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Neck, Throat, and Mouth

Neck & Throat & Mouth

Swallowing Disorders

Those that suffer from dysphagia, or swallowing disorders, have difficulty or pain moving food or liquids from their mouth to their stomach; some may not be able to swallow at all. Many people have experienced an occurrence of dysphagia if they eat too quickly or don’t chew their food well enough; this is not cause for concern. Frequent episodes of dysphagia on the other hand may indicate a serious medical condition and should be addressed immediately.The common symptoms of dysphagia are pain when swallowing, having a sensation of food being stuck in your throat, throwing up food, frequent heartburn and drooling. Not being able to eat or drink enough may also lead to weight loss and dehydration.

The complicated process of swallowing contains three phases: oral, pharyngeal and esophageal. The oral phase involves chewing and moving food or liquid around into the throat. The pharyngeal phase is the beginning of the swallowing process; food is squeezed down the throat while the airway is closed off to prevent food or liquid from entering. The final phase is esophageal; this involves a series of relaxing and tightening movements of the esophagus in order to push the food through to the stomach.

Much like the process of swallowing, the various swallowing disorders are also broken up into separate categories: esophageal and oropharyngeal.

Oropharyngeal swallowing disorders involve an issue with moving food from your mouth into your throat, to start the swallowing process. Choking, gagging and coughing are all common symptoms of this type of disorder. Neurological disorders such as multiple sclerosis and Parkinson’s disease, neurological damage and some cancers and cancer treatments can weaken the throat muscles, leading to this type of swallowing disorder.

Esophageal dysphagia involves food sticking within the throat or chest after the swallowing process has begun. There are multiple causes for this type of swallowing disorder. Achalasia prevents the lower esophageal muscle from relaxing properly, causing food to back up into the throat. Esophageal stricture occurs when the esophagus has been narrowed, usually by gastroesophageal reflux disease (GERD), and food becomes stuck. Scleroderma is the development of scar-like tissue within the esophagus causing the tissue to harden. This leads to an acid backup within the esophagus.

After reviewing your medical history, there are a variety of tests your doctor may need to perform in order to make a diagnosis. An X-ray with contrast (such as a barium solution) is used to show the shape of your esophagus. A dynamic swallowing study involves swallowing barium-coated foods. Your doctor is able to watch the food travel through your mouth to your stomach to see where the problem is located.

Once your doctor is able to diagnose the specific cause of your dysphagia the next step is treatment. If you are suffering from an oropharyngeal dysphagia your doctor may recommend exercises to retrain your swallowing muscles and new swallowing techniques to practice. Treating an esophageal dysphagia is more complicated. If the dysphagia is caused by a tight or narrowed esophagus an esophageal dilation may be performed. This involves your doctor inserting a balloon to gently expand the width of your esophagus. If the dysphagia is caused by an obstruction in the throat, such as a tumor, surgery may be needed to remove the blockage. Medication can be useful if the cause is related to an increase in stomach acid, such as GERD.

If dysphagia is severe enough to not respond to treatment, a liquid diet or a feeding tube may be necessary. This would ensure you were still getting adequate nutrition and hydration.

Hoarseness

Hoarseness is characterized by any abnormal change in the voice. Your voice could change in volume or pitch and may sound breathy, raspy or strained. Typically, a change to your voice is related to a disorder of the vocal folds, located in the larynx (voice box). Vocal folds open while breathing and come together when speaking. Air leaving the lungs while the folds are closing causes a vibration; this is sound. Swelling or growths on the vocal folds can lead to changes in your voice.Hoarseness can be caused by a number of different changes to the vocal fold. Acute laryngitis is the most common cause of hoarseness, and is the result of swelling of the vocal folds. Usually, acute laryngitis occurs during a cold or upper respiratory tract viral infection. Voice misuse, such as excessive use or speaking loudly in a noisy environment can cause swelling of the vocal folds as well as the development of benign vocal cord lesions. These lesions are callus-like growths on the vocal folds called nodules, polyps or cysts. Other causes such as allergies, thyroid problems and even cancer can also lead to hoarseness.

