Entsa of Appleton
Entsa of Appleton

Swallowing Difficulty, Tonsillities, Thyroid and Vocal Cord Issues

Most individuals have experienced a change in their voice at some point in their life. This could be something as simple as singing too loudly and waking up the next day to a scratchy throat. On the other end of the spectrum a change in voice can be a symptom of a nasal polyp. Many conditions have similar symptoms. This is why at the first sign of trouble you should schedule an appointment with one of our experienced ENT physicians.

If you are experiencing any throat pain or soreness, please contact Ear, Nose and Throat Surgical Associates, in Appleton at (920) 734-7181 to schedule an appointment.

Adenoids are the pair of soft tissues that sit behind the nasal cavity. They are part of your body’s immune system, helping to prevent bacteria and viruses from entering your body through the nose. Because of this role they can easily become infected. Adenoids are present at birth and as we age they begin to shrink to the point that the adenoids, in most adults, are non-existent.

If the adenoids do become infected they will swell and cause a stuffy nose, sore throat, ear problems and snoring. This condition is called adenoiditis. In order to diagnose this, your doctor will review your list of symptoms and use a small mirror to examine your adenoids.

Antibiotics will be prescribed to treat the infection. If you continue to develop frequent infections or if the antibiotics do not help, your adenoids may need to be removed. This outpatient procedure is called an adenoidectomy. Oftentimes, this surgery will be performed at the same time as a tonsillectomy.

After the surgery, you may feel nauseated while the anesthesia wears off. A sore throat is common and may last for seven to ten days following the procedure. A low-grade fever for a few days after the procedure is also normal. If the fever gets higher than 102 degrees Fahrenheit, you should seek medical attention. Most experience some swelling in the throat, which may lead to mouth breathing and snoring for one to two weeks after the surgery.

Your larynx, also called your voice box, is an important part of the speech process. Within the larynx sits your vocal cords. If everything is functioning normally air is pushed from your lungs, up your windpipe and past the vocal cords. As air passes through the cords they vibrate, creating a buzzing sound. The length and tension of the vocal cords determines the pitch of your voice. This sound is passed through the throat, nose and mouth which all work together to change the buzzing into speech.

If the vocal folds become irritated or inflamed your voice can become distorted. Laryngitis is the inflammation of the larynx. There are two types of laryngitis: acute (short-lived) and chronic (long-lasting). Episodes of acute laryngitis are usually caused by a viral infection, vocal strain or a bacterial infection. Chronic laryngitis lasts for more than three weeks and can be caused by exposure to an irritant, vocal strain or a growth on the vocal cords. Cancer and vocal cord paralysis, while less common, can also cause chronic laryngitis.

Your doctor will review your medical history and symptoms and complete a physical exam. To get a better look at your larynx, a laryngoscopy will be performed. This test can be completed with a collection of mirrors properly positioned to be able to see down your throat. The medically preferred method involves inserting an endoscope down your nose or mouth.

Usually acute laryngitis will go away on its own. Chronic laryngitis is treated by correcting the underlying cause. Corticosteroids can be used to treat the inflammation in the larynx and antibiotics may be used if laryngitis has been caused by a bacterial infection.

The process of swallowing is complicated, and consists of four phases: oral preparatory, oral transit, pharyngeal and esophageal.

Food is mixed with saliva and transformed into a consistency that can be swallowed in the oral preparatory phase. The tongue pushes food and liquid to the back of the mouth in the oral transit stage. Food is then passed through the pharynx into the esophagus in the pharyngeal phase. The final phase, the esophageal phase, involves food passing through the esophagus into the stomach.

A swallowing difficulty, know as dysphagia, can be caused by an issue in any part of the swallowing process.

Typically, swallowing disorders are broken down into two categories: esophageal dysphagia and oropharyngeal dysphagia.

