Frequently Asked Questions - Throat & Neck


Tonsils/Adenoids

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, an that they help 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.

Tonsillectomy (removal of tonsils) is recommended for people who experience frequent throat infections. Adenoideciomy (removal of adenoids) are recommended for recurrent ear or nasal infections. Other reasons to remove tonsils and adenoids is if they are enlarged, as this can cause obstructive symptoms, such as sleep apnea, swallowing difficulties, nasal sounding speech, dental malocclusion and even heart failure. Recent reports also link enlarged tonsils and adenoids to obstructive breathing and sleep apnea, which can cause poor concentration and irritability during the day. This can be confused with ADHD. These patients often improve significantly after removal of their tonsils and adenoids. This procedure rarely requires hospitalization and can be safely done in our surgery center.

The two most common reasons for removal of tonsils and adenoids are recurrent infection despite antibiotic therapy, and difficulty breathing due to enlarged tonsils and /or adenoids. Some orthodontists believe chronic mouth breathing from large tonsils causes malformations of the face and poor teeth alignment. Adenoids are very close to the Eustachian tube and when infected or enlarged can contribute to ear disease. Much more rarely tonsils are removed to check for the possibility of cancer in patients with very asymmetric tonsils or others signs of malignancy.

Patients having tonsillectomy and adenoidectomy are usually discharged the same day or within 24 hours after surgery. The general technique for removal is fairly constant between ENT surgeons with the difference being in the instruments used to remove the tonsils and to prevent bleeding. Overall the operation is very safe with the main major risk being bleeding. This happens in less than 5% of patients and is usually easy to control, but needs to be brought to the attention of your surgeon when it happens. Other risks such as anesthesia reaction, infection, scarring, and voice change are quite unusual.

The recovery after tonsillectomy/adenoidectomy varies between patients. If tonsils are removed for breathing problems the effects can be often noticed the first night The main complaint after surgery is throat and/or referred ear pain. Pain medicine usually relieves this discomfort until the wound is healed which can take up to two weeks. Patients are encouraged to drink plenty of liquids to avoid dehydration and then slowly advance their diet back to normal.

Snoring/Sleep Apnea

Obstructive sleep apnea is diagnosed when loud snoring is interrupted by episodes of completely obstructed breathing. This condition can be serious and sometimes fatal if not treated. The cumulative effects of these obstructed breathing episodes is reduced blood oxygen levels to the brain, forcing the patient to stay in a lighter sleep stage and preventing them from getting the rest benefit only achieved during deeper sleep. This can lead to a tendency to fall asleep during daytime hours, on the job, or worse at the wheel of a car. Also, over time the heart needs to work harder and other body systems are affected by sleep apnea.

The patients symptoms and physical examination often point to the diagnosis and then a sleep study (polysomnogram) is performed to confirm the diagnosis and to provide more details on the severity of the sleep apnea, which will then help in deciding the best treatment.

One out of four people is a habitual snorer. The problem is more frequent in males and the overweight and worsens with age. Socially snoring can be the source of resentfulness causing others to have sleepless nights. Medically snoring can disturb the sleep pattern and if severe may be an indicator of sleep apnea.

Snoring is a very common problem which results from the disturbance of air flow. Vibration of the uvula and soft palate creates most of the unpleasant noise. Treatment centers around stiffening and/or removal of these structures. Before treatment is applied, it is very important to rule out sleep apnea, a condition in which snorers stop breathing while asleep. Sleep apnea is a serious condition that may lead to heart, lung or brain problems. Treatment options to reduce snoring include: 1) Injection Snoreplasty; injection into the soft palate leads to subsequent stiffening; 2) Somnoplasty: Radiofrequency stiffening treatments of the soft palate; 3) Radiofrequency Turbinate Reduction; shrinks nasal tissue that may also contribute to sound production; 4) Other procedures that involve tissue removal (uvula, palate, and/or tonsils). Many of these newer procedures can be performed in our office with minimal discomfort.

Self-help remedies such as weight loss, exercise, regular sleeping hours, avoidance of heavy meals, alcohol or sedatives at bedtime work well for the light snorer. Sleeping on your side and with the head elevated often help too. Surgical treatments aimed at shrinking the palate and uvula have been advanced recently. Surgical treatments, such as the new Pillar® Procedure (soft-palate insert system), help to alleviate some of the anatomic obstruction in the nose or throat, and can be done safely in the physician's office.

Most procedures for the treatment of sleep apnea are covered by insurance with appropriate documentation by sleep studies. However, snoring procedures are not routinely covered presently.

Depending on the severity of the sleep apnea, the age and other medical conditions, sleep apnea is usually able to be controlled. Self-help remedies such as weight loss, exercise, regular sleeping hours, avoidance of heavy meals, alcohol or sedatives at bedtime are important.. Sleeping on your side and with the head elevated often help too. Breathing devices (e.g. CPAP-continuous positive airway pressure breathing) are very successful when tolerated by the patient and requires wearing a small mask over the nose at bedtime to provide a steady column of airflow and preventing collapse of the "floppy" airway. Dental appliances have been used to pull the tongue forward, again opening the air passages that collapse in sleep apnea. Surgical therapies by your ENT surgeon are aimed at opening the nasal and oral airway. In children removing the tonsils and adenoids often provides dramatic relief. In adults removing the tonsils, tightening the loose palatal tissues and expanding the airway are usually successful in decreasing apnea. Certain patients may have a retrusive jaw/tongue which can be corrected also. Lastly, for those with severe apnea at high risk a tracheotomy can be life saving.