Hoarseness will usually go away on its own. If it lasts longer than a week and you are not currently suffering from a cold or the flu you should contact your doctor. In addition, you should see a doctor if you cough up blood, have difficulty swallowing or experience pain when speaking.

After reviewing your medical history, your doctor will perform a complete physical exam in order to diagnose the cause of your hoarseness. A laryngoscopy enables your doctor to examine the back of your throat, the larynx and the vocal folds. This can be done as an indirect laryngoscopy or a direct fiber-optic laryngoscopy. Indirect involves a series of mirrors and lights to see into the back of your throat. The direct fiber-optic exam involves a small lighted flexible tube inserted through the nose to get a closer look at the vocal folds. In some cases, tests used to evaluate the irregularities in the voice may be performed.

The most common treatment for hoarseness is rest; this involves using your voice in moderation or not using it at all. The amount of time this is recommended for depends on the severity and the cause of the hoarseness. Not smoking, avoiding second-hand smoke and drinking plenty of fluids is also recommended. If your hoarseness is caused by a lesion on the vocal folds, surgery may be required.

Vocal Cords

Have you ever thought about how you speak? It seems easy enough: a thought develops and moments later it comes out of your mouth. Speech is actually a complex process that relies on multiple parts.

In order to create sound you must have air. The act of inhaling takes air into the lungs. To speak, air is pushed through the lungs and into your windpipe. On the top of the windpipe sits your vocal cords, known technically as vocal folds. These folds open while breathing and close when producing sound. As air is blown out of the lungs it passes between the two vocal folds and causes them to vibrate. The pitch of your voice is determined by the length and tension of the vocal folds.

The sound that comes from the vibrating vocal folds sounds like a buzzing. That sound passes through the throat, nose and mouth, which work together to change the buzzing into speech.

A disorder that can affect the vocal cords, and thus affect speech, is vocal cord paralysis. Bilateral vocal cord paralysis involves both cords becoming stuck half open and half closed, not moving in either direction. Unilateral vocal cord paralysis occurs when only one side is stuck or has very limited movement.

Hoarseness, a breathy voice, an inability to speak loudly and choking or coughing while eating are all common signs of a vocal cord paralysis. In order to make a diagnosis, your doctor will use an endoscope and look through your nose or mouth. Your doctor will then be able to watch the vocal folds as you speak.

If you are diagnosed with bilateral vocal cord paralysis you may require a tracheotomy, a procedure that creates an opening in your neck, allowing you to breathe and eat safely. Surgery may be needed for unilateral vocal cord paralysis to move the paralyzed vocal fold.

Non-surgical treatments such as behavioral therapy can be utilized. This therapy teaches you how to increase breath support and how to find the best body position for optimizing your voice.

Voice Disorders

Sleep Apnea

Sleep apnea is a serious sleep disorder in which you stop breathing multiple times throughout the night. There are three main types of sleep apnea: obstructive, central and complex sleep apnea syndrome.Obstructive is the most common type and is caused by your throat muscles incorrectly relaxing. When the muscles relax, your airway narrows or closes. This makes taking a breath difficult. Usually your brain will sense this inability to breathe and wake you. Most people immediately go back to sleep after being woken up, leaving them unaware of the problem and thinking they slept right through the night.

Central sleep apnea is caused by a neurological issue, occurring when your brain is not sending the proper signals to the muscles that control breathing. This leads to your body making no effort to breathe for a short period of time. Those with this type of sleep apnea will often awaken with shortness of breath.

Complex sleep apnea syndrome is a combination of obstructive and central.

Loud snoring and multiple episodes of breathing cessation are the most common and telltale symptoms of sleep apnea. Abrupt awakenings, a headache and dry mouth or sore throat when waking are additional signs. If you are snoring loud enough to wake your partner or wake up gasping for breath you should consult a doctor.

