Treatment for Oropharynx diseases in Bangalore
Acute tonsillitis
This is an inflammation of the palatine tonsils. It can be caused due to virus or bacterial infection. Patient presents with sore throat, cough, fever, painful swallowing and swellings in the upper part of neck. It can also be associated with generalised myalgia, congestion of nose, runny nose, bad breath, ear ache, change in voice, difficulty opening the mouth etc. Acute tonsillitis can be divided into 4 types.
Acute catarrhal tonsillitis
Here we see severe congestion of the tonsils as a part of generalised pharyngitis.
Acute parenchymatous tonsillitis
Here we see enlarged and congested tonsils. The substance of the tonsil is affected.
Acute follicular tonsillitis-
Here we see tonsils studded with white or yellow spots with congestion due to infection of the crypts of the tonsil.
Acute membranous tonsillitis
Here we see tonsils covered by a whitish/ yellowish patch over a congested tonsil.
Acute tonsillitis if not treated early and accurately can lead to complications like peritonsillar abscess, deep neck space infections which can be life threatening.
Recurrent Acute tonsillitis caused by group A beta haemolytic streptococcus can also lead to long term complications like Rheumatic fever, Glomerulonephritis and dermatitis.
Hence depending on the type of tonsillitis, patient will be either treated on OPD basis or by hospitalisation.Recurrent episodes of Acute tonsillitis leads to chronic tonsillitis which can warrant surgical removal of tonsils (tonsillectomy).
Chronic tonsillitis
This is a persistent inflammation of the palatine tonsils as a result of complication of acute tonsillitis or subclinical infection of the tonsils. Patients present with difficulty in swallowing, bad breath, poor appetite, recurrent episodes of sore throat. Main signs of chronic tonsillitis are - residual congestion of the anterior pillars, cheesy material expressed from tonsils (Irwin Moore sign), enlarged neck lymph nodes.
There are 3 types of chronic tonsillitis
Chronic parenchymatous tonsillitis- here there is enlargement of tonsils.
Chronic follicular tonsillitis- here the tonsils are studded by yellowish spots.
Chronic fibrotic tonsillitis- here the tonsils are small and congested.
Acute exacerbation is treated conservatively with antibiotics and analgesics. Chronic tonsillitis is treated by surgical removal of tonsils( Tonsillectomy). It is done under general anesthesia in an operation theatre. There are various methods like cold dissection, coablation assisted, electrocautery assisted, cryo method, laser assisted etc.Acute exacerbation is treated conservatively with antibiotics and analgesics. Chronic tonsillitis is treated by surgical removal of tonsils( Tonsillectomy). It is done under general anesthesia in an operation theatre. There are various methods like cold dissection, coablation assisted, electrocautery assisted, cryo method, laser assisted etc.
Chronic Adenoiditiss
This is the chronic inflammation of the adenoid tissue located in the nasopharynx. It is caused by virus or bacteria or as a part of generalised upper respiratory infection. It causes enlargement of the adenoids with or without enlargement of the tonsils. It leads to blockage of the Eustachian tube resulting in dysfunction and problems in the middle ear and difficulty breathing through nose. Patients present with typical facial features called “Adenoid facies”. It is characterised by open mouth, dull look, pinched up nose, crowded upper teeth, high arched palate. Main symptoms will be mouth breathing, snoring while sleeping, decreased hearing, recurrent history of upper respiratory infection. It is diagnosed based on history, diagnostic nasal endoscopy or X-ray neck. Depending on the grading, it can be treated by medications or may require surgical removal I,e. Adenoidectomy. When it is removed along with tonsils it’s called Adenotonsillectomy. There are various methods of doing Adenotonsillectomy like cold dissection using Adenoid curette, Microdebrider assisted endoscopic removal, coablation assisted etc. it is done under General Anesthesis in an operation theatre.
Tonsillar cyst
It is a type of retention cyst seen on the tonsils. It is caused due to obstruction to the crypts of tonsils. It is usually asymptomatic. It can present as bad breath, foreign body sensation in throat. There can be history of recurrent episodes of acute tonsillitis. On examination it appears as whitish yellow sac containing debris. Depending on the severity of symptoms, it has to be surgically removed along with tonsillectomy.
Tonsillolith
Also called tonsil stones. These are calcified deposits seen in the tonsils. Repeated infection of tonsils may be the cause. It presents as foreign body sensation in throat, bad breath, sore throat, difficulty in swallowing or even ear ache. It is treated by using medicated gargles and removal by an experienced doctor
Peritonsillar abscess
Also called “Quinsy”. It is one of the complications of acute tonsillitis which results in collection of pus in the space surrounding the tonsil. Patient will present with high grade fever associated with chills and rigours, difficulty in opening the mouth, sever pain in the throat, swelling in the neck. On examination there will be varying degree of trismus, congestion in the throat, bulge in the tonsillar region pushing the uvula to the opposite side. It is treated by draining the pus in the OPD setup by a wide bore needle aspiration or by doing incision and drainage using quinsy forceps. Patient is usually hospitalised and put on IV antibiotics and analgesics. Aspiration or drainage has to be repeated till the peritonsillar region is clear of any pus. If not treated early can lead to life threatening conditions like deep neck space infections.
