The throat is important for taste, swallowing and speech. Symptoms include sore throat, lump in throat, problems with swallowing, voice changes, bad breath, altered taste sensation and blood stained saliva. A persistent swelling or ulcer in your mouth should be evaluated by an ENT doctor.
During your visit, a complete head and neck examination with nasal endoscopy, otoscopy, and neck palpation will be performed.
Throat Conditions
Throat Procedures
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Throat Conditions
Persistent cough
You should see an ENT specialist if you experience coughing lasting for more than three weeks, especially if it is associated with symptoms of blood stained phlegm, shortness of breath or a change in voice. Common causes include post nasal drip, reflux, respiratory infections, smoking and asthma. A full head and neck examination with nasal endoscopy is used to evaluate the upper airway. Treatment will be targeted at the underlying cause.
Tonsilitis
Tonsilitis is a condition commonly described as a severe sore throat due to inflammation of the tonsils. Associated symptoms include spiking fever, swollen neck nodes and problems swallowing. Symptoms may develop acutely, recurrent or chronic due to viral or bacterial infections. Treatment of acute tonsilitis includes rest, hydration, painkillers, and antibiotics for bacterial infections. Severe tonsilitis can give rise to peritonsillar abscess formation. This is a medical emergency needing incision and drainage. Tonsillectomy is indicated for recurrent or chronic tonsilitis.
Tonsil Stones (Tonsiloliths)
You may be having tonsil stones (tonsiloliths) if you experience bad breath, throat discomfort and recall episodes of spitting out small, pebble-lumps from your tonsils. These stones are made of hardened minerals (eg. calcium) and food debri which form in your tonsils. They are harmless but may cause tonsillar inflammation. Treatment include regular antibacterial mouthwash to the back of your throat to dislodge the stones and to prevent them from recurring. Some stones can be removed with forceps in the clinic. Elective tonsillectomy maybe an option.
Foreign body in throat
You may have a foreign body in your throat if you had accidentally swallowed a bone and experience persistent localised sharp pain in the neck on swallowing. This is a medical emergency and you should consult an ENT specialist immediately. A swallowed foreign body is commonly lodged in your tonsil, back of your tongue or the entrance of your food pipe. These can be visualised clinically and removed safely. If you are symptomatic and the foreign body cannot be seen, a x-ray lateral neck or CT neck maybe ordered as the foreign body may be lodged lower in your food pipe. If positive, removal under general anesthesia with rigid esophagoscopy has to be performed.
Laryngopharyngeal reflux (LPR)
You may have laryngopharyngeal reflux if you experience frequent throat clearing, phlegm in throat, sensation of a lump in your throat, persistent cough or voice change. This condition occurs when stomach acid refluxes into your food pipe and into your throat and voice box causing inflammation, similar to gastroesophageal reflux disease (GERD). Treatment include avoiding spicy foods, caffeine, taking small regular meals, not lying down within 3 hrs after eating a meal, sleeping on a higher pillow (head up) and taking acid suppressants. A referral to gastroenterology may be needed if you experience stomach symptoms as well.
Vocal cord nodules, polyps, cysts
Vocal cord nodules, polyps and cysts are lumps which form in the lining of your voice box (larynx) from conditions such as voice overuse (eg. singers, teachers). They are harmless but can affect the quality of your voice and cause airway issues if the lesion is large. Nasal endoscopy is used to visualize the voice box. Voice therapy may be helpful. Endoscopic laryngeal microscopic surgery (ELMS) may be performed in certain cases.
Vocal cord immobility, dysfunction
This is a condition whereby your vocal cords (voice box) cannot move or close properly (immobility, paresis, paralysis); or when your vocal cords do not open correctly (dysfunction, paradoxical movement). Your voice may sound weak or raspy and you may have associated symptoms of shortness of breath or aspiration. Underlying causes include viral, autoimmune, intubation injury or vocal cord cancer. Nasal endoscopy is performed for diagnosis. Treatment commonly includes voice therapy.
Oral cavity ulcers
Oral cavity ulcers maybe multiple, recurrent or manifest as a single non-healing ulcer. You should consult a doctor to exclude underlying medical conditions (eg. vitamin deficiency, autoimmune). Biopsy is necessary to exclude cancerous changes for non-healing ulcers.
Oral Mucoceles
If you have a painless fluid filled swelling in your oral cavity (eg. inner surface of lower lip, cheek), with a history of trauma (eg. bite), it is likely a mucocele. Do not try to burst it as they are harmless and may self-resolve. Removal maybe considered if the lesion is large affecting the way you chew, swallow or speak.
Oral cavity, oropharyngeal, laryngeal cancer
Alcohol, betel nut chewing, oral human papillomavirus (HPV) infection, smoking are risk factors. Persistent non healing ulcers, blood stained saliva, pain or problems on swallowing, change in voice warrant further evaluation. A full head and neck examination with pan-endoscopy and biopsy is required for diagnosis. Treatment will depend on disease stage (staging scans) and histology.
Throat Procedures
Excision biopsy of oral cavity lesions
Depending on the size of the lesion and patient’s comfort level, this procedure can be performed under local or general anesthesia. The lesion is excised as a whole and sent for histology. The cavity is either left to heal or by closed with dissolvable sutures. Soft diet, analgesia and antibiotics are given for a week.
Tonsillectomy
Tonsillectomy is a procedure whereby both your tonsils are removed under general anaesthesia through your mouth. It can be performed as a day surgery or some patients may opt to stay in the hospital for one night. It is indicated in recurrent tonsilitis, chronic tonsilitis, snoring/obstructive sleep apnea, asymmetrical tonsils, tonsil stones and previous peritonsillar abscess. It is important to rest the throat for two weeks post procedure, have a soft diet avoiding alcohol and spice, and to stay well hydrated. Throat pain is managed with oral analgesia, lozenges, gargle and throat sprays. There is a risk of bleeding which can be minor or major (requiring surgical hemostasis) in the second post operative week.
Endoscopic laryngeal microsurgery (ELMS)
This is a fine procedure done under general anesthesia whereby Dr Soon will use micro-instruments with the aid of the microscope or endoscope to remove the lesion in your voice box (vocal cord polyp, cyst, nodule) through your mouth. The lesion is sent for histology. It is important to rest your voice and avoid reflux causing foods and smoking for at least a month post-surgery. Speech therapy may be helpful to prevent recurrences
Pan-endoscopy and biopsy
This procedure is performed when there is a high suspicion of a head and neck cancer involving the oral cavity, oropharynx, hypopharynx, larynx and/or esophagus. The area of concern is examined through a direct laryngoscope, esophagoscope and tissue is taken for diagnosis.
Rigid Esophagoscopy and removal of foreign body
This procedure is performed under general anaesthesia whereby a long narrow metal rigid tube is inserted through your mouth and into your food pipe (esophagus). It is indicated in patients symptomatic for an ingested foreign body or to remove an ingested foreign body (eg. fish bone) seen on x-ray/CT neck.