In order to diagnose sleep apnea, your doctor will review your medical history. An overnight sleep observation will then be performed. There are two types, a nocturnal polysomnography or a home sleep test. A nocturnal polysomnography requires you to spend the night at a sleep clinic while your heart, lungs and brain are monitored. A home sleep test is a much simpler test that can be performed in the comfort of your own home. A small machine will monitor your heart rate, blood oxygen levels, airflow and breathing patterns.

Treatments for sleep apnea can range from home remedies to surgery. Often, lifestyle changes such as losing weight or quitting smoking can do the trick. If you are suffering from obstructive sleep apnea, surgery may be required to remove the blockage in your nose or throat. One of the most common therapies is continuous positive airway pressure (CPAP). This machine provides you with air pressure through a mask while you sleep, which helps keep your airwaves open. With so many options for therapies you and your doctor can work together to figure out which works best for your type of sleep apnea.

Thyroid/Parathyroid

The thyroid is a butterfly shaped gland that sits in the lower front of the neck. The thyroid gland uses the iodine from your food to create two hormones that your body uses for energy, to stay warm and keep the brain, heart, muscles and other organs working properly.Hyperthyroidism occurs when the thyroid produces too many hormones. One type of hyperthyroidism is Grave’s Disease, which is caused by antibodies in the blood that tell the thyroid to grow and create too many hormones. Another type of hyperthyroidism is called toxic nodular, and occurs when a nodule or lump within the thyroid grows too large, causing the thyroid to produce too many hormones. A viral infection may also cause your thyroid to temporarily produce too many hormones.

Too many hormones cause your body to speed up, leading to nervousness, irritability, racing heart, difficulty sleeping and weakness in your muscles. Frequent bowel movements and weight loss are also common.

A blood test is typically all that is needed to diagnose hyperthyroidism. If the blood test comes back positive your doctor will usually order a scan of your thyroi, in order to have a reference point for its size in the future. There are a number of drug therapies available to treat this condition. Antithyroid drugs are used to block the thyroid’s ability to create new hormones. Radioactive iodine can be used to destroy the hormones after they are created by the thyroid. A permanent solution to your hyperthyroidism is surgery to remove most of your thyroid. To ensure you receive the hormones going forward, daily hormone supplements will be prescribed.

Hypothyroidism is the opposite or hyperthyroidism; those with this condition do not produce enough hormones. This will lead to a slowdown of your body, making you feel colder and more tired. Some patients experience depression and constipation. A blood test is the only way to diagnose hypothyroidism.

Daily hormone supplements are the preferred method of treatment. In order to make sure you are taking the correct dose, you will need to have your hormone levels checked with a blood test every 6 to 10 weeks.

A goiter is an abnormal enlargement of your thyroid gland. This is not always an indication that the thyroid is functioning incorrectly, as an enlarged thyroid can still produce the correct amount of hormones.

Iodine deficiency is the most common cause of goiters worldwide. In the US, Hashimoto’s thyroiditis is the most common cause. This is an autoimmune condition that involves the destruction of the thyroid by your own immune system. The destruction of the thyroid will lead to a decrease in hormones. The pituitary gland can sense the low levels of hormones and try to compensate, causing the thyroid to grow.

A physical exam can diagnose the presence of a goiter and a blood test can be used to determine the cause. Typically, once you figure out the cause of the goiter, it can be treated and no surgery is needed.

The parathyroid glands are four small glands located behind the thyroid gland. The parathyroid helps to control the amount of calcium in your blood.

The most common disorder associated with the parathyroid glands is hyperparathyroidism. This occurs when one (or more) of the parathyroid glands develops a tumor, leading to an increase in the hormone that regulates the calcium in your blood. This condition leads to high blood calcium, causing kidney stones, frequent headaches and depression. A blood test is necessary to diagnose this condition. In order to treat it, the tumor must be removed.