Throat Disease

Throat cancer usually occurs in smokers and hoarseness is usually noticed early. Some other signs such as weight loss, difficulty swallowing, sore throat, referred ear pain, and lump in the neck might occur too.

If diagnosed early throat cancer can often be cured by radiation therapy or limited surgery. If the disease has progressed and is not too far gone, good results can still be obtained but often will require surgical removal of the voice box followed by radiation therapy. Fortunately, today ENT surgeons and speech pathologists have ways of restoring some vocal ability after removal of the voice box.

Depending on the age of the patient the most common causes of neck masses changes. In children, most masses are related to infections or inflammatory cysts. The treatment therefore usually starts with antibiotics and if the mass persists or enlarges it should be removed. During adulthood cancer becomes much more common and needs to be excluded as a possibility, often requiring a biopsy by your ENT physician along with a thorough head and neck exam.

Swallowing problems can be related to many causes including anatomic obstruction (e.g. cancer), neurologic disease (e.g. stroke), infection (e.g. candida), reflux, muscle tone problems, diabetes, alcoholism, vitamin deficiency, foreign bodies, caustic ingestion, aging and many other possibilities. The swallowing mechanism is complex and any disorder affecting from the tongue to the stomach can create swallowing difficulties. In addition to the routine head and neck exam studies such as esophagoscopy (direct view of the esophagus), Barium swallow (X-ray observation of dye being swallowed, pH probe (detects acid reflux), and manometry (monitors muscle coordination of swallowing), may be ordered by the physician and swallowing therapist to assist in diagnosis and treatment. Patients may require comprehensive video testing (video stroboscopy) to determine the underlying pathology of voice disorder.

Reflux of acid from the stomach most commonly causes acid indigestion. The acid can travel further up the esophagus and into the throat especially while lying flat on the back. Symptoms such as a lump in the throat, frequent throat clearing, burning sensation, chronic cough, and hoarseness have all been occasionally attributed to reflux.

Initially lifestyle modifications like avoiding fatty foods, citrus foods, garlic, onions, caffeine, chocolate and peppermint will decrease reflux. Eating meals further from bedtime, elevating the head of bed, losing weight and quitting tobacco use will also help. Antacid medications and now more potent acid production blockers are often prescribed with great success.

Vocal straining patterns (e.g. screaming, untrained singing) along with tobacco irritation, reflux or trauma to the vocal cords may cause the formation of polyps or nodules. They are often successfully treated by removing or treating the underlying cause sometimes in conjunction with voice therapy. If they persist and are causing voice, swallowing or airway symptoms they can be removed by precise surgical excision by your ENT surgeon.

Thyroid

Hyperthyroidism and Graves’ disease can cause nervousness, tremors, mood swings, rapid heart beating, high blood pressure, diarrhea, insomnia, heat intolerance, thickened skin, and bulging eyes.

Hypothyroidism can cause weakness, lethargy, cold intolerance, swelling, coarse dry skin, and hearing loss.

The cause of multiple thyroid nodules is not completely understood, but is thought to be related to changes in thyroid hormone and iodine metabolism. Solitary nodules are more worrisome for the possibility of a tumor in the thyroid gland. These tumors are usually benign, but in order to make the diagnosis your ENT surgeon often performs surgical removal to be sure that there is no evidence of malignancy.

Goiter simply means enlargement of the thyroid gland. Most often no therapy is required after full evaluation to look for signs of over- or underactive thyroid activity as well as ruling out evidence of malignant growth, or compression on the airway or esophagus.

Smoking

ENT physicians can almost always find some visible abnormality in patients that smoke and often in those exposed to second hand smoke. Children have increased risk of ear disease and airway troubles when their parents smoke. The major risk factor for the majority of head and neck cancers is clearly smoking or oral tobacco use. These risks are worsened when combined with frequent alcohol use.

Chewing tobacco or snuff can cause cancer of the cheeks, gums and throat along with staining the teeth, causing bad breath and elevating blood pressure.

Most people know that smoking causes cancer. What some people don't know is that smoking contributes to other illnesses. Noxious fumes and chemicals from cigarette smoke (including second hand exposure) reduce the effectiveness of the body's protective immune functions. A young child whose parents smoke will be prone to more ear infections. Smokers have more frequent and worse sinus and lung infections. Cigarette smoke may lead to hoarseness and in its worst case, cancer of the vocal cords. All persons who have been hoarse for over six weeks should have an endoscopic evaluation of their vocal cords. Protect the health of yourself and others and STOP SMOKING TODAY! See your primary care physician and learn of the variety of prescription products that may help you in your endeavor to quit.

Nerve Stimulation (VNS)

Chronic depression can be an illness that requires life-long management. Success rates in treating depression are sometimes low, and it is estimated that more than half of patients with depression have significant relapses. Drugs and electroconvulsive (shock therapy) treatment may not relieve symptoms in some patients.

Seizures also do not always respond to treatment. Some patients have tried two or more medications and still have seizures, as well as side effects from the drugs, both of which affect their quality of life.

Vagus nerve stimulation is a technique in which a small device is implanted under the skin of the chest. A small wire runs to the vagus nerve, which is then stimulated by the device, in much the same way a pacemaker works. Patients with depression usually experience an improvement in alertness and memory, plus have more energy and a better mood. These quality-of-life benefits improve over time. Vagus nerve stimulation has proven to be a safe and effective way to control seizures and improve depression. In addition, because drugs are not used, there are no side effects which are commonly associated with anti-depressant or seizure-control medications.

The Surgery Center of Charleston The South Carolina Sinus Institute