Throat & Mouth

Problems in the throat and mouth (oropharynx and oral cavity) can range from being a small annoyance to a major issue. CornerStone Ear, Nose & Throat specializes in diagnosing and treating all types of throat and mouth disorders. Our ENT physicians will provide a thorough examination and determine the proper course of treatment for patients of all ages with mouth and throat concerns, especially if primary care or urgent care providers have not fully resolved the issue. Several of the most common types of throat and mouth disorders are listed below.

Sore Throat

A sore throat is usually due to an infection caused by a virus or bacteria, but other causes such as trauma, foreign bodies, reflux, ulcerations, neurologic disorders, boney abnormalities, scar tissue, and even tumors can originally present themselves with symptoms of sore throat. Other frequent contributing factors to sore throats include environmental allergies, sinus infections with resultant postnasal drip, gastric reflux into the throat, as well as irritation from dry heat, pollutants, chemicals, and voice strain.

A mild sore throat can often be treated conservatively by increasing liquid intake, using a steamer or humidifier, gargling with warm salt water, and taking over-the-counter pain relievers like acetaminophen or Ibuprofen.

If your sore throat is more severe, is not related to an identified and avoidable allergy or another source of irritation, and lasts longer than five to seven days, you should seek medical care from your primary care physician if you have one. If your sore throat becomes recurrent or chronic (lasting more than 12 weeks), CornerStone Ear, Nose & Throat physicians can assist your doctor by determining if different antibiotics are needed, or if your sore throat is the symptom of a more serious condition, such as an abscess or tumor.

The following signs and symptoms related to a persistent sore throat should alert you to see a primary care, emergency, or urgent care physician:

  • A sore throat lasting more than five days
  • Difficulty swallowing
  • Difficulty opening the mouth
  • Joint pain
  • Earache
  • Rash
  • Fever (over 101°)

When the sore throat lasts constantly for more than a month despite medical therapy or occurs in a smoker or person who drinks or drank a significant amount of alcohol over time, or if the following signs are also noticed, an ear, nose and throat specialist (otolaryngologist) should be consulted immediately:

  • Blood in saliva or phlegm
  • Lump in the neck
  • Weight loss
  • Difficulty breathing
  • Hoarseness for more than a month

Dysphagia (Difficulty Swallowing)

Dysphagia is a condition that can happen to us at any age but is most common among older adults. People with dysphagia have a problem swallowing food or liquids from the mouth and throat down into the stomach. This condition is usually temporary and is rarely linked to a more serious disease, such as a tumor or neurological disorder. However, if the problem does not clear up by itself in a short period of time, it is important to seek medical care. The physicians for CornerStone Ear, Nose & Throat have the experience to assist you or a family member with this condition.

Common Causes Of Dysphagia Include:

  • Unhealthy teeth leading to inadequate chewing of the food bolus prior to swallowing
  • Age-related muscle weakness
  • Dentures that do not fit properly
  • The common cold
  • Pharyngitis (sore throat)
  • Gastroesophageal reflux (heartburn)
  • Diabetes
  • Stroke
  • Foreign body or food lodged in the swallowing passages

To diagnose the cause of a swallowing disorder, it may be necessary for our doctors to perform a fiber-optic endoscopic laryngoscopy. In some cases, a barium swallow or modified barium swallow with a speech therapist present or evaluation by a gastroenterologist will be recommended instead. The fiber-optic endoscopic laryngoscopy involves topical numbing spray in the nose followed by the use of a small tube that runs through the patient’s nose and into the throat. A barium swallow is an X-ray with contrast to see the shape and structures of the back of the tongue, throat, and esophagus during the swallowing process. Neither test is painful or to be avoided due to anxiety. Once the cause of the swallowing problem is determined, an effective treatment plan can be created.

Treatment Options For Swallowing Disorders

Medication – Muscle relaxants, antacids, antihistamines and other drugs can provide relief, depending on the cause of the swallowing disorder.

Swallowing Therapy – Exercises can help stimulate nerves that trigger the swallowing reflex and techniques can be taught to help patients feed themselves more efficiently with less risk of aspiration into the lungs, which can cause pneumonia.

Surgery – If a physical narrowing or blockage exists in the throat or esophagus, due to scar tissue, inflammation, or growth, a biopsy or surgical stretching or removal may be necessary.

Tonsillitis

At some point, almost every child in the United States will have at least one episode of tonsillitis. This is the most common form of bacterial pharyngitis, especially in school-aged children. This bothersome and often painful condition occurs when the palatine tonsils, which are lymphoid (antibody producing) organs on the side of the throat, become inflamed due to a viral or bacterial infection.

Types Of Tonsillitis And Associated Symptoms

Acute tonsillitis – Symptoms typically include fever, sore throat, bad breath, difficulty swallowing, and painful swallowing. Sometimes the patient develops mouth breathing, snoring, sleep apnea, a “scarlatina” rash (scarlet fever), and a feeling of lethargy. These symptoms can last from three days up to two weeks. By definition, acute tonsillitis lasts for less than four weeks, and typically each episode responds well to oral antibiotics and hydration of the patient.

