Throat

The throat is an area of constant activity. Food and liquids that are swallowed must cross to the back of the throat to reach the esophagus which goes down to the stomach without dropping down the windpipe. At the same time when we breathe the air must get into the windpipe without bringing any food or liquid down into the lungs with it. This is also where the sound of the voice is produced. Some common problems of the throat are discussed on the following pages.

Chronic Cough or Throat Clearing

Coughing is usually triggered by irritation to the nerves that control the movement of the vocal cords which are branches of the Vagus Nerve, a very long nerve in the body. Coughing is primarily a protective mechanism to prevent things other than air from entering the lungs. Coughing can also be triggered by allergic irritation, post nasal drip, and chronic vocal cord irritation from numerous causes including smoking, infection, acid reflux. Chronic cough can also be a symptom of asthma. It can be due to a problem in the lungs including cancer in rare cases.

To evaluate chronic cough a detailed history including duration, consistency, improving/exacerbating factors, previous treatment, and other general questions is essential. The evaluation of this problem includes a simple in-office procedure called Flexible Fiberoptic Laryngoscopy which allows direct assessment of the vocal cords and the opening to the esophagus.

It is important to examine the vocal cords directly for signs of irritation or potential causes of irritation. Additional tests may be ordered including x-rays or CT scans. Treatment is recommended based on the complete evaluation.

Difficulty Swallowing

There are numerous potential causes of difficulty swallowing and/or chronic cough. These include neurological conditions of the throat and esophagus, functional disorders of the throat or esophagus, vocal cord paralysis or weakness, problems that affect the opening of the upper esophageal sphincter (muscle ring), acid reflux. and cancer.

A detailed history of duration, character, alleviating/exacerbating factors, previous treatments, weight loss, etc. is essential for swallowing difficulties. The evaluation of this problem includes a simple in-office procedure called Flexible Fiberoptic Laryngoscopy which allows direct assessment of the vocal cords and the opening to the esophagus.

In some cases additional tests may be ordered including swallowing xrays and video fluoroscopy or CT scans.

A common cause of 'difficulty swallowing', or a 'lump in the throat', sometimes called a 'hair ball' is Laryngo-Pharyngeal Reflux' (LPR). We only began to understand this condition in the early 1990's. While it is similar in some respects to Gastro-Esophageal Reflux (GERD), there are people who have LPR who never have heartburn. Severe LPR can also cause chronic coughing, chronic hoarseness, and contribute to asthma. Only an Ear Nose and Throat specialist can diagnose and treat this condition.

Hoarseness or Loss of the Voice

Hoarseness ranges from a subtle change in vocal quality to a complete loss of the voice. This can be intermittent ('my voice comes and goes'), or it can be continuous ('I am always hoarse'). It may be accompanied by pain, but usually is not.

To evaluate hoarseness a detailed history is taken. This includes assessing the pattern of hoarseness (mornings or evenings), assessing occupational and recreational vocal activities (telephone operator, waitress, soccer coach), and asking other questions to identify how the voice is used in order to identify other potential causes of injury.

To evaluate hoarseness a detailed history of duration, character, alleviating/exacerbating factors, previous treatments, weight loss, etc. is essential for hoarseness. The evaluation of this problem includes a simple in-office procedure called Flexible Fiberoptic Laryngoscopy which allows direct assessment of the vocal cords and the opening to the esophagus.

To evaluate hoarseness it is essential to directly visualize the vocal cords to identify any signs or sources of irritation; this includes nodules, polyps, or tumors. Vocal cord mobility is also closely inspected.. Additional tests may be ordered including CT scans. Treatment recommendations are based on the findings of the complete evaluation and may include medications, dietary modifications, voice therapy or training. In some cases where there is a growth, surgical biopsy and removal is indicated.

Sore Throat

Sore throats are a common occurrence for both adults and children. They come to the attention of an ear, nose and throat specialist when they don't clear up with initial treatment or they recur despite medical treatment.

One of the most common causes of sore throats in children and adults is infection of the tonsils. When this is a chronic or recurring problem, the treatment is removal of the tonsils. In the past, tonsils were removed when they were large. Today we remove tonsils only if they are causing a problem. The main types of problems that tonsils can cause are frequent infections, difficulty swallowing, and difficulty breathing.

While this is a common problem in children studies have shown that adults who have tonsils removed for recurring infections take fewer sick days and less medications.

Other causes of sore throat include chronic acid reflux, chronic post nasal drip, viral or bacterial infection of the pharynx when the tonsils have been removed, glossopharyngeal neuralgia (an inflammation of the nerves), or in rare cases cancer. Each of these have a specific evaluation which is begun after common tonsillitis has been ruled out as a cause.