Sore Throat

We all get sore throats from time to time. Some people are troubled excessively by sore throats, sometimes a specific diagnosis can be made and there is a clear treatment, other times it is less clear-cut. Common causes of a sore throat would be: 1) viral pharyngitis 2) recurrent acute tonsillitis 3) gastro oesophageal reflux (GOR) 4) muscle tension.

1) The commonest cause of a sore throat is a self-limiting viral infection (acute pharyngitis/viral pharyngitis) usually symptomatic treatment is all that is necessary. If this becomes very frequent or prolonged, one must consider the possibility that it many be a manifestation of

2) Silent gastro oesophageal reflux. Most people commonly consider acid indigestion as being heartburn felt in the chest or stomach. It is being increasingly recognised however that acid may escape from the stomach and escape into the oesophagus (gullet) and cause a variety of symptoms including a poorly localised discomfort in the throat. The throat diagnosis will depend on history, a thorough examination including endoscopy of the throat to exclude more serious causes and often a trial of medicine designed to suppress acid formation.

3) Acute tonsillitis, this is a common condition of childhood and may follow on from an acute viral infection. It may be difficult to distinguish viral and bacterial infections of the throat and tonsils. Initially patients should be treated symptomatically with pain relief and kept well hydrated. The use of antibiotics is controversial in some cases of acute bacterial tonsillitis the effective antibiotics may be to shorten the period of ill health however there are many studies that have looked at this issue and have shown that the effect is at best marginal and increasingly there is pressure not to prescribe antibiotics unless absolutely necessary.

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Your GP may have strong views on the subject; most of these conditions are dealt with by a General Practitioner rather than an ENT specialist. If despite management by your General Practitioner the patient seems to suffer repeated attacks and is loosing a lot of time off school/work then the benefits of removing the tonsils (tonsillectomy) may out weigh the disadvantages.

4) Muscle tension – chronic sore throats may be the result of muscle tension, either due to poor position or associated with voice abuse.

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Hoarse voice

Commonly a hoarse voice is associated with a simple acute laryngitis, again a viral infection like pharyngitis, which is often uncomfortable but short lived, and self-limiting. A hoarse voice in an adult smoker raises the possibility that this may be due to a cancer of the voice box and any adult smoker over the age of 40 who has a hoarse voice, which persists for more than six weeks, must seek urgent medical attention. A hoarse voice which is not due to a cancer may well be due to straining the voice box, this occurs often in singers, teachers, actors or anybody who has to project or use their voice a lot. Anybody who smokes is also liable to irritate the larynx and gastro oesophageal reflux may also present as a hoarse.

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Voice

Neck Lumps

The complaint of a “sensation” of a lump in the throat is very common. Lumps in the neck, which are visible to an outside observer, are less common. The perception of a lump in the neck or throat, often described, as a “frog in the throat” is often worrying but fortunately rarely due to a serious disease. Patients often feel at the base of the neck that there is something there and they have to continually clear their throat. Sometimes the voice is slightly affected. If the complaint is long standing and there is no change in diet or weight, it is extremely unlikely that there is a sinister cause. Weight loss and the need to eat finely chopped food is however a sinister symptom and anybody with such complaints should seek urgent medical attention. A complaint of a lump in the neck, which is visible externally, should always be taken seriously. There are many causes for this as they’re many organs within the head and neck, which can produce disease. An ENT surgeon is trained to consider what the likely origin of the lump is over what type of disease, i.e. infection or tumour is the likely cause.
The site of the lump is the single most useful guide to the possible cause.

1) Thyroid gland – should it become enlarged (goitre). Usually the cause of this is a benign goitre, which consists of multiple cysts. There may be a benign lump or rarely a malignant lump. Diagnosis usually rests on blood tests, a needle biopsy and sometimes an ultra sound examination.

2) Lymph glands, there are many lymph glands within the neck and indeed the whole human body. Strictly speaking we refer to these as lymph nodes, not lymph glands, but often the public will talk about “their glands are up”. This may be a non-specific reaction to a generalised infection or an inflammatory or malignant process nearby e.g. tonsillitis or cancer of the throat. For this reason any lump in the neck, which is not associated with an acute cold and does not resolve within three weeks should be examined by a Doctor urgently.

3) Salivary glands including parotid and submandibular – the saliva in our mouth is produced by various glands within the neck, the two largest of which are the parotid gland just below and in front of the ear and the submandibular gland which is tucked up underneath the jaw bone. These may become enlarged because of infection (e.g. mumps) obstructed by a stone or a tumour. Removal of the submandibular gland or the parotid gland (parotidectomy) are delicate operations with risk and complications of which the patient must be aware.

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Cancer of the head and neck

Fortunately cancer of the head and neck is rare. Unfortunately it often presents late and the treatment may involve major surgery and/or radiotherapy. Cancer of the mouth, voice box or gullet is almost unheard of in non-smokers. If caught early treatment is often highly successful and for this reason an adult smoker with any of the following symptoms should seek medical attention urgently.

1) A hoarse voice, which persists for more than six weeks.
2) A sore throat which persists for more than six weeks
3) difficulty swallowing food,
4) change in diet or weight loss,
5) any neck lumps which persists for more than three weeks.
5) A mouth ulcer that does not heal.

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