Recurrent tonsillitis – When a patient has multiple episodes of acute tonsillitis (see above symptoms) in a single year, he or she is said to have recurrent tonsillitis. Typically, an ENT doctor will be consulted after a patient experiences five to six episodes of acute tonsillitis in a 12-month period.

Chronic tonsillitis – Symptoms include chronic sore throat, bad breath, tonsillitis, and persistently tender cervical nodes. This condition is often associated with a related condition called tonsillar cryptitis with or without cryptic debris. This refers to chronic infection of the pockets of the tonsils with or without a buildup of organic material, sometimes inaccurately called “tonsil stones” (or tonsilloliths). Tonsil stones and chronic tonsillitis are among the most common reasons adults seek to have their tonsils out.

Peritonsillar abscess – Severe throat pain, fever, drooling, foul breath, difficulty opening the mouth (trismus), and muffled voice quality are typical symptoms of a patient with a peritonsillar abscess. This condition is extremely uncomfortable and develops rapidly over a few days, often in patients with no prior history of tonsillitis. Patients with a peritonsillar abscess invariably have pain much worse on one side of the throat than the other. This can be true for acute tonsillitis, but not as predictably so. If suspicious of a peritonsillar abscess, the patient should seek emergency or ENT care immediately.

Treatment Of Tonsillitis

Antibiotics are the standard initial treatment for most forms of tonsillitis. If the problem is chronic or recurrent, a tonsillectomy, or surgery to remove the tonsils (usually with the adenoids as well, which are simply tonsils in the back of the nose), is often recommended. In the case of peritonsillar abscess, drainage via incision or needle aspiration is almost always necessary. Historically, electrical cautery has been the most common method for the removal of tonsils. However, this process burns the tissue at very high temperatures, effectively creating a third-degree burn in the throat of the patient and subsequently thick eschar (scabs) that must heal.

At CornerStone Ear, Nose & Throat, we exclusively use a Coblation® device, as opposed to using an electrocautery device or cold steel knife, to make an incision to cut away the tissue. The Coblation procedure typically results in much less risk of bleeding and pain for the patient. This is largely because while the electrocautery device operates at several hundred degrees Celsius (and leaves a third-degree burn in the throat), the Coblation device works at about 70 degrees Celsius under constant cool saline (saltwater) irrigation. With Coblation, the tissue is cut and cooled simultaneously, avoiding a deep thermal burn, which would be more likely to lead to dehydration and bleeding during the healing process. This allows patients to tolerate fluids and food more quickly, while allowing them to recover in less time with fewer complications and less discomfort, according to multiple published studies as well as our practice’s lengthy experience performing the procedure.

Reflux Disorders

Gastroesophageal Reflux (GERD)

Gastroesophageal reflux disease, also known as GERD, takes place when the lower esophageal sphincter (LES) does not work adequately, allowing stomach acid to enter into the esophagus in significant amounts. This results in the sensation of “heartburn.” Normally, the LES constricts to prevent contents in the stomach from refluxing into the esophagus. Most people experience heartburn from time to time, but if it starts occurring more than twice a week, you may have Gastroesophageal reflux disease.

  • Symptoms Of GERD
  • Persistent or frequent heartburn
  • Acid regurgitation into the throat with sour taste and nausea
  • Pain in the chest that mimics a heart attack
  • Hoarseness, especially in the morning
  • Trouble swallowing
  • The sensation of having food or phlegm stuck in the throat
  • Dry, irritative cough
  • Bad breath

Laryngopharyngeal Reflux (LPR)

Laryngopharyngeal reflux (LPR) is similar to GERD but has several notable differences. Many patients with LPR do not experience heartburn because the volume and frequency of refluxing are not high. However, patients with LPR have the acidic stomach contents continue past the upper esophageal sphincter and into the back of the throat. While the esophagus is a hearty, muscular organ designed to handle some reflux as well as spicy food and even caustic substances such as alcohol on occasion, the larynx or voice box, in contrast, is a delicate organ that is severely irritated by even a small amount of the digestive enzymes in the gastric contents. This invariably causes swelling of the soft tissues, which to the patient feels like phlegm in the throat that they just cannot clear.

Symptoms Of LPR In Adults

  • Frequent nonproductive throat clearing
  • Feeling that something is stuck in the throat
  • A bitter taste
  • A sensation of burning or soreness, often worse on one side of the throat
  • Hoarseness
  • Difficulty swallowing

Symptoms Of LPR In Infants And Children

  • Cough
  • Hoarseness
  • Stridor (noisy breathing)
  • Croup
  • Asthma
  • Sleep-disordered breathing
  • Feeding difficulty (spitting up)
  • Turning blue (cyanosis)
  • Aspiration
  • Sleep apnea
  • Severe deficiency in growth

Causes Of GERD And LPR

Alcohol use, obesity, pregnancy, over-eating, anatomical abnormalities, and smoking can all make it more likely for a person to have gastroesophageal reflux disease and laryngopharyngeal reflux disease. Certain foods can also trigger the conditions, such as dairy products, chocolate, spicy foods, caffeinated recreational beverages, and tomato-based foods.