Laryngitis/Laryngoscopy

Laryngitis is the inflammation of your larynx, also called your voice box. Within your larynx sits your vocal folds. Normally, the vocal folds open and close, creating sound as air passes through and causes them to vibrate. If they become inflamed or irritated, the sound they create is distorted. This results in your voice sounding hoarse, often almost inaudible.There are two types of laryngitis, short-lived (acute) or long-lasting (chronic). Most cases of laryngitis are short-lived and caused by a viral infection, vocal strain or a bacterial infection. Chronic laryngitis is defined by an episode of laryngitis lasting longer than three weeks. This type is usually caused by prolonged exposure to an irritant, vocal strain or growths on the vocal folds. While less common, cancer, vocal cord paralysis or bowing of the vocal cords can also cause laryngitis. Vocal cord bowing, which usually only affects those over the age of 60, occurs when the cords become too weak to close completely.

The most common symptoms of laryngitis are hoarseness, a weak voice, a sore throat and a dry cough. If these symptoms last longer than two weeks you should consult with a doctor.

In order to diagnose laryngitis, your doctor will review your medical history and complete a physical exam. In order for your doctor to get a better look at your larynx, a laryngoscopy will be performed. There are two ways to perform a laryngoscopy. One involves a light and a series of mirrors positioned to allow your doctor to see down your throat. The second type is the preferred method and involves inserting an endoscope through your nose or mouth. The endoscope is a thin flexible tube with a light and a camera on the end. Either of these versions will enable your doctor to take a closer look and watch how your vocal cords react when you speak.

Acute laryngitis will usually get better on its own within a week with rest and proper hydration. The treatments for chronic laryngitis are aimed at treating the underlying cause, such as avoiding irritants. Corticosteroids can be used to reduce vocal cord inflammation and antibiotics may be used if your laryngitis is caused by a bacterial infection.

Tonsils

Your tonsils are a pair of soft tissue masses that sit at the sides of your throat. They act as a defense mechanism, preventing infections from entering your body. Since they come into contact with various bacteria and viruses, they can easily become infected.Tonsillitis occurs when the tonsils become inflamed. Common symptoms of this condition are a sore throat, difficulty swallowing, a scratchy-sounding voice and bad breath. If your sore throat does not go away after a few days, it is best to visit your doctor.

Your doctor will use a lighted instrument to look at your throat, ears and nose in order to determine the cause of your infection. They will also feel your throat for swollen glands and listen to your breathing. A swab will be used to get a sample from the back of your throat; this is sent to the lab to be analyzed for streptococcal bacteria (strep throat). If the test comes back positive you have a bacterial infection, and if it comes back negative, you have a viral infection.

Tonsillitis can be treated with at-home remedies, antibiotics or surgery. Typically, your doctor may wait up to 10 days after the onset of symptoms before prescribing antibiotics. Rest, plenty of fluids and gargling with salt water can all help speed up the recovery time.

If the tonsillitis is confirmed to be the result of a bacterial infection, antibiotics will be prescribed. A 10-day course of penicillin is prescribed, unless you are allergic. It is important to take the full course of antibiotics, even though it is tempting to stop once the symptoms go away.

If you experience frequent tonsillitis, or your tonsillitis does not respond to treatment, you may need to have surgery to remove your tonsils. This procedure is called a tonsillectomy. It can be performed as an outpatient procedure and usually only takes one to two weeks for patients to fully recover.

Aphasia

Aphasia is a neurological disorder that affects your ability to speak. There are three main types: nonfluent, fluent and global. Those suffering from nonfluent aphasia find it hard to get words out, speaking in very short choppy sentences and often leaving out words. They can understand what others are saying, but cannot get their response out. This can lead to a lot of frustration. Those suffering from fluent aphasia can speak easily but what they are saying does not make sense. They typically do not understand what others are saying. Global aphasia is caused by extensive damage to the brain; those with this type of aphasia can usually only produce a few words and can understand little or no spoken words.Brain damage from a stroke is the most common cause of aphasia. This disorder can also be caused by severe head trauma, a tumor or an infection in the brain. Problems with memory and confusion often accompany this type of brain damage. While these events may cause a sudden onset of aphasia, primary progressive aphasia can develop gradually. This is due to the slow degeneration of brain cells. This type of aphasia will often develop into generalized dementia. Migraines or seizure can produce temporary periods of aphasia.

