Throat
& Neck:
1.Sore Throats: Causes and Cures
2.Salivary Glands What's Normal, What's Abnormal
Sore Throats: Causes and Cures :
What Causes a 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.
While bacteria respond to antibiotic treatment, viruses do not.
Viruses: 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. The body builds antibodies that destroy the virus, a process that takes about a week.
Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.
Sore throats accompany other viral infections such as measles, chicken pox, whooping cough, and croup. Canker sores and fever blisters in the throat also can be very painful.
One viral infection takes much longer than a week to be cured: infectious mononucleosis, or "mono." This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface and swollen glands in the neck, armpits, and groin. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice— yellow skin and eyes. It also causes extreme fatigue that can last six weeks or more.
"Mono," a severe illness in teenagers but less severe in children, can he transmitted by saliva. So it has been nicknamed the "kissing disease," but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of towels and eating utensils.
Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Because of these possible complications, a strep throat should be treated with an antibiotic. Strep is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, persuade the physician to prescribe antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment. For example, severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Similarly, negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests. Tonsillitis is an infection of the lumpy tissues on each side of the back of the throat. In the first two to three years of childhood, these tissues "catch" infections, sampling the child's environment to help develop his immunities (antibodies). Healthy tonsils do not remain infected. Frequent sore throats from tonsillitis suggest the infection is not fully eliminated between episodes. A medical study has shown that children who suffer from frequent episodes of tonsillitis (such as three- to four- times each year for several years) were healthier after their tonsils were surgically removed. Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it. The most dangerous throat infection is epiglottitis, caused by bacteria that infect a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. A strep test may miss this infection. Allergy: The same pollens and molds that irritate the nose when they are inhaled also may irritate the throat. Cat and dog danders and house dust are common causes of sore throats for people with allergies to them. Irritation: During the cold winter months, dry heat may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake. Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need examination and treatment of the nose. Pollutants and chemicals in the air can irritate the nose and throat, but the most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages, and spicy foods. A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes. Reflux: An occasional cause of morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, tilt your bedframe so that the head is elevated four- to six-inches higher than the foot of the bed. You might find antacids helpful. You should also avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. If these tips fail, see your doctor. Tumors: Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing, sometimes with pain radiating to the ear, may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Other important symptoms include hoarseness, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.
When Should I See a Doctor?
Whenever a sore throat is severe, persists longer than the usual
five- to seven- day duration of a cold or flu, and is not associated
with an avoidable allergy or irritation, you should seek medical
attention. The following signs and symptoms should alert you to
see your physician:
- Severe and prolonged sore throat
- Difficulty breathing
- Difficulty swallowing
- Difficulty opening the mouth
- Joint pain
- Earache
- Rash
- Fever (over 101°)
- Blood in saliva or phlegm
- Frequently recurring sore throat
- Lump in neck
- Hoarseness lasting over two weeks
When Should I Take Antibiotics?
Antibiotics are drugs that kill or impair bacteria. Penicillin or
erythromycin (well-known antibiotics) are prescribed when the physician
suspects streptococcal or another bacterial infection that responds
to them. However, a number of bacterial throat infections require
other antibiotics instead. Antibiotics do not cure viral infections,
but viruses do lower the patient's resistance to bacterial infections.
When such a combined infection occurs, antibiotics may be recommended.
When an antibiotic is prescribed, it should be taken as the physician
directs for the full course (usually 10 days). Otherwise the infection
will probably be suppressed rather than eliminated, and it can return.
Some children will experience recurrent infection despite antibiotic
treatment. When some of these are strep infections or are severe,
your child may require a tonsillectomy. Should Other Family Members be Treated or
Cultured?
When a strep test is positive, many experts recommend treatment
or culturing of other family members. Practice good sanitary habits;
avoid close physical contact; and sharing of napkins, towels, and
utensils with the infected person. Handwashing makes good sense. What If My Throat Culture Is Negative?
A strep culture tests only for the presence of streptococcal infections.
