Throat Conditions

Throat conditions treated by Dr Jae Park

What is Tonsillitis?

Tonsillitis, also described as pharyngitis, refers to inflammation of the pharyngeal tonsils, which are lymph glands located in the back of the throat that are visible through the mouth.

Typically, tonsillitis happens suddenly (acute). Some patients experience recurrent acute episodes of tonsillitis, while others develop persistent (chronic) tonsillitis.

Tonsillitis is often caused by viral or bacterial infection. Antibiotics help treat bacterial tonsillitis, and have significantly reduced complications such as rheumatic fever, a noncontagious acute fever that causes inflammation, especially of the heart, blood vessels, and joints.

What are the symptoms of Tonsillitis?

Common symptoms include fever, sore throat, and swollen lymph nodes, but the type of tonsillitis determines what symptoms may occur.

Acute tonsillitis

Tonsillitis most often occurs in children, but rarely in those younger than two-years-old. Symptoms of acute tonsillitis include:

• Fever

• Sore throat

• Bad breath

• Difficulty swallowing

• Painful swallowing

• Dehydration

• Tender lymph nodes in the neck

• Mouth breathing, snoring, or sleep apnea

• Tiredness, lethargy, and malaise

• White patches, pus, and/or redness of the tonsils

A fine red rash over the body suggests that scarlet fever may be complicating a case of tonsillitis. These symptoms usually clear up in three to four days, but may last up to two weeks, even with therapy. Some patients experience recurrent acute tonsillitis in which symptoms return shortly after completing antibiotic therapy.

Chronic tonsillitis

Symptoms of chronic tonsillitis include:

• Chronic sore throat

• Bad breath

• Tonsil stones (debris that has collected on your tonsils)

• Persistently tender lymph nodes in the neck

Peritonsillar abscess

Peritonsillar abscess is a severe case of tonsillitis in which an abscess or pocket of pus develops around the tonsil. It is usually found in adolescents and adults but can occur occasionally in children. Symptoms of peritonsillar tonsillitis include:

• Fever

• Severe throat pain

• Drooling

• Difficulty opening the mouth (called trismus)

• Muffled voice quality

• One tonsil may appear larger than the other

What are the treatment options?

Viral tonsillitis usually gets better without additional treatment. Hydration and pain control are important, and hospitalization may be required in severe cases, particularly when a patient becomes dehydrated or has an airway obstruction.

Bacterial tonsillitis is usually treated with antibiotics. Common antibiotics used to treat tonsillitis include penicillins, cephalosporins, macrolides, and clindamycin.

In certain situations determined by your ENT specialist, surgery may be recommended to remove the tonsils. Typically, children who have seven episodes of tonsillitis in one year, or five episodes per year for two consecutive years, or three episodes per year for three consecutive years, are considered candidates for tonsillectomy. If a patient has a severe case of tonsillitis—peritonsillar abscess—surgery may be needed to drain the abscess around the tonsil.

What is Zenker’s diverticulum (ZD)?

A Zenker’s diverticulum (ZD) is a rare condition where an “outpouching” occurs where your throat meets your oesophagus, the swallowing pipe that leads into your stomach.

When this happens, a pouch forms and mucous, food, and/or liquid can become stuck instead of going down your oesophagus and into your stomach like normal.

What are the symptoms of ZD?

If you have a ZD, you may experience:

• Difficulty swallowing

• Regurgitating or vomiting undigested food hours after eating

• Inhaling food or saliva down your windpipe (called aspiration)

• Belching

• Noisy swallowing

• Bad breath

• Choking

• Coughing

• Hoarseness

• Feeling like something is stuck in the back of your throat

• Weight loss

• Recurrent lung infections in severe cases

What causes ZD?

ZD is most commonly caused by increased tension in the muscle at the top of your oesophagus (called the cricopharyngeus muscle), which obstructs the proper passage of food and liquids into your stomach.

What are the treatment options for ZD?

Your ENT specialist may diagnose your condition using a “barium swallow” study. This is a special type of X-ray test that helps your doctor take a closer look at the back of your mouth, throat, and oesophagus to see how you swallow food and liquid.

There are no current medications to treat ZD, so the usual treatment is surgery unless your ZD is small and doesn’t cause too much difficulty or discomfort. If your doctor recommends surgery, however, there are several options including making an incision on the neck, as opposed to a less-invasive approach through the mouth.

For open surgery, a small incision is made in the neck and the pouch is either removed or tacked upside down so that it doesn’t collect food. During this procedure the muscle below the ZD, your cricopharyngeus muscle, is cut to prevent recurrence of the ZD. Most patients stay in the hospital for a few days after surgery to recover from this procedure.

