Tonsils

Tonsils are made of soft glandular tissue and are part of the immune system. Tonsils vary in size from person to person. A main function of tonsils is to trap bacteria and viruses (germs) which you may breathe in. Antibodies and immune cells in the tonsils help to kill germs and help to prevent throat and lung infections.

Adenoids

Adenoids are also made of glandular tissue and are part of the immune system. They hang from the upper part of the back of the nasal cavity. Adenoids get bigger after you are born but usually stop growing between the ages of three and five years. Like tonsils, adenoids help to defend the body from infection. They trap bacteria and viruses which you breathe in through your nose. They contain cells and antibodies of the immune system to help prevent throat and lung infections.

Tonsillitis

Tonsillitis is an infection of the tonsils. A sore throat is the common symptom. In addition, you may also have a cough, fever, headache, feel sick, feel tired, find swallowing painful, and have swollen neck glands. Pus may appear as white spots on the enlarged tonsils. Symptoms typically get worse over 2-3 days and then gradually go, usually within a week. Most cases of tonsillitis are caused by viruses, some are caused by bacteria.

Do I need my tonsils taken out?

If you have frequent and severe bouts of tonsillitis. This usually means:
• Seven or more episodes of tonsillitis in the preceding year, or
• Five or more such episodes in each of the preceding two years, or
• Three or more such episodes in each of the preceding three years.
• The bouts of tonsillitis affect normal functioning. For example, they are severe enough to make you need time off from work or from school.
The adenoids may also be removed at the same time for this reason. Throat infections are not totally prevented if the tonsils are removed. However, there is a good chance that their number and severity will be reduced. Many people say they generally feel better in themselves after having their tonsils removed if they previously had frequent bouts of tonsillitis.
• If you have large tonsils that are partially obstructing your airway, this may be a contributing factor to a condition called obstructive sleep apnoea syndrome.

Some problems associated with adenoids

Swollen or enlarged adenoids are common in children. Causes include:

• Infections with viruses or bacteria. Once an infection clears, the swelling often goes down but sometimes the adenoids remain enlarged.
• Allergies.
• Often there is no apparent cause.

The adenoids may also be removed at the same time for this reason. Throat infections are not totally prevented if the tonsils are removed. However, there is a good chance that their number and severity will be reduced. Many people say they generally feel better in themselves after having their tonsils removed if they previously had frequent bouts of tonsillitis.

• Breathing through the nose may be noisy. This may get worse and cause difficulty breathing through the nose. The child then mainly mouth breathes.
• A constantly runny nose.
• Snoring at night. In severe cases sleep may be disrupted by the blocked nose and there is difficulty in breathing.
• Swollen adenoids may block the entrance of the Eustachian tube. This is the tube that goes from the back of the nose to the middle ear. It normally allows air to get into the middle ear. If this tube is blocked it may contribute to the formation of glue ear (fluid in the middle ear).

What is the treatment for enlarged adenoids?

In most cases, no treatment is needed. Often the symptoms are mild but may flare up during a cold or throat infection. Adenoids normally gradually shrink in later childhood and usually almost disappear by the teenage years. So symptoms tend to clear in time. If symptoms are severe then a doctor may consider removing the adenoids. For example, if a child regularly has difficulty sleeping or disrupted nights’ sleep due to a blocked nose. Also, some children with glue ear may benefit from removing the adenoids.

Hoarseness is an abnormal deep, harsh voice caused by a variety of conditions. Hoarseness is simply a term used to describe a voice that sounds raspy, strained or deeper in pitch. Changes in the voice are usually caused by a swelling, lump or bump on the vocal folds, the sound-producing portion of the larynx (or voice box). The vocal folds remain apart when breathing, but the sound is created when the vocal folds vibrate together. Swelling or other conditions which keep the vocal folds from coming together to vibrate properly can cause hoarseness or a change in voice pitch. These vocal fold conditions can be caused by straining the voice or by a relatively benign illness such as laryngitis. However, chronic, prolonged or reoccurring hoarseness may be a symptom of a more serious condition, such as a tumor of the larynx, and should be checked out by an otolaryngologist.