Esophageal dysphasia is categorized by the sensation of food sticking or getting stuck in the base of your throat or chest after you swallow it. There are a number of disorders that fall into this category. Achlasia occurs when the muscle in the lower esophagus, called the sphincter, does not relax properly. This prevents food from passing through the esophagus into the stomach. An esophageal stricture occurs when food gets stuck in a narrowed esophagus, usually the cause of scar tissue from reflux. Gastroesophageal reflux disease (GERD) is a condition in which stomach acid gets backed up and damages the lining of the esophagus.

Oropharyngeal dysphagia is a category of conditions that makes it hard for you to move food from your mouth into your throat and esophagus. Typically, you will choke, gag or cough whenever you try to swallow and you will have a sensation of food going down your windpipe or up your nose. Neurological disorders, such as muscular dystrophy and Parkinson’s disease, and neurological damage such as a stroke or a brain injury, can cause this type of dysphagia. Pharyngeal diverticula is a disorder where a small pouch forms just above your esophagus. Food particles collect in the pouch, which can lead to difficultly swallowing, gurgling and bad breath.

In order to make a dysphagia diagnosis your doctor will review your symptoms and compete a physical exam. An X-ray with a barium swallow will help your doctor get a detailed look at your esophagus. During this test, you may be asked to swallow barium-coated food in order for your doctor to watch how it moves through your system. An endoscopy involves passing a thin flexible lighted instrument down your throat. This gives your doctor a detailed look at your esophagus.

Treatments for dysphagia vary based on the cause. Oropharyngeal dysphagia may be treated by studying different swallowing techniques and by learning exercises to help coordinate your swallowing muscles. Esophageal dysphagia may require surgery or medications. Those with severe dysphagia may require a special liquid diet or a feeding tube, but this is only in the most severe cases.

If you are having trouble swallowing or feeling like food gets stuck in your throat, contact our office at (920) 734-7181 to schedule an appointment.

A tonsillectomy is the surgical removal of your tonsils. Tonsils are the two oval-shaped pads of soft tissue that sit at the back of your throat. They are part of your body’s defense system, helping to filter out harmful bacteria and viruses that enter through your mouth. Because of their proximity to germs, the tonsils can easily become infected—this is called tonsillitis.

Tonsillitis is usually caused by a virus, such as that of a common cold or Epstein-Barr (mononucleosis), or a bacterial infection, such as streptococcus (strep throat). Symptoms include a sore throat, difficulty swallowing, chills, headache, and red and swollen tonsils with white or yellow spots.

There are two types of tonsillitis: recurrent and chronic. Recurrent tonsillitis is characterized by multiple episodes of acute tonsillitis a year. Chronic involves multiple episodes of tonsillitis a year as well as a chronic sore throat, bad breath and tender lymph nodes in the neck.

In order to make a diagnosis your doctor will review your symptoms and complete a physical exam. A throat culture will be taken which involves rubbing a swab on your tonsils. This is then sent off to the lab to be analyzed. This test can only detect a bacterial infection so if the swab comes back negative a viral infection is assumed and no antibiotics will be prescribed.

If you are experiencing recurrent or persistent episodes of tonsillitis, surgery may be needed to remove the tonsils; this procedure is called a tonsillectomy. This outpatient produce may use lasers, radio waves, ultrasonic energy or a traditional scalpel to remove your tonsils. A tonsillectomy takes only 30 to 45 minutes to complete. Throat, ear, jaw and neck pain are all common side effects of the surgery. Pain medication may be prescribed to treat these ailments.

Vocal cords, often referred to as vocal folds, play in important role in how we produce sounds. First there must be air in your lungs; this occurs through the act of inhaling. The air is then pushed through the lungs into your windpipe. At the top of the windpipe sits your vocal cords. The cords stay open when breathing and close when you produce sound. As the air gets pushed out of the windpipe it passes between the vocal cords, causing them to vibrate. This vibration sounds like a buzzing. This sound is passed through the throat, nose and mouth, which all work together to change the buzzing into speech.

Any disorder that affects the vocal cords will affect your speech.

Vocal cord paralysis can be bilateral or unilateral. Bilateral involves both cords becoming stuck half open and half closed. The cords are unable to move in either direction. Unilateral occurs when only one side is stuck or has very limited movement.

