnose swallowing disorders especially those involving the pharyngeal stage of swallowing. This is an x-ray study where you are asked to swallow multiple consistencies of liquid and food mixed with barium. The test is usually administered by a speech pathologist in a hospital or radiology center.
• Fiberoptic laryngoscopy:  This exam will permit us to examine your entire throat.
• Flexible Endoscopic Evaluation of Swallowing (FEES): This exam will permit us to look into your throat as you swallow multiple consistencies of liquid and food.
• Upper endoscopy:  An examination of the esophagus, stomach, and duodenum.  This exam is usually performed in an endoscopy center under intravenous sedation.
• X-ray studies including chest x-rays, CT scans and MRI:  These tests may be necessary to diagnose problems in the chest and abdomen that may be the cause for swallowing problems.
• Neurological evaluation:  Many neurologic diseases can cause swallowing problems. A neurologic consultation may be necessary to make the diagnosis.

Treatment:

• Treatment of swallowing disorders will depend on the type and severity of the swallowing disorder.
• Treatment of swallowing disorders may respond to the use of medications.
• Swallowing therapy with a speech therapist can be extremely helpful.
• Surgery: In certain cases surgery may be helpful for patients with swallowing problems. Procedures to dilate or open up the throat and or esophagus may be appropriate for certain swallowing disorders.

Throat pain

The most common cause of sore throats in all age groups is the common cold caused by viruses. In children, strep throat and strep tonsillitis caused by bacteria is also quite common.

If throat pain does not resolve after five to seven days using symptomatic treatment with gargles and the use of over-the-counter pain medication.

Please contact us for an evaluation.

Causes:

• Viral infections
• Bacterial infections – pharyngitis, tonsillitis
• Fungal infection
• Allergies
• Acid reflux
• Exposure to irritants
• Epiglottitis
• Tumors

Diagnosis:

• Complete ear, nose, and throat examination
• Throat culture
• Fiberoptic laryngoscopy

Acute Tonsillitis:

Is an infection of the tonsils most often caused by a virus or bacteria. Viral tonsillitis almost always resolves without any specific treatment. When tonsillitis is caused by a bacteria, most notably, Group A Streptococcus, it is called strep throat or strep tonsillitis. These infections will almost always require the use of antibiotics.

Symptoms:

• Sore throat
• Pain in the ears and neck
• Difficulty swallowing
• Fever
• Headache
• Malaise
• Swollen red tonsils
• Swelling of the lymph nodes in the neck
• White or other coating on the tonsils
• Bad breath

Diagnosis:

• Symptoms lasting only two or three days are almost always viral.
• High fever, inability to drink liquids, significant neck swelling, severe throat pain on just one side of the throat, and impaired breathing are among the warning signs that you may have a bacterial infection. This usually requires additional treatment including antibiotics.
• Please contact us to schedule an appointment if your throat pain persists.

Treatment:

• Treatment will depend on whether the infection is viral or bacterial.
• Viral infections require symptomatic treatment with analgesics, gargles, and drinking lots of fluids.
• Treatment of bacterial infections, especially strep, will also require the use of antibiotics. Penicillin type antibiotics are most often prescribed, unless patients are penicillin allergic and other antibiotics are prescribed.
• Abscesses occasionally develop around the tonsil. These require surgical treatment.

Chronic and Recurrent Tonsillitis:

Recurrent tonsillitis is defined as multiple episodes of acute tonsillitis. Recurrent tonsillitis is most common in children. Treatment for this condition consists of the use of antibiotics, analgesics, and proper hydration.

Throat culture may be helpful to confirm the diagnosis of each episode. Documentation of fever and other symptoms and signs are important to record for each episode.

Chronic tonsillitis is most common in adolescents and adults. Symptoms include sore throat, chronic bad breath, persistently tender or swollen lymph nodes in the neck, cryptic tonsils with debris in the tonsils, and tonsil stones.

Tonsillectomy and Adenoidectomy

The indications for tonsillectomy and adenoidectomy for children have changed over the past several years. The current guidelines for pediatric tonsillectomy and adenoidectomy are as follows:
History of recurrent throat infection with a frequency of:

• At least seven episodes in the past year
• At least five episodes per year for two years
• At least three episodes per year for three years

The patient’s history should show one or more of the following:

• Temperature >38.3°C (101°F)
• Cervical adenopathy
• Tonsillar exudate
• Positive test for Group A Streptococcus
• Tonsil hypertrophy
• Sleep-disordered breathing: snoring, mouth breathing, and, or pauses in breathing