What causes hoarseness?

Hoarseness is generally caused by irritation of, or injury to, the vocal cords. The larynx (also referred to as the voice box), is the portion of the respiratory (breathing) tract containing the vocal cords. The cartilaginous outer wall of the larynx is commonly referred to as the “Adam’s apple.” The vocal cords are two bands of muscle that form a “V” inside the larynx. When we sing or speak, the vocal cords vibrate and produce sound. Hoarseness can be caused by a number of conditions. The most common cause of hoarseness is acute laryngitis (inflammation of the vocal cords) caused by an upper respiratory tract infection (usually viral), and less commonly from overuse or misuse of the voice (such as from yelling or singing).

What are the signs and symptoms of hoarseness?

Hoarseness typically gives the voice a raspy and harsh quality, though it may also cause a change in the pitch or volume of the voice. The rapidity of onset and any associated symptoms will depend on the underlying cause leading to hoarseness.

How are the causes of hoarseness diagnosed?

Your Otolaryngologist will ask questions about hoarseness and any other associated symptoms. A physical exam will focus on the head and neck. Often times, a diagnosis can be made based on this initial assessment. In some instances, a long lighted flexible tube (fiberoptic scope) will be inserted into the throat to directly visualize the vocal cords if no other cause is initially identified.

What is the treatment for hoarseness?

The treatment for hoarseness depends on the underlying cause, for example:

• Acute laryngitis caused by an upper respiratory tract infection will usually improve on its own as the infection clears the body.
• Voice rest is also recommended in order to avoid further irritation or injury to the vocal cords.
• Antibiotics are not indicated for most cases of acute laryngitis.
• Individuals with hoarseness caused by vocal overuse or misuse should adhere to voice rest, as serious injury can occur to the vocal cords if the voice is strenuously used during episodes of acute laryngitis.
• Medications for gastroesophageal reflux (GERD) or allergies can treat hoarseness if either of these is found to be the underlying cause. In some instances, surgery may be necessary for benign nodules or polyps, trauma to the larynx/vocal cords and for cancer of the larynx.

How is hoarseness prevented?

Hoarseness can be prevented in some instances, for example:

• Avoid situations that require excessive strenuous voice use, and if a person needs to project their voice, use a microphone if possible.
• Voice therapists or singing teachers may be helpful in certain cases to assist individuals with vocal training and voice modification.
• Smoking cessation can prevent hoarseness or the development of cancer of the larynx.
• Individuals with hoarseness caused by gastroesophageal reflux (GERD) can benefit from medications and dietary modification (such as avoiding alcohol, caffeine and spicy foods).

The vocal folds are the vocal cords along with the larynx or voice box are primarily responsible for the production of sound in humans. People who tend to strain their voice can develop vocal cord nodules. These nodules grow on the mucous membrane of the vocal cords.

Causes of Vocal Cord Nodules: People who stretch the limits of their voice or overly strain them or prone to develop these nodules. Teachers, singers, auctioneers, clergy members are usually the people who use their voices as part of their profession. Upon excessive usage, the voice would grow hoarse or breathy.

Vocal cord nodules may result in hoarseness, reduced vocal range, breaks in speech, and pain when speaking or singing. They appear on both sides of the vocal cords as symmetrical swellings and impact the vocal folds’ ability to rapidly change air pressure necessary to produce speech. Their cause is usually the result of strenuous vocal cord use, such as shouting, screaming, and coughing. People who must use their voices in loud settings are most susceptible to throat nodules. Singers, preachers, teachers, and drill instructors are at greatest risk for developing vocal cord nodules.

Tips for Voice Professionals

• Always warm up before a performance. This can include relaxation techniques and gentle exercise. Then warm up with singing exercises in the mid-range of the voice.
• Rest the voice between performances as much as possible, and avoid tension and stress.
• If you have not had formal voice training, learning vocal techniques from a singing coach or vocologist can protect and enhance your voice.
• Avoid smoky rooms, bars and places where the environment can negatively affect voice quality.
• Avoid pitching your voice at a lower or unnatural level.
• Use alcohol moderately, if at all.
• Keep the voice hydrated by drinking lots of water — at least eight to ten glasses each day, or more for those who are heavier.
• If your throat is dry, try sleeping with a humidifier.
• Practice a healthy lifestyle that includes aerobic exercise and a nutritious diet.