Hoarseness, an inability to speak loudly and choking or coughing while eating are common signs of vocal cord paralysis. To make a diagnosis, your doctor will review your symptoms and complete a physical exam. An endoscope will be inserted down your nose or throat so your doctor can get a better look at your vocal cords. Once the vocal cords are in view, your doctor will ask you to speak in order to watch what happens.

If you are diagnosed with bilateral vocal cord paralysis, a tracheotomy may be needed. This procedure creates a hole in your trachea and a tube is inserted to help you breathe. Unilateral vocal cord paralysis may also require surgery to move the paralyzed vocal cord.

Non-surgical treatments such as behavioral therapy may be recommended by your doctor before surgery is needed. This type of therapy will teach you how to breathe better and how to find the best body positon for you to produce strong speech.

Your thyroid is the butterfly-shaped gland that sits on the front of your neck, below the Adam’s apple. The thyroid’s primary role is to secrete hormones responsible for metabolism, growth and development and body temperature. The thyroid uses the iron from your food to produce these hormones.

Hyperthyroidism occurs when your thyroid produces too many hormones. This can be caused by Grave’s disease, toxic nodular or a viral infection. Grave’s disease causes the antibodies in the blood to instruct the thyroid to produce too many hormones. Toxic nodular is caused by a nodule or lump within the thyroid; as the lump grows larger it can cause the thyroid to produce too many hormones. A viral infection can temporarily cause the thyroid to produce too many hormones.

Too many hormones cause the body to speed up. This can lead to nervousness, irritability, a racing heart, difficultly sleeping, frequent bowel movements and weight loss. Hyperthyroidism can be diagnosed with a blood test. If necessary, a scan can be taken of your thyroid. This is primarily done so your doctor has a reference, which may be needed for comparison in the future.

The most common treatment for hyperthyroidism is antithyroid drugs, which block the thyroid’s ability to produce too many hormones. Radioactive iodine is used to eliminate the extra hormones that have already been created.

If you continue to have problems even after the use of medication, surgery may be needed. Most of your thyroid is removed and you will be prescribed daily hormone supplements.

Hypothyroidism occurs when your thyroid does not produce enough hormones. This leads to a slowdown in the body. Most report feeling colder, more tired, depressed and constipated. As with hyperthyroidism, a blood test is needed to confirm this diagnosis.

Daily hormone treatments are usually used to treat this condition. In order to confirm you are not accidently taking too many hormones, you will need your blood tested every six to ten weeks.

A goiter is caused by the swelling of the thyroid. While normally harmless, a goiter can lead to your thyroid producing an incorrect amount of hormones. Iodine deficiency is the most common cause of goiters worldwide. In the US, the most common cause of a goiter is an autoimmune condition called Hashimoto’s thyroiditis. This condition causes your own immune system to slowly destroy your thyroid, resulting in a decrease in hormone production. The pituitary gland senses this decrease and causes the thyroid to grow in order to compensate. A blood test and a physical exam are usually all that is necessary to diagnose a goiter.

Thyroid cancer, nodules, cysts and hyperthyroidism are the most common causes of thyroid surgery. The surgery may require the removal of part or all of the thyroid. A total thyroidectomy is the removal of the entire thyroid and the lymph nodes surrounding the gland. A thyroid lobectomy with or without an isthmectomy is used to remove one of the lobes of the thyroid, whichever holds the nodule. The narrow band that connects the lobes may also be removed. The nodule will then be looked at under a microscope to determine if there are any cancer cells. A subtotal thyroidectomy involves the removal of one lobe, the connective band and part of the other lobe. This is used to treat Grave’s disease.

A tracheotomy is the surgical procedure of creating a hole through the front of your trachea. This hole is called a tracheostomy and helps you breathe by creating an air passage when the traditional route of breathing is obstructed or impaired. This procedure may be needed for a number of reasons.

