Category: Laryngology

¿What are the tonsils and adenoids?

The tonsils are two lumps of tissue situated on both sides of the throat (see illustration right). They are mainly formed of unique cells that produce antibodies to fight infection. Each tonsil has various depressions on its surface which extend into the tonsil called "crypts". When we swallow the tonsils are squeezed together by throat muscles, and small amounts of food, viruses and bacteria enter the tonsils through the crypts triggering an immune response against viruses and bacteria.

The adenoids, located behind the nasal passage and on the soft palate, are also made up of cells that produce antibodies to fight infection (See image).

The adenoids process the foreign particles that are deposited when we breathe air through the nose and mouth. Therefore, adenoids are at increased risk for respiratory infection.

The adenoids and tonsils constitute a small portion of the human body immune system. Hence, the removal of adenoids or tonsils does not affect the general immune system.

¿What is tonsillitis or adenoiditis?

Tonsillitis or adenoiditis is the inflammation of the tonsils or adenoids usually caused by infection caused by a virus or bacteria. Common symptoms include sore throat, difficulty swallowing, bad breath, fever, swollen neck glands (lymph nodes), loss of appetite, changed voice, and feeling ill and tired. During infection, tonsils are swollen and red, and white or yellow pus usually comes from the pits on the surface of the tonsils.
We all have experienced tonsillitis at some point in our life. However, is us most common in young children as their immune system is yet not fully developed to fight the bacteria or virus causing the infection. Some patients develop recurrent or chronic infections which cause enlargement of the tonsils or adenoids. This could increase the risk of bad breath, abscess, sleep related breathing disorders, and in small children recurring ear problems, facial deformities, crooked teeth or stunted growth.

¿What is the treatment?

The treatment depends on the severity of the condition or symptoms, the number of episodes of tonsillitis, the response to the treatment and if there are underlying conditions which could put the patient's health at risk.
The decision of prescribing antibiotics should be done by a medical professional and should depend on the probability of a bacterial infection, since antibiotics are not effective against viruses. The use of antibiotics should be taken lately since the inconsiderate use of antibiotics causes antibiotic resistance. This means that the bacteria causing infection no longer respond to common prescribed antibiotics. Infections caused by antibiotic-resistant bacteria are challenging and sometimes impossible to treat.
Surgical removal of the tonsils or adenoids (tonsillectomy or adenoidectomy) is considered in cases of repeating and severe infection, which cannot be managed with medical treatment. Most patients are admitted to the hospital during the surgical treatment for one or two days, and recovery time is between two to three weeks.

The decision to have any surgical procedure should be after the surgeon knows all the patient’s medical history and has fully explained as well as discussed the surgical procedure, possible complications and risks.

* This information does not take the place of your doctor's advice. Please consult your healthcare provider for information about a specific medical condition.

References

Anmlsingh et al. (2018). Tonsillectomy and Adenoidectomy: Indications, Complications and their Management. Journal of Surgery: Open Access, 4(4). https://doi.org/10.16966/2470-0991.173 

Archer, S., Rosenfeld, R., Mitchell, R., & Baugh, R. (2010). Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngology–Head and Neck Surgery, 143(2_suppl). https://doi.org/10.1016/j.otohns.2010.06.616 Ross, R., Milder, E., & Gerber, J. S. (2015).

Impact of a Clinical Practice Guideline on Antiboitic Use for Pediatric Tonsillectomy. Open Forum Infectious Diseases, 2(suppl_1). https://doi.org/10.1093/ofid/ofv133.997

What is dysphonia?

 Dysphonia is a symptom of alteration in the quality of the voice. The sound of the voice may be harsh or hoarse, and the affected person may sound strained when making an extra effort to be able to speak. 

Diseases that compromise the quality of the voice affect patients of all ages and sex, although it is more frequent in teachers, older adults and people who use their voice as a work tool such as singers, instructors, announcers or telephone operators. 

What Causes Dysphonia?

Changes in voice quality generally represent a vocal cord problem which can be caused by a large number of medical conditions. 

Most cases are a minor condition, caused by an upper respiratory infection, which usually resolves within 3 weeks. In the case of a respiratory tract infection, dysphonia is generally accompanied by general malaise, runny nose, sore throat or cough. Other minor causes of dysphonia can be: tobacco or alcohol consumption, excessive use of the voice, gastric reflux or inhalation of irritants. 

However, having any change in voice quality that persists for more than 3 weeks is prudent to seek medical attention. Since it could be caused by some other medical condition less likely to resolve spontaneously which could cause irreversible damage to the vocal cords and your voice. 