Diagnosis

These developments in the vocal folds would definitely affect the voice, but as such have no general health effects. But, it is important that this problem is corrected, for your profession might be at a stake, especially if you are a professional singer or teacher. Fibre Optic Laryngoscopy is often suggested by many physicians to detect the mucous growth in the voice box.

Treatment:

Treatment of vocal cord nodules often involves speech therapy and vocal training. Removal of the nodules is sometimes done surgically and is considered a relatively safe procedure. On occasion, it is necessary to address the psychological consequences of throat nodules, particularly in the case of singers and actors.

Snoring is a common problem that may occur alone or in combination with obstructive sleep apnea.

Primary snoring:

Snoring typically is caused by vibration of tissues within the oral pharynx (the uvula and palate). Nasal obstruction can be another cause. In mild snoring, these measures may help: losing weight, sleeping on your side rather than your back, avoiding sedatives and alcohol. Surgery can reduce the size of the soft tissue of uvula and palate, and also relieve nasal obstruction. Office turbinateurgery may also help snoring by improving nasal breathing.

Obstructive Sleep Apnea:

Obstructive apnea is a cessation of breathing that lasts ten seconds or more. Repeated episodes can significantly disrupt sleep. Manifestations of sleep apnea include snoring, restless sleep, and daytime fatigue. Many advances have been made in treatment of sleep apnea.

Snoring can be a funny situation at home, where everyone can get a good laugh out of the noise that’s coming from a sleeping family member. But unfortunately, this scenario does not remain a comical experience for too long. Both the snorer and their family may soon realize that this is a matter not to be taken lightly, especially if the condition escalates to persistent sleeplessness, disturbed sleep and breathing difficulty.

Snoring is a common sleep disorder that affects millions. Not that this is any consolation for the sufferer or their immediate family, but the good news is there are plenty of snoring cures available that can treat such disorders.

What are the causes of Oral sub-mucous fibrosis?

The reasons for Oral sub-mucous fibrosis are as follows:

• Chewable items such as betel nuts contain substances that irritate the oral mucosa thereby making it lose its elasticity. Pan Masala and gutkha contain a very high concentration of areca nut and consuming them regularly causes OSWF.
• Consumption of red chillies in large quantities.
• Immunological diseases.
• Climatic conditions that are extreme in nature
• Lack of iron & vitamins in the diet.

What is the treatment for Oral sub-mucous fibrosis?

The type of treatment to be rendered is dependent mainly on the stage of the disease. If you stop taking Pan Masala at the right time it is possible to reverse the disease. However, the existence of this disease is discovered when it reaches the moderate to the severe stage in most of the cases. Two types of treatments are given for Oral sub-mucous fibrosis – medical and surgical. Before treating this disease it is necessary to get biopsy screening done.
As a part of the treatment the patient should adhere to the following:

• Stop the habit of chewing betel nut and tobacco
• Minimize the consumption of spicy foods and chillies
• Maintain a good oral hygiene.
• Get the third molars extracted.
• Round off the sharp edges of teeth.
• Take Vitamin B Complex, Vitamin A and Vitamin C
• Take iron supplements.
• Practice muscle stretching exercise for the mouth

What are the medications for Oral sub-mucous fibrosis?

The following medical treatments are given:

• Weekly sub mucosal intra-lesional injection or topical application of steroids – dexamethasone, Triamcinolone, acetonide, and betamethasone valerate.
• Injection or topical hyaluronidase with or without steroids.
• Intralesional interferon gamma.
• Submucosal injection of healthy human placental extracts.

What are the surgical treatments for Oral sub-mucous fibrosis?

The following surgical treatments are given: Surgical treatment includes reconstructive surgery by an orofacio-maxillary or plastic surgeon. Simple excision of a fibrous band is to be avoided to prevent contracture of tissue and exacerbation.