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  • Tonsillectomy and Adenoidectomy
  • Sore Throat
  • Hoarseness
  • Dysphagia
  • (Difficulty Swallowing)
  • Direct fiber-optic (flexible or rigid) laryngoscopy
  • Thyroid Ultrasound
  • Transnasal Endoscopy
  • (TNE)

    Tonsillectomy and Adenoidectomy

    Tonsils and adenoids are masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.

    Tonsils and adenoids are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They "sample" bacteria and viruses and can become infected themselves. Scientists believe they work as part of the body's immune system by filtering germs that attempt to invade the body, and that they help to develop antibodies to germs.

    This happens primarily during the first few years of life, becoming less important as we get older. Children who must have their tonsils and adenoids removed suffer no loss in their resistance.

    The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing and swallowing problems. Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare, but can grow on the tonsils.

    You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids

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    Sore Throat

    Sore throat is a symptom of many medical disorders. Infections cause the majority of sore throats and are contagious. Infections are caused either by viruses such as the flu, the common cold, mononucleosis, or by bacteria such as strep, mycoplasma, or hemophilus. The causes of sore throat include:

    • Virus
      Most viral sore throats accompany flu or colds along with a stuffy, runny nose, sneezing, and generalized aches and pains. These viruses are highly contagious and spread quickly, especially in winter. Sore throats may also accompany a variety of viral infections, such as measles, chicken pox and croup.

    • Bacteria
      Bacterial infections can cause the throat to swell and block the air passage. Some of the more dangerous forms of bacterial infections in the throat include strep throat, tonsillitis and infection of the epiglottis. Infection in the nose and sinuses can also cause sore throats.

    • Allergies
      Pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog dander and house dust are common causes of sore throats for people with allergies to them.

    • Irritation
      Dry heat, yelling, chronic stuff nose, pollutants, smoke, chemicals, alcohol, tobacco and spicy foods are some causes of irritation.

    • Reflux
      Caused by regurgitation of stomach acids up into the back of the throat.

    • Tumors
      Usually associated with long-term tobacco and alcohol usage. Symptoms include pain radiating to the ear when swallowing, hoarseness, lump in the neck, unexplained weight loss, and/or spitting up of blood in the saliva or phlegm.

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    Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch.

    There are many causes of hoarseness, including (but not limited to):

    • Smoking
    • Acute laryngitis
    • Swollen vocal cords from raising of the voice
    • Acid reflux
    • And other causes such as allergies, thyroid problems, trauma to the voice box and occasionally a normal menstrual cycle

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    Dysphagia (Difficulty Swallowing)

    Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an otolaryngologist–head and neck surgeon.

    Dysphagia is caused by the interruption of the swallowing process. It may be due to simple causes such as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastroesophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: stroke; progressive neurologic disorder; the presence of a tracheostomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.

    Some of the symptoms of dysphagia include:

    • Drooling
    • A feeling that food or liquid is sticking in the throat
    • Discomfort in the throat or chest (when gastroesophageal reflux is present);
    • A sensation of a foreign body or "lump" in the throat;
    • Weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing; and
    • Coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs.

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    Direct fiber-optic (flexible or rigid) laryngoscopy

    Direct laryngoscopy uses a fiber-optic scope that allows the doctor to see deeper into the throat than during indirect laryngoscopy. The laryngoscope is either flexible or rigid. Fiber-optic scopes provide better views and are better tolerated than older, rigid scopes. Rigid scopes are still used to do surgery.

    Why It Is Done

    Using either indirect or direct laryngoscopy helps a doctor:

    • Detect causes of voice problems, such as a breathy voice, hoarse voice, weak voice, or no voice.
    • Discover causes of throat and ear pain.
    • Evaluate blood-tinged sputum, difficulty in swallowing, or a persistent sensation of a lump in the throat.
    • Detect injuries to the throat (lesions), narrowing of the throat (strictures), or obstructions or masses in the airway.

    Direct, rigid laryngoscopy may be used to perform surgical procedures, including removing foreign objects that may get caught in the throat, collecting tissue samples (biopsy), removing polyps from the vocal cords, or performing laser treatment. Direct, rigid laryngoscopy may also be used to help diagnose cancer of the voice box (larynx).

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    Thyroid Ultrasound

    The thyroid is a gland located in the neck that regulates metabolism. Ultrasound is a painless method of examining the thyroid. This test involves high-frequency sound waves that are emitted and received by a transducer (a handheld instrument), and the sound waves penetrate the body. The sound waves are arranged into an image seen on a screen, based on the way they bounce off of the various body structures.

    Ultrasound is usually performed on the thyroid to differentiate between a cyst (a sac containing fluid) and a tumor (an abnormal tissue growth that may or may not be cancerous).

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    Transnasal Endoscopy (TNE)

    TNE is used to examine patients who have a mass in the neck, throat, airway, or esophagus. Patients with sleep apnea may undergo TNE to check for obstruction in the throat, though typically patients with sleep apnea will undergo transnasal flexible laryngoscopy (TFL) to help determine the cause of sleep apnea. Patients suffering from gastroesophageal reflux disease (GERD) may also benefit from TNE, as it can reveal manifestations of GERD in the esophagus. Transnasal esophagoscopy may also be used to examine patients who have swallowing difficulties (dysphagia) due to obstructive or mechanical problems.

    During transnasal esophagoscopy (TNE), a thin, flexible endoscope is inserted through the nose and down the throat in order to gain view of the vocal folds, larynx (voicebox), esophagus, or other structures of the throat. Because patients do not need to be sedated before undergoing TNE, the risk of complications is lower than with conventional endoscopy. The most common complication associated with TNE is nosebleed.

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