Many other infections, both bacterial and viral, will yield negative
cultures and sometimes so does a streptococcal infection. Therefore,
when your culture is negative, your physician will base his/her
decision for treatment on the severity of your symptoms and the
appearance of your throat on examination.
How Can I Treat My Sore Throat?
A mild sore throat associated with cold or flu symptoms can be made
more comfortable with the following remedies:
- Increase your liquid intake.
- Warm tea with honey is a favorite home remedy.
- Use a steamer or humidifier in your bedroom.
- Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water
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Salivary Glands What's Normal, What's Abnormal :
Where Are Your Salivary Glands?
The glands are found in and around your mouth and throat. We call
the major salivary glands the parotid, submandibular, and sublingual
glands.
They all secrete saliva into your mouth, the parotid through tubes that drain saliva, called salivary ducts, near your upper teeth, submandibular under your tongue, and the sublingual through many ducts in the floor of your mouth.
Besides these glands, there are many tiny glands called minor salivary glands located in your lips, inner cheek area (buccal mucosa), and extensively in other linings of your mouth and throat. Salivary glands produce the saliva used to moisten your mouth, initiate digestion, and help protect your teeth from decay.
As a good health measure, it is important to drink lots of liquids daily. Dehydration is a risk factor for salivary gland disease.
What
Causes Gland Problems?
Salivary gland problems that cause clinical symptoms include:
Obstruction: Obstruction to the flow of saliva most commonly occurs in the parotid and submandibular glands, usually because stones have formed. Symptoms typically occur when eating. Saliva production starts to flow, but cannot exit the ductal system, leading to swelling of the involved gland and significant pain, sometimes with an infection. Unless stones totally obstruct saliva flow, the major glands will swell during eating and then gradually subside after eating, only to enlarge again at the next meal. Infection can develop in the pool of blocked saliva, leading to more severe pain and swelling in the glands. If untreated for a long time, the glands may become abscessed.
It is possible for the duct system of the major salivary glands that connects the glands to the mouth to be abnormal. These ducts can develop small constrictions, which decrease salivary flow, leading to infection and obstructive symptoms.
Infection: The most common salivary
gland infection in children is mumps, which involves the parotid
glands. While this is most common in children who have not been
immunized, it can occur in adults. However, if an adult has swelling
in the area of the parotid gland only on one side, it is more likely
due to an obstruction or a tumor.
Infections also occur because of ductal obstruction or sluggish
flow of saliva because the mouth has abundant bacteria.You may have a secondary infection of salivary glands
from nearby lymph nodes. These lymph nodes are the structures in
the upper neck that often become tender during a common sore throat.
In fact, many of these lymph nodes are actually located on, within,
and deep in the substance of the parotid gland or near the submandibular
glands. When these lymph nodes enlarge through infection, you may
have a red, painful swelling in the area of the parotid or submandibular
glands. Lymph nodes also enlarge due to tumors and inflammation. Tumors: Primary benign and malignant
salivary gland tumors usually show up as painless enlargements of
these glands. Tumors rarely involve more than one gland and are
detected as a growth in the parotid, submandibular area, on the
palate, floor of mouth, cheeks, or lips. An otolaryngologist-head
and neck surgeon should check these enlargements.
Malignant tumors of the major salivary glands can grow quickly,
may be painful, and can cause loss of movement of part or all of
the affected side of the face. These symptoms should be immediately
investigated. Other Disorders: Salivary gland
enlargement also occurs in autoimmune diseases such as HIV and Sjögren's
syndrome where the body's immune system attacks the salivary glands
causing significant inflammation. Dry mouth or dry eyes are common.
This may occur with other systemic diseases such as rheumatoid arthritis.
Diabetes may cause enlargement of the salivary glands, especially
the parotid glands. Alcoholics may have salivary gland swelling,
usually on both sides.How Does Your Doctor Make the Diagnosis? Diagnosis of salivary gland disease depends on the
careful taking of your history, a physical examination, and laboratory
tests.If your doctor suspects an obstruction of the major
salivary glands, it may be necessary to anesthetize the opening
of the salivary ducts in the mouth, and probe and dilate the duct
to help an obstructive stone pass. Before these procedures, dental
x-rays may show where the calcified stones are located. If a mass is found in the salivary gland, it is
helpful to obtain a CT scan or a MRI (magnetic resonance imaging).
