Symptoms (Throat)

A sore throat is usually due to acute tonsillitis or acute pharyngitis. On occasions acid reflux is the primary cause.

Acute tonsillitis affects mainly the sides of the throat and can be caused by viruses and/or bacteria. There is fever,halitosis, pain on swallowing, enlarged red inflamed tonsils with exudates, tender swollen neck glands and the patient feels generally sick and unwell. Acute pharyngitis, which affects the centre of the back of the throat as well as the sides, is usually caused by a virus. It tends to give milder symptoms and typically results in a URTI with nasal irritation and congestion. Glandular fever caused by the Epstein Barr virus is an exception, however, and causes symptoms like very severe tonsillitis

Bad breath is commonly caused by acute or chronic throat infections, tonsilloliths, chronic rhinosinusitis with a post-nasal drip and poor mouth and dental hygene. It may also be due to dietary factors, such as eating onions or garlic, or perhaps insufficient food leading to the formation of ketones in the stomach

Snoring is noisy breathing during sleep and can be loud enough to match the sound generated by a passing motorcycle. It is also due to turbulent airflow and can be socially very disabling. It is more common in overweight and older people. With increasing age the throat muscles become more floppy and collapsible when breathing in. Common sites are the nose (nasal blockage), soft palate and tongue base. Snoring may be associated withobstructive sleep apnoea (OSA), a condition in which breathing stops frequently but temporarily causing partial suffocation.

A cough is a protective reflex caused by irritation of the lining mucosa in the voice box (larynx) or windpipe (trachea). Sudden expulsion of air from the lungs at high speeds of up to 80 mph clears mucus or foreign material from the airway. A cough usually starts with a viral upper respiratory tract infection (URTI) which may spread to involve the sinuses (sinusitis) or lower down to the involve the trachea (tracheitis), bronchi (bronchitis) or lungs (pneumonia). Subsequent bacterial infection is common and prolongs the local inflammation irritation. A chronic cough may occur if there is persistent local inflammation or a tumour. The violent jet of air propelled through the airway at the level of the vocal cords may also result in a frequent recurrent irritant effect, hence the importance of suppressant medicines in management.

Aspiration occurs when the normal protective reflexes of the larynx are defective (Laryngeal incompetence). It is often associated with hoarseness and cricopharyngeal malfunction with swallowing problems. As a result ingested food and liquids “go down the wrong way”, passing through the vocal cords into the trachea and lower airway with a real risk of pneumonia. Patients may cough and splutter due to the protective cough reflex, but some patients with neurological swallowing disorders have lost sensation to these areas. Chronic aspiration may therefore cause few if any symptoms until a secondary chest infection occurs.

Hoarseness is a change in voice quality caused by abnomal vocal cord vibration.

The commonest acute causes are viral laryngitis and voice abuse, when even mild degrees of vocal cord swelling affect the normal mucosal wave pattern. These conditions usually respond quickly to voice rest, humidification and sometimes antibiotics when there is a secondary bacterial infection. In patients with chronic hoarseness consider acid reflux laryngitis, nodules, polyps, tumours, voice abuse, vocal cord weakness or Laryngeal dystonia.

In these conditions the vocal cords and larynx are working normally, but there are articulation or rhythm problems mainly with the tongue and/or soft palate which result in an indistinct voice. These medical problems vary from a simple tongue tie, to neurological disorders of the tongue and pharynx such as cerebrovascular disease and motor neurone disease, or a stammer. Some genetic females are born with certain male characteristics and vice versa. In some of these individuals there may be desire to higher or lower their basic voice pitch therefore as part of a gender re-assignment programme