Keratosis pharyngis
It is a chronic inflammation of the pharynx which is characterised by whitish/yellowish spots or patch covering the tonsils or the pharynx. It is caused due to persistent bacterial or fungal infection due to low immunity. Patient presents with bad breath, foreign body sensation in throat. It is also related to chronic GERD. Treatment with topical and systemic medications are given depending on the severity and the cause.
Oropharyngeal Candidiasis
This is a fungal infection caused by Candida albicans. Patient presents with whitish patches over the oropharynx which cannot be cleared, difficulty in swallowing and foreign body sensation. This is usually seen in immunocompromised patients.
Depending on the severity patients are treated with topical and systemic anti fungal medications.
Pharyngitis
This is a mucosal and submucosal inflammation of pharynx. Pharynx is prone to reactive changes in response to the virus and bacteria due to the presence of lymphoid tissues.
Pharyngitis is of 2 types
Acute pharyngitis
This is caused by various virus like Adeno virus, rhino virus, respiratory syncytial virus, influenza and parainfluenza virus and it can be a part of the exanthematous fevers like chicken pox(Varicella zoster) or measles. The causative bacteria are Strepotcoccus haemolyticus, pneumococcus, H.Influenza. The risk factors include cold and damp climatic conditions, local trauma, corrosive injury, exposure to smoke, dust, chemicals etc.
Patient presents with sore throat, fever, myalgia. It can be associated with other upper respiratory symptoms like runny/blocked nose, headache, earache. On examination we can see severe congestion of throat. It can also be associated with congestion of nasal mucosa, post nasal drip and swollen lymph nodes in the neck.
It is treated by antibiotics and supportive medications like analgesics and antipyretic.
Chronic pharyngitis
This may be due to a primary infection in the pharynx or by disease in the other parts of the respiratory tract like chronic rhinosinusitis, chronic tonsillitis, dental sepsis, gastritis, bronchitis, GERD and immunocompromised state. It can also be due to long term exposure to dust, smoke, irritant fumes, spicy food intake, Alcohol and smoking.
Patients presents with dry cough, foreign body sensation in throat, pain in throat and retching. On examination we can see severe congestion of throat with granularities on the pharyngeal wall. We can also see post nasal drip. On Laryngoscopic examination we can see congestion of the arytenoids and the mucosa of the larynx. Treatment of this can be challenging. It is treated depending on the cause by anti reflux medications, analgesics, antibiotics and other supportive medications.
Globus Pharyngeus
It is a chronic condition where patient presents with long term history of foreign body sensation in throat, difficulty swallowing. It is usually related to GERD (gastroesophageal reflux disease) or sometimes can be psychological. On examination minimal congestion of the throat can be seen and no other obvious findings. It is difficult to treat. Requires long term treatment with anti reflux medications and good counselling and reassurance.
Laryngopharyngeal reflux disease
This is a chronic condition related to GERD or post nasal drip which presents as chronic throat related issues like dry cough, sore throat, foreign body sensation, difficulty swallowing. On examination congestion of throat can be seen and on indirect laryngeal examination we can see congestion in the laryngeal mucosa and over arytenoids. It is treated by anti reflux and other supportive medications.
Benign and malignant lesions of oropharynx
The various benign lesions seen here are papilloma, hemangioma, lingual thyroid, epidermoid cysts, pleomorphic adenoma etc.
Malignant lesions seen here are mostly involving the tonsils, posterior pharyngeal wall, soft palate, base of tongue, vallecula and epiglottis. Risk factors are smoking and chewing tobacco. Patient presents with painful swallowing, difficulty swallowing, lump in the throat, muffled speech, difficulty in opening the mouth and swellings in the neck. It is diagnosed by clinical examination which will reveal a mass/ growth in the throat. Further extent is evaluated by laryngeal endoscopy. Confirmation is by tissue biopsy which is done on an OPD basis and the extent and other synchronous primary malignancies are evaluated by CT scan and Pan endoscopy. Earlier the detection better the chances of cure. Thus we will evaluate thoroughly and based on staging of cancer the various treatment modalities are explained. Depending on the type of malignancy It is treated by Radiation, chemotherapy or surgical. There are many advances in the surgical treatment of cancer like TORS (Trans-oral robotic surgery)and TLS (Trans-oral laser surgery) which aims at surgical debulking with clear margins. The prognosis is better when diagnosed early and treated early. .