Some have medical conditions that block or obstruct their airway and require the use of a breathing machine, called a ventilator. Neurological problems, such as paralysis, may make it hard to cough up secretions from your throat. These require direction suctioning of the trachea in order to clear the airway. Some receive a tracheotomy in preparation for a major head or neck surgery, as they will need assistance in breathing during their recovery. Emergency situations may also arise in which breathing becomes obstructed and a breathing tube cannot be placed through the mouth. In this case, a tracheotomy will be performed.

If you are receiving a tracheostomy in a planned tracheotomy procedure you will be given information beforehand on how to prepare for the general anesthesia. Usually, you will be asked to avoid eating and drinking for several hours before the procedure and you may be asked to stop certain medications. A tracheotomy will usually require a several day stay in the hospital in order for the tracheostomy to heal.

There are two types of procedures that can create a tracheostomy: surgical or minimally invasive. A surgical tracheotomy is performed in an operating room. A horizontal incision is made through the skin on the lower part of the front of the neck. The surgeon will pull back the surrounding muscle and cut through the thyroid gland to reach the trachea. A small hole is made in the trachea and a tracheostomy tube is placed in the hole. A neck strap is attached to hold the tube in place.

A minimally invasive tracheotomy is performed in a hospital room. A small incision is made in the base of the neck and a lens is fed through the mouth to help the surgeon see the inside of the throat. A needle is inserted into the windpipe to create the hole in the trachea. The small hole is then expanded to create a hole large enough for the tracheostomy tube. A neck strap is then attached to keep the tube in place.

After this procedure you will spend several days in the hospital in order for your body to heal. You will be taught how to care for the new tube, especially how to clean it to prevent an infection. You will be taught how to use a device or new techniques in order to speak. Air will flow through the hole in your trachea instead of being pushed through the voice box. During the healing process you will not be able to eat; you will receive nutrients through an intravenous line instead.

For most patients, a tracheostomy is temporary. It is simply providing an alternative breathing route until the medical issue causing the obstruction is resolved. Those that require a ventilator indefinitely require a tracheostomy as a permanent solution.

Most people have experienced a change in their voice at some point throughout their lifetime. There are a number of voice problems; some are caused by simple things, such as singing too loudly, and clear up on their own. Other causes are more serious.

Non-cancerous growths, such as nodules or polyps can develop on the vocal cords. These usually develop from vocal abuse, using your voice too much or incorrectly. Soft and swollen spots can develop after misuse and over time these spots can turn into hard growths called nodules. Polyps can develop in the same process, except instead of turning hard they transform into blister-like growths. If not address, both polyps and nodules will continue to grow.

Growths on the vocal cords can lead to hoarseness and a lump-in-the-throat sensation. If these symptoms do not resolve after a few weeks you should contact your doctor. Your doctor will review your symptoms and complete a physical exam. To get a closer look at your vocal cords your doctor will use an endoscope, a thin lighted instrument that can be inserted through your nose or down your throat.

The treatment for vocal cord growths can range, based on their size. Large or old growths are usually removed through surgery. Acid reflux or a thyroid problem may make vocal cord growths worse. Medical intervention is available to treat these conditions. Behavioral therapy is available to prevent further vocal abuse.

Paradoxical vocal fold movement is a voice disorder that is often misdiagnosed with asthma. Your vocal cords will work normally and then all of a sudden something will cause them to close when they should be open. This action can cause wheezing and difficulty breathing. This is a difficult disorder to diagnose. Your doctor will review your symptoms and examine your vocal cords with an endoscope. A voice evaluation may also be performed.

After this procedure you will spend several days in the hospital in order for your body to heal. You will be taught how to care for the new tube, especially how to clean it to prevent an infection. You will be taught how to use a device or new techniques in order to speak. Air will flow through the hole in your trachea instead of being pushed through the voice box. During the healing process you will not be able to eat; you will receive nutrients through an intravenous line instead.

The only available treatment for this condition is making you aware of your triggers. That way, you are able to avoid an episode. Triggers may include cold air, shouting or irritants in the air.