Changes in voice quality that do not resolve naturally are usually caused by misuse or abuse of the voice; particularly in people who use their voice in a professional way. Therefore, a timely diagnosis and treatment of any affectation in the vocal cords prevents absence from work, and psychological or economic consequences. 

In the same way, it is important to emphasize the importance of going to a voice specialist when having any change in the tone of voice for more than 3 weeks since persistent dysphonia can be an early sign of cancer of the vocal cords or lung, mainly in smokers. 

What to do if I have dysphonia with a cold or a sore throat?

• Avoid or eliminate tobacco use. 
• Don't use your voice more than necessary, but don't whisper or speak in a low voice. A soft, calm voice is best for your throat. 
• Cancel any nonessential commitments.
• Drink plenty of warm fluids without caffeine (coffee or green / black tea).
• Try natural throat lozenges that are lubricating and do not numb the throat. 
• Avoid eucalyptus or menthol-based throat lozenges as they numb and dry the throat. Sensations such as itching or a sore throat are there for a reason: they tell us to take care of and rest our voice. 

Do you have dysphonia for more than three weeks?

It is important to see a voice specialist or laryngologist to be able to properly evaluate, diagnose and treat your problem. 

Without a doubt, the best way to prevent a problem with your voice is to eliminate tobacco use, and improve the use of your voice, particularly if you use it professionally. 

Go to our blog called vocal care: http://www.sabmedic.com/en/cuidado-vocal/ to learn better habits in the use of the voice. 

* This information does not take the place of your doctor's advice. Please consult your healthcare provider for information about a specific medical condition. 

References

Digitales, C. (n.d.). Disfonía, Una enfermedad silenciosa. Retrieved May 25, 2021, from https://www.achs.cl/portal/ACHS-Corporativo/newsletters/pymes-achs-al-dia/Paginas/Disfonia-la-enfermedad-silenciosa.aspx

Hoarseness. (2020, December 14). Retrieved May 25, 2021, from https://www.nidcd.nih.gov/health/hoarseness#1

Stachler, R. J., Francis, D. O., Schwartz, S. R., Damask, C. C., Digoy, G. P., Krouse, H. J., . . . Nnacheta, L. C. (2018). Clinical practice guideline: Hoarseness (dysphonia) (update). Otolaryngology–Head and Neck Surgery, 158(1_suppl). doi:10.1177/0194599817751030

Incorporate these essential voice care tips into your daily routine. This will prepare you to make good progress with your treatment, as it is important that your voice is as healthy as possible. 

The vocal cords must be moist; when they are dry, the voice loses flexibility and they are prone to damage.

• Try to drink 2 liters of water a day. 
• Make sure you have water on hand and sip water regularly throughout the day. Carrying a bottle of water is a good idea.
• Herbal teas, water with a lemon wedge, ginger, mint leaves, or diluted juice are good alternatives to water. 
• Hot drinks are helpful as they help to relax the throat. 
• Keep your alcohol and caffeine intake low to avoid dehydration. Remember that green, white, and black teas have caffeine. Drink a glass of water if you can't live without a caffeinated drink! This will help moisten the vocal tract.  
• Take steam inhalations every day; using a bowl or cup filled with hot water. Place a towel over your head to contain the steam. Breathe in through your mouth for 5 to 10 minutes or until the steam stops.

Some medications can adversely affect the voice; they can cause hoarseness, dry vocal tract, and reflux.

• The next time you see your doctor, discuss the medications you are taking and the possible side effects; There may be other medications that have less impact on your voice that can be prescribed.

Voice care when you experience a cold or sore throat

• Don't use your voice more than necessary, but don't whisper or speak in a low voice. A soft, calm voice is best for your throat. 
• Cancel any nonessential commitments.
• Drink plenty of warm fluids without caffeine.
• Try natural throat lozenges that are lubricating and do not numb the throat. 
• Avoid eucalyptus or menthol-based throat lozenges as they numb and dry the throat. Sensations such as itching or a sore throat are there for a reason: they tell us to take care of and rest our voice. 