Sometimes, a fine needle aspiration biopsy in the doctor's office
is helpful. Rarely, dye will be injected through the parotid duct
before an x-ray of the gland is taken (a sialogram).A lip biopsy of minor salivary glands may be needed
to identify certain autoimmune diseases.How Is Salivary Gland Disease Treated?
Treatment of salivary diseases falls into two categories: medical
and surgical. Selection of treatment depends on the nature of the
problem. If it is due to systemic diseases (diseases that involve
the whole body, not one isolated area), then the underlying problem
must be treated. This may require consulting with other specialists.
If the disease process relates to salivary gland obstruction and
subsequent infection, your doctor will recommend increased fluid
intake and may prescribe antibiotics. Sometimes an instrument will
be used to open blocked ducts. If a mass has developed within the salivary gland,
removal of the mass may be recommended. Most masses in the parotid
gland area are benign (noncancerous). When surgery is necessary,
great care must be taken to avoid damage to the facial nerve within
this gland that moves the muscles face including the mouth and eye.
When malignant masses are in the parotid gland, it may be possible
to surgically remove them and preserve most of the facial nerve.
Radiation treatment is often recommended after surgery. This is
typically administered four to six weeks after the surgical procedure
to allow adequate healing before irradiation. The same general principles apply to masses in the
submandibular area or in the minor salivary glands within the mouth
and upper throat. Benign diseases are best treated by conservative
measures or surgery, whereas malignant diseases may require surgery
and postoperative irradiation. If the lump in the vicinity of a
salivary gland is a lymph node that has become enlarged due to cancer
from another site, then obviously a different treatment plan will
be needed. An otolaryngologist-head and neck surgeon can effectively
direct treatment. Removal of a salivary gland does not produce a dry
mouth, called xerostomia. However, radiation therapy to the mouth
can cause the unpleasant symptoms associated with reduced salivary
flow. Your doctor can prescribe medication or other conservative
treatments that may reduce the dryness in these instances.
Salivary gland diseases are due to many different causes. These diseases are treated both medically and surgically. Treatment is readily managed by an otolaryngologist-head and neck surgeon with experience in this area.
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| Laryngitis : |
Laryngitis
is usually due to a viral infection. You may become hoarse, but
symptoms usually go within a week or so. See a doctor if symptoms
persist.
What is laryngitis? The larynx joins the back of the throat to the trachea (windpipe). The vocal cords are in the larynx. Laryngitis means inflammation of the larynx. It is usually due to a viral infection (viral laryngitis). What
are the symptoms of viral laryngitis? A typical viral laryngitis gets worse over 2-3 days. It then eases and goes, usually within a week. However, you may have a croaky voice for a week or so even after the other symptoms have gone. This is because the inflammation of the vocal cords may take a while to settle after the virus has gone. Breathing difficulty is an uncommon complication. This may occur if there is a lot of inflammation and swelling in the larynx which causes the windpipe to narrow. This is rare in adults, but sometimes happens in young children with smaller, narrower windpipes. See a doctor as soon as possible if you have any difficulty in breathing. What is the treatment for viral laryngitis?
A more severe laryngitis is sometimes due to bacteria. An antibiotic may be advised if the infection is severe, if it is not easing after a few days, or if your immune system is not working properly (for example, if you have had your spleen removed or if you are taking chemotherapy, etc). Other causes of laryngitis and hoarseness Laryngitis and hoarseness are occasionally due to other conditions that affect the vocal cords. For example: rare infections, allergies, voice overuse, tobacco smoke, or other irritants or chemicals that you may inhale. A benign (non-cancerous) cyst on a vocal cord sometimes causes hoarseness. A tumour (cancer) on the vocal cord is an uncommon cause. See a doctor if any of the following develop.
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Find
It Early and Be Cured Here's What You Should Watch for: BE SAFE: See your doctor early! And practice health habits which will make these diseases unlikely to occur. |