In order to diagnose aphasia, a physical exam and a neurological exam must be completed. An imaging test such as an MRI will usually be ordered and a language skills test will be performed.

Mild forms of aphasia may go away on their own. Language and speech therapy will be needed to control all other cases. Speech therapy is most effective when started soon after the brain injury. Many find working in therapy groups more effective than working alone, as participants can practice their language skills in a safe place. Medications that improve blood flow to the brain have been shown in small studies to have some promise.

Adenoids

The adenoids are a pair of soft tissue masses located behind the nose. They work with your tonsils to provide your body with its first line of defense. Any bacteria or virus that enters your body through you nose is trapped by the hairs and mucus within the nose and then destroyed by the white blood cells produced by the adenoids. Since the adenoids play such a key role in protection, they often come into contact with germs and then become infected.Enlarged adenoids can block airflow through your nose, which can lead to mouth breathing, snoring and a dry and sore throat. Yellow or green discharge from the nose can also occur. In addition to swollen adenoids, infected adenoids can lead to middle ear infections, sinusitis and a chest infection.

Treatment for enlarged adenoids depends on what else has been infected. A common treatment is a full course of antibiotics, as this can get rid of an infection in the adenoids and the middle ear.

If your child is prone to infections in their adenoids, surgery may be recommended. This surgery, called an adenoidectomy, is performed under general anesthesia. Just like tonsils, while they are responsible for fighting germs, there is little research to show you are any less healthy after they are removed. Oftentimes, if the adenoids are being removed the tonsils will also be taken out.

You may have noticed that children are more likely to suffer from infections in their tonsils and adenoids. This is because as you age, both your tonsils and your adenoids shrink.

Throat Cancer

Any cancerous growth in the throat, voice box or tonsils is referred to as throat cancer. Cancer begins when a cell develops a genetic mutation that causes it to grow uncontrollably; eventually these cells will form a tumor. While it is not clear what causes the cells to mutate, there are some factors that may increase your risk.Tobacco use, both smoking and chewing, long-term alcohol use, human papillomavirus (HPV) and gastroesophageal reflux disease (GERD) have all been linked to throat cancer.

Throat cancer may go undetected for some time, since the symptoms closely resemble a number of other conditions. A cough, hoarseness or other changes in voice, difficulty swallowing and a sore throat are all common symptoms.

In order to determine what is causing these symptoms, your doctor will review your medical history and perform a physical exam. They will then perform an endoscopy with use of an endoscope, a thin tube with a light and a camera, in order to get a closer look. Once they find the growth they collect a sample to be sent out for a biopsy. Surgical tools can be passed through the endoscope, making the sample collection easy.

Once the biopsy has come back positive for cancer cells, the next step in the diagnosing process is to determine your cancer’s stage. The stages range from I to IV, I being a small tumor confined to a single area and IV being the most advanced. Imaging tests such as an MRI or CT scan may be ordered to see how far the throat cancer has spread.

There are a number of different treatment options for throat cancer. The extent and location of your cancer play just as much a role as your health and personal preference when choosing a treatment. There are three main types of treatment: radiation, surgery and chemotherapy. Typically, a combination of treatments will be used.

Radiation therapy uses high-energy beams, such as X-rays, to kill the cancer cells. This type of therapy is often able to successfully treat early stage cancers with no additional treatments needed.

The extent of the surgery needed to remove the cancerous cells depends entirely on how deep the cancer has spread. For mild cases the cancer cells can be scraped off the wall of the throat, while larger portions of your throat may need to be removed if the cancer has spread.

Chemotherapy uses drugs injected into your body to kill the cancer cells. Some forms of chemotherapy make the cells more susceptible to radiation so both treatments are used.

After your treatment, you may require rehabilitation. This therapy will help you work through any eating or swallowing difficulties or speech problems.