Early Detection & Treatment Is Important

If left untreated, GERD and LPR can result in more serious medical problems, including ulcers, precipitated asthma attacks in asthmatics, throat and laryngeal inflammation, secondary inflammation, and infection of the lungs, and even collection of fluid in the sinuses and middle ear in rare cases. GERD can also cause Barrett’s Esophagus, a condition that along with LPR has been found to lead to cancer in some patients.

The ENT physicians at CornerStone Ear, Nose & Throat have the expertise to diagnose GERD and LPR. If appropriate, a videostroboscopy may be recommended to obtain a more precise and baseline diagnosis. Patients with predominantly GERD symptoms are more typically referred to a gastroenterologist for ongoing diagnosis and treatment.

Mouth Sores

Two of the most common mouth sores are fever blisters (also known as cold sores) and canker sores (also known as aphthous ulcers). Although they are very similar, these two conditions have distinct differences.

Fever Blisters (Herpes Simplex Virus Type 1)

These fluid-filled blisters usually appear on the lips but can occur on the gums and roof of the mouth, especially in the initial infection. When multiple blisters are seen in and around the mouth, typically that is indicative of a primary herpes simplex virus infection. These outbreaks can be severe in some cases until the body builds up antibodies against the virus. Isolated fever blisters are caused when the herpes simplex virus in a previously infected patient is activated by stress, fever, trauma, hormonal changes, or sunlight. These sores represent “secondary infections” and are usually painful even before they are visible. The blisters rupture within hours of appearing, crust over, and last seven to 10 days. Fever blisters tend to reappear in the same location.

Fever blisters are contagious from the time the blister ruptures until the sore is completely healed. The virus can spread to the person’s eyes and genitalia, as well as to other people. Therefore, it is important for people with a fever blister to avoid touching the blister and to wash their hands thoroughly before touching their eyes, genital area, or another person. Note: Despite all precautions, it is possible to transmit the herpes virus even when no blisters are present.

There is no cure for fever blisters, nor is there a reliable way to ensure that they will not recur. Typical treatment consists of coating the sores with a protective barrier ointment until they heal, and/or use of an oral or topical antiviral medication as soon as the symptoms of a fever blister are detected.

Canker Sores

Eighty percent of the U.S. population between the ages of 10 to 20 experience canker sores at some point in their lives. Women are more likely to get this condition. Canker sores also called aphthous ulcers, or aphthous stomatitis, are small, red, or white ulcers that can appear on the tongue or inside the lips and cheeks. Canker sores can be very painful, and usually, last five to 10 days if they are of normal size.

Unlike fever blisters, canker sores are not known or suspected to be caused by a virus or bacteria. Instead, they are thought to be a local breakdown of the oral mucosa for local or systemic reasons. They are linked to stress, trauma, irritation, and acidic foods such as tomatoes, citrus fruits, and some nuts. This means canker sores are not contagious.

Treatment usually involves relieving discomfort and guarding against infection by using a topical corticosteroid and protective watertight barrier.

When To See A Doctor

If a mouth sore has not healed within two weeks, you should see a physician to rule out infection or other more serious conditions. It is important to remember that the first sign of oral cancer is a mouth sore that does not heal. However, it should be noted that there is a subclass of patients who develop severe and relapsing aphthous stomatitis. Sometimes those ulcers can grow to several centimeters and be destructive, leaving soft tissue defects and scarring in some cases. In such situations, the ulcer can take three months or longer to heal, and there can be multiple ulcers at one time. This is a truly terrible condition to endure, and ENT evaluation to rule out cancer and treat symptomatically is typically sought.

Other Types Of Mouth Sores That May Cause Concern

Leukoplakia – This thick, whitish-color patch on the inside of the cheeks, gums or tongue is common among tobacco users and can progress to cancer.

Candidiasis – This fungal infection (also called moniliasis or oral thrush) is common among denture wearers, the very young, the elderly, and those who have a problem with their immune system or have recently been on antibiotics.

Oral and Pharyngeal Cancer – These sores may appear as a white or red patch in the mouth, or a small ulcer that looks like a canker sore, initially. Oral cancer is most common on the lips, tongue, and the floor of the mouth (under the tongue). However, especially in those who drink or drank a lot of alcohol, the tonsil area, tongue, palate, lower throat (hypopharynx), and esophagus areas are also often involved. Accompanying symptoms can include a lump inside the mouth or neck; pain or difficulty in swallowing, speaking, or chewing; any wart-like mass visible in the mouth or throat; weight loss; or hoarseness that lasts for more than four weeks. Pain radiating up to the ear on the same side as the sore throat is also a sign of possible invasive cancer, though infection and ulcers can cause the same symptom of referred pain. It should be noted that smokers who never drank a lot of alcohol are more likely to have cancer develop in the area of the voice box (larynx). Oropharyngeal and laryngeal cancers are also often associated with the human papillomavirus (HPV), and those cancers consistently have a much better prognosis when properly treated.