During an endoscopy or approach through the mouth to make repairs, there are no incisions on the outside of the neck. With this approach, a stapling device is used to divide the wall between the oesophagus and the ZD to make a common cavity for food and liquid to flow directly into the oesophagus without becoming stuck. Your doctor can discuss the pros and cons of each procedure and help you choose the best option for you.

What is Gastro-oesophageal reflux disease (GORD)/ Laryngopharyngeal reflux (LPR)?

Acid reflux occurs when acidic stomach contents flow back into the oesophagus, the swallowing tube that leads from the back of the throat to the stomach.

When acid repeatedly “refluxes” from the stomach into the oesophagus alone, it is known as gastro-oesophageal reflux disease (GORD). However, if the stomach acid travels up the oesophagus and spills into the throat or voice box (called the pharynx/larynx), it is known as laryngopharyngeal reflux (LPR).

While GORD and LPR can occur together, people sometimes have symptoms from GORD or LPR alone. Having symptoms twice a week or more means that GORD or LPR may be a problem that could be helped by seeing a doctor.

What are the Symptoms of GORD and LPR?

Many patients with LPR do not experience classic symptoms of heartburn related to GERD. And sometimes, adult patients may experience symptoms related to either GERD or LPR like:

• Heartburn

• Belching

• Regurgitation (a surge or rush back) of stomach contents

• Frequent throat clearing or coughing

• Excess mucus

• A bitter taste

• A sensation of burning or throat soreness

• Something “stuck” or a “lump” in the back of the throat

• Hoarseness or change in voice

• Difficulty swallowing

• Drainage down the back of the nose (post-nasal drip)

• Choking episodes (can sometimes awaken from sleep)

• Difficulty breathing, if the voice box is affected

Signs in infants and children are different from adults and may include:

• Breathing problems such as a cough, hoarseness, noisy breathing, or asthma

• Pauses in breathing (apnea) or snoring when sleeping

• Feeding difficulty (spitting up)

• Turning blue (cyanosis)

• Choking

• Apparent life-threatening event where there is arching of the back while in distress

• Trouble gaining weight or growing

What causes GORD and LPR?

GORD and LPR can result from physical causes and/or lifestyle factors. Physical causes can include weak or abnormal muscles at the lower end of the oesophagus where it meets the stomach, normally acting as a barrier for stomach contents re-entering the oesophagus. Other physical causes include hiatal hernia, abnormal oesophageal spasms, and slow stomach emptying. Changes like pregnancy and choices we all make daily can cause reflux as well. These choices include eating foods like chocolate, citrus, fatty foods, spicy foods or habits like overeating, eating late, lying down right after eating, and alcohol/tobacco use (see below).

GORD and LPR in infants and children may be related to causes mentioned above, or to growth and development issues.

What are the treatment options?

GORD and LPR are usually suspected based on symptoms, and can be further evaluated with tests such as an endoscopic examination (a tube with a camera inserted through the nose), biopsy, special X-ray exams, a 24-hour test that checks the flow and acidity of liquid from your stomach into your oesophagus, oesophageal motility testing (manometry) that measures muscle contractions in your oesophagus when you swallow, and emptying of the stomach studies. Some of these tests can be performed in an office.

Options for treatment include lifestyle and dietary modifications (see below), medications, and rarely surgery. Medications that can be prescribed include antacids, ulcer medications, proton pump inhibitors, and foam barrier medications. To be effective, these medications are usually prescribed for at least one month, and may be tapered off later after symptoms are controlled. For some patients, it can take two to three months of taking medication(s) to see effects.

Children and adults who do not improve with medical treatment may require surgical intervention. Surgical treatment includes “fundoplication,” a procedure that tightens the lower oesophageal muscle gateway (lower oesophageal sphincter, or LES). Newer techniques allow this to be done in an endoscopic or minimally invasive manner. Another surgical option uses magnetic beads to tighten the LES.

What changes can I make to prevent GORD and LPR?

For adults, you can take certain steps to reduce or prevent occurrences of GORD and LPR, including:

• Lose weight.

• Cut down or stop smoking tobacco products.

• Limit or avoid alcohol.

• Wear clothing that is looser around the waist.

• Eat three to four small meals a day, instead of two to three large ones, and eat slowly.

• Avoid eating and drinking within two to three hours of bedtime.

• Limit problem foods, such as caffeine, carbonated drinks, chocolate, peppermint, tomatoes, citrus fruits, fatty and fried foods, and/or spicy foods.