December 22, 2006

Catarrh related Problems


There are many problems associated with Catarrh, some of the most commonest are explained below;

This is a condition often related to catarrhal symptoms. That is because the causes of catarrh are often the causes of snoring – large, fissured tonsils, often full of smelly debris (tonsilloliths = “tonsil stones”), a blocked nose, caused by polpys, chronic sinus disease or a deviated cartilaginous septum, or an elongated soft palate and uvula, the latter lying on the back of the tongue, causing the desire to clear the throat, yet nothing comes up. The uvula may also cause the feeling of something at the back of the tongue, postnasal drip, choking attacks at night.

A view of the back of the throat, small tonsils but a long soft palet and muscular uvula – causes snoring. - - - - - >

This basically means “stopping breathing at night”. It sounds worrying, and indeed it potentially is. Sleep apnoea is known to be associated with a wide range of conditions, not least heart disease, headaches, high blood pressure, loss of memory, irritability, loss of libido, daytime sleepyness etc. OSA is caused by obstruction to the breathing tube, which occurs somewhere in the nose or throat. It is often associated with being overweight. Other causes include large tonsils, large lingual tonsils (see elsewhere on this site), an oversized tongue, blocked nose, retrograde jaw, long soft palate and uvula. The treatment of OSA depends upon its severity, which can be diagnosed by means of simple sleep tests which measure flow of air and oxygen saturation. Severe OSA warrantd referral to a specialist with an interest in ventilation assistance – called CPAP. Mild to moderate OSA can often be controlled with a variety of local interventions, such as a Mandibular advancement splint, or correction of the relevant abnormality, e.g. with nose unblocking surgery, tonsillectomy, laser palatoplasty or somnoplasty.

This picture shows obstruction to the flow of air due to collapse of the palate and tongue base.
Large tonsils and lingual tonsils, or a blocked nose, all make this worse.

Sinus Problems
Chronic and acute sinus disease causes a number of catarrhal symptoms. These include loss of sense of smell and taste, chronic post nasal drip, nose blockage, facial pains and pressures. Sinus disease can be related to nose polyps, asthma, trauma, allergy and congenital problems. The treatment of sinusitis relies upon xray findings (usually CT scans) followed by medical treatment – steroids, antibiotics, decongestants etc. Should this therapy not work, surgical treatment can be instigated, usually with endoscopic functional surgical techniques.

Normal CT scan

Blocked Nose
Catarrh is sometime caused by this condition. That is because a chronically blocked and stuffy
nose leads to the sufferer breathing through his/her mouth. This bypasses the nose, whose function is to warm and humidify inspired air. Therefore the air that is breathed in is not optimal, so influencing the state of the mouth, throat and lung lining, leading to dryness, thick mucous and throat congestion – all catarrhal symptoms. Furthermore, nasal secretions, which usually pass down the nose unhindered, can become caught up in nasal obstruction – leading to damming and sudden flooding of mucous into the back of the mouth – one of the causes of postnasal drip.
Treatment depends upon the cause – it can range from the use of simple steam inhalations to day case operations under general anaesthetic.
A bent nasal septum seen from the right - - >

Bad breath
This condition is difficult to categorise – some catarrhal symptoms are associated with this. In particular, mouth breathing due to a blocked nose, large unhealthy tonsils full of white or yellow lumps, (sometimes with tonsillitis), dryness in the mouth and thickened mucous, constant throat clearing due to a large uvula can all cause this symptom. There are several different ways to improve these conditions, which mainly involve surgery.

A very common illness. Generally occurs in children, then burns itself out by the ag
e of 8 or 9. Some people however continue to suffer with a variety of symptoms well into adult life. This can be exacerbated or triggered by glandular fever in their teens. Typically, bad sore throats cause a high temperature, the patient feels very unwell, with painful glands in the neck. Several days off work or school is often required until the patient feels better – the whole episode can last up to 10 days. The usual treatment for tonsillitis requires drug management of the acute condition, although the role of antibiotics is unclear. Powerful painkillers / anti inflammatories such as Diclofenac usually help significantly. Long term, the best treatment is tonsillectomy, the use of lasers, such as the carbon dioxide laser in ablation mode, minimises post operative pain and complications.

Tonsilloliths (stones in the tonsils)
This is quite a common condition which people often don’t admit to. It can be associated with acute or chronic sore throats, or may simply occur on its own. It is due to the presence of fissures or crevices on the surface of the tonsils – some people have these, some don’t. If you have them, they can trap particles of food, which become organised over time, enlarging slowly. Eventually they extrude from the surface of the tonsil as a cheesy white or yellow lump. These can be picked off using toothpicks or tweezers etc. They are soft and smelly and can be quite off putting. The treatment is mainly surgical, lasers can e used to resurface or remove the crypts so that they can no longer collect food debris. This is a procedure performed using local anaesthetic spray only, and causes very little postoperative discomfort.

Lingual tonsils
These structures are separate from the normal tonsils we think of in the back of the throat. They sit just above the voice box, at the very bottom of the tongue. They are often the cause of sore throats when patients have already undergone tonsillectomy. They can also cause a variety of catarrhal symptoms when enlarged, in particular throat clearing, tickly cough and a lump sensation at the back of the tongue. The treatment of lingual tonsil problems usually requires thorough ENT assessment to establish the correct diagnosis (which is often missed). A long term combination of anti inflammatory and antibiotic drugs usually controls the condition. If surgery is required, this is quite complex and requires referral to a specialist centre.
Adapted from CATARRH Sponsored by London Laser Clinic(LLC)