Reflux is a common cause of voice problems

• Gastric reflux refers to when acid from the stomach moves up the esophagus into the throat or larynx. This causes inflammation and sometimes scarring. This is called "silent reflux" because it is not accompanied by indigestion or heartburn, so many people do not know they have it. Reflux can sometimes cause a sore throat, hoarseness, clearing of the throat, excess mucus, difficulty swallowing, a bad taste in your mouth, a dry mouth, or a lump in your throat. 
• Keep a food diary or consult your doctor or nutritionist to make modifications to your diet or to understand if any food allergies can cause symptoms of gastric reflux. 
• Common foods that cause reflux are (but are not limited to): 

• Carbonated drinks
• Chocolate
• Caffeine
• Mint / menthol                    
• Onions
• Spicy foods / hot sauces
• Citrus fruits / juice

• Stop smoking.
• Elevate the head of your bed 4 to 6 inches by placing blocks under the bed frame. 
• Lose any excess weight.
• Avoid tight or restrictive clothing.
• Workout.
• Avoid eating an hour or two before bedtime.
• Avoid overeating.
• Improve stress management.
• Drink plenty of water between meals, but avoid drinking while eating, as this can slow digestion.
• Chew your food well (30 times per bite) to improve digestion. 

Frequent clearing or coughing can irritate and damage the larynx

• Avoid constantly coughing or clearing your throat. Throat clearing causes the vocal cords to constantly scratch, leaving them dry and rough. In response to this, more mucus or discharge is produced which leads to the need to clear the throat further. It is important to avoid coughing or clearing your throat.
• If you feel the need to cough or clear your throat.
  • Stop.
  • Drink water or swallow saliva.
  • Wait for irritation to pass while drinking water
  • If you still need to remove the irritation, use an air cough to clear the mucus from the vocal cords. 
  • Only if absolutely necessary, give a single, short, gentle cough.
  • Use natural (sugar-free) throat lozenges.

Living a healthy lifestyle is important for vocal health

• Be aware of the impact stress can have on your body. When we are stressed, the cells of the body are in a state of "fight or flight", which weakens the immune system, accelerates the heart and respiratory rate, creates tension in the muscles and inflames surrounding tissues. Take time to de-stress, relax, and practice self-care.
• Make sure you get enough sleep.
• Eat a balanced diet and exercise regularly.
• Whenever possible, avoid airborne smoke, pollutants, dust, and other irritants. If you work in an environment where you are exposed to irritants, wear a mouth guard.  
• Maintain an upright, comfortable posture to reduce tension in the throat and improve respiratory function.  

Be aware of how you use your voice

 The vocal cords are delicate and can be easily damaged:

• Whenever possible, avoid speaking over background noise (eg music, machines, etc.) or from a long distance.  
• Get closer to the person you are talking to so you can see their face and hear them more easily
• Minimize yelling, whispering, or speaking quietly.
• When you can, schedule regular voice breaks throughout the day. 
• Think of other ways to get someone's attention (for example, clap your hands, use an instrument in a classroom).
• If you are often asked to speak to large groups, consider using a microphone or amplifier.

Maintain a healthy lifestyle.

- Maintain adequate habits to rest and sleep.
- Maintain a healthy diet
- Exercise regularly
- Practice techniques to manage stress properly.
- Stay well hydrated:
- Drink 6 to 8 glasses of water not including coffee, tea, juices, soft drinks, alcohol or
energy / hydrating drinks.
- Drink sips of water when giving presentations or speaking for
long time.
- Avoid drinking / ingesting dairy as they thicken mucus or saliva.
make you clear your throat constantly and hurt your throat.

Avoid misuse of voice:

- Do not smoke as it is a great irritant to the throat and voice. In addition,
avoid prolonged exposure to smoke, pollution, dust, and irritants.
- Avoid excessive alcohol consumption. For every drink of alcohol take one
glass of water.
- Avoid clearing your throat or coughing constantly as this irritates and hurts the
throat. Instead, salivate or have a drink of water.
- Avoid talking in a loud environment or music for a long time.
- Avoid talking loudly, yelling or whispering for a long time.
- Use a loudspeaker or microphone when speaking in front of a large number of
people.
- Rest your voice regularly. For example, if you are a teacher, avoid talking
excessively between classes or if you are a singer or actor, avoid socializing between
performances.
- Avoid singing outside of your voice range (whether it is too high or too low)

What is gastric reflux?

Gastric reflux occurs when acid produced and stored in the stomach travels up the esophagus. This acid can also reach the throat or larynx.

There are two different types of gastric reflux: gastroesophageal reflux (GERD) and laryngopharyngeal reflux (LRF); a person can have one or both types of reflux. 

GERD occurs when stomach acid flows from the stomach into the esophagus. It usually occurs at night when people are lying down. Symptoms can include heartburn, belching, regurgitation of stomach contents, and swallowing difficulties.

LRF It occurs when stomach acid flows up through the esophagus into the throat or larynx. It can occur during the day or at night. The acid irritates the vocal cords and surrounding tissues. Symptoms may include voice changes, clearing throat, postnasal drip, a feeling of mucus in the back of the throat, cough, sore throat, choking spells, difficulty swallowing, or a feeling of a lump in the throat.

How is gastric reflux treated?

Reflux can be treated through dietary and lifestyle modifications; as well as some proton pump inhibitor (PPI) medications, and in some cases surgery. Certain foods are more likely to cause acid reflux. By eliminating or limiting these foods you can reduce acid reflux and associated symptoms. 

* For a better reading of the graphic table, visualice in pc or tablet.

Food group	Allowed foods	Foods to avoid
Dairy products	Skim milk, low-fat milk, plant-based milk, and cheeses made with part-skim milk.	Whole milk with or without flavoring, cream, whole milk cheeses and hot chocolate.
Protein and other protein alternatives.	Veal, beef, lamb, fish, poultry; as well as tofu, beans, peas, or lentils	Fried or fatty meats, pork, bacon, cold cuts, foods packed in oil.
Eggs	Prepared without added fat. Egg white to taste.	Fried eggs.
Vegetables	All prepared without added fat. Avoid vegetables that give you reflux or discomfort.	Avoid tomato sauce or foods that contain baked or roasted tomatoes.
Fruits	Anyone except those that may cause symptoms or discomfort.	Avoid citrus fruits: banana, strawberries, etc.
Bread	Commercial whole grain or enriched breads, French bread, hamburger buns, hard or plain rolls	Commercial sweet bread, donuts, croissants and cakes.
Cereals	All cereals, hot or cold	None
Potatoes and substitutes	Potatoes, sweet potato, rice, noodles, spaghetti and macaroni.	French fries or rice. Everything that is prepared with cheeses and creamy sauces.
Fats	Butter, margarine, vegetable oils, mayonnaise, gravy, reduced-fat salad dressing, or lightly seasoned dressing.	Lard, bacon fat, meat fat, commercial sauces or dressings.
Drinks	Natural or flavored water and substitute for sugar, coffee or decaffeinated tea.	Green or black coffee or tea, citrus juice (orange, grapefruit, lemonade, cranberry), caffeinated beverages, shakes, carbonated beverages, and alcohol.
Soups	Consommé, dairy-free broth, consommé, packaged / dehydrated soup, and soups made with skim milk.	Commercial cream soups (made with whole milk, cream, or added fat)
Sweet desserts	Fruit, jelly, fruit smoothies made with skimmed milk, water-based ice cream, meringues, jam, preserves, sugar, syrup and honey.	Ice cream, commercial cakes, cakes, cookies and puddings made with whole milk Any dessert that contains chocolate, nuts, cream, coconut or whole milk.
Condiments and cough drops.	Mild condiments and sugar-reduced candies	Spicy condiments Cough drops that contain menthol, peppermint, or peppermint flavor.

Lifestyle modifications

• Do not lie down or exercise after eating, avoid wearing tight clothing around the waist.
• Eat 3 to 4 small meals throughout the day instead of 2 to 3 large meals.
• If you are overweight, try to lose weight.
• Reduce or stop tobacco use.
• Evite comer 2-3 horas antes de acostarse.
• If reflux occurs at night, raise the head of your bed (i.e. put old books under the front legs or buy an angled pillow)
• Using 2 or more regular pillows can make reflux worse by causing the body to slouch.

How to take medication for reflux?

If you are taking PPIs like omeprazole, esomeprazole, etc. Take it in the morning on an empty stomach 30 minutes to an hour before breakfast or dinner.

How long will it take for you to notice improvement?

Acid damage or symptoms in your esophagus or throat may take 4-6 weeks to improve, so do not stop medications or diet or lifestyle modifications without consulting your doctor.

Complete resolution may take 3-4 months.

What problems can acid reflux cause?

Prolonged reflux can cause voice problems, Barrett's esophagus, and, in some extreme cases, esophageal or throat cancer.

Laringology is a subspecialty of otorhinolaryngology that
takes care of diseases in the larynx (or throat) and treats voice problems,
breathing and swallowing (the function of swallowing liquids or food).

The larynx is a tubular organ, located (roughly) in the middle of the
neck.

Its main functions are:

- Facilitate the passage of air that we inhale or exhale from the nose and / or mouth towards the
lungs to breathe.

- Allow the passage of liquids or food from the mouth to the stomach.

- Produce the voice and sounds through the vibration of the vocal cords.