Reflux

Gastroesophageal reflux disease (GERD) is caused by the backup of stomach acid into the esophagus. Normally, when you swallow food or liquid it travels down the esophagus and the lower esophageal sphincter, a band of muscle around the bottom of the esophagus, relaxes to allow the food or liquid to continue on into your stomach. When the lower esophageal sphincter weakens or begins relaxing abnormally, stomach acid can begin moving back into your esophagus. This causes heartburn. Over time, the lining of your esophagus will become inflamed and can wear away, causing bleeding, narrowing or even a precancerous condition.Those with GERD will experience a burning sensation in their chest (commonly known as heartburn), difficultly swallowing, chest pain, regurgitation of food or bile and hoarseness. If you are taking over-the-counter heartburn medication more the twice a week or are experiencing chest pain, consult a doctor.

Your doctor will review your medical history and complete a physical exam. GERD is usually able to be diagnosed with only a description of your symptoms. An endoscopy may be performed in order for your doctor to get a better look at your esophagus. An endoscope, a flexible tube with a light and a camera, is threaded down your throat into the esophagus.

If your doctor thinks it is helpful, they may order a test to monitor the amount of acid in your esophagus. An ambulatory acid (pH) probe test measures the amount of acid in your esophagus over a 24-hour period. One variety of this test uses a thin plastic tube that is threaded through your nose into your esophagus and connects to a portable computer worn around the waist. Another version uses a clip that is inserted in your esophagus during an endoscopy. The probe stays in your system for two days and then falls out and is passed on its own.

An x-ray of your upper digestive system (also known as a barium swallow) helps your doctor see an outline of your whole digestive system. You will be asked to drink a chalky liquid which will coat the lining of your upper digestive track. This liquid is what stands out on the x-ray.

Over-the-counter antacids are the initial treatment for GERD. They will only provide fast-acting, temporary relief of the symptoms, but will not treat the inflamed esophagus. Next, medications that aim to reduce acid production should be used. They provide longer-lasting relief. The final over-the-counter medication to try is proton pump inhibitors, which block stomach acid production and heal the esophagus.

If the over-the-counter medications do not provide you with relief from your symptoms, the prescription strength may. If you are one of the few individuals who continues to experience symptoms, surgery may be needed. Nissen fundoplication is a surgical procedure that tightens the lower esophageal sphincter to prevent stomach acid from traveling back up. A new version of this procedure, called Linx, involves magnets that are strong enough to prevent acid backwash but weak enough to allow food to pass through.

Head & Neck Masses

There are a number of causes for a head or neck mass to develop. These range from a simple cyst to cancer.Most neck masses are caused by enlarged lymph nodes. The lymph nodes could become enlarged as a result of a nearby infection (such as a cold), a bacterial infection of the lymph nodes or an infection in the body. A nearby infection will cause soft, non- tender masses that return to normal after the infection has gone away. A bacterial infection will create tender masses. An infection of the body will cause multiple lymph nodes to enlarge. The most common causes of this type of reaction are mononucleosis (mono), human immunodeficiency virus (HIV), and tuberculosis (TB).

Cancerous masses are more common in older people and usually develop from cancer that has spread from the mouth or throat. These masses are not painful or tender but are hard to the touch.

Cysts are common in younger people. These masses are hollow and fluid-filled and usually painless unless they become infected. Cysts that develop in the skin are called sebaceous cysts.

In order to figure out the cause of a head or neck mass your doctor will review your medical history and perform a physical exam. The doctor is trying to figure out how long the mass has been there, whether it is painful and if you are at risk for any viral or bacterial infections such as HIV or TB. They will then examine the mass itself, looking to see if it is a hard lump. They will also check to see if there are sores or growths in the mouth and if you are experiencing any difficulty swallowing or hoarseness.

If the lump only lasts for a few days your doctor may not perform any tests. If the mass does not go away, a blood test, chest x-ray and a biopsy of the mass will be performed.

Usually, no treatment is needed for a head or neck mass. If the results come back and the mass is cancerous, the lump as well as the lymph node may be removed. If necessary, radiation may also be performed.