Laryngopharyngeal Reflux and Children

Food or liquids that are swallowed travel through the esophagus and into the stomach where acids help digestion. Each end of the esophagus has a sphincter, a ring of muscle, that helps keep the acidic contents of the stomach in the stomach or out of the throat. When these rings of muscle do not work properly, you may get heartburn or gastroesophageal reflux (GER). Chronic GER is often diagnosed as gastroesophageal reflux disease or GERD.


Sometimes, acidic stomach contents will reflux all the way up to the esophagus, past the ring of muscle at the top (upper esophageal sphincter or UES), and into the throat. When this happens, acidic material contacts the sensitive tissue at back of the throat and even the back of the nasal airway. This is known as laryngopharyngeal reflux or LPR.


During the first year, infants frequently spit up. This is essentially LPR because the stomach contents are refluxing into the back of the throat. However, in most infants, it is a normal occurrence caused by the immaturity of both the upper and lower esophageal sphincters, the shorter distance from the stomach to the throat, and the greater amount of time infants spend in the horizontal position. Only infants who have associated airway (breathing) or feeding problems require evaluation by a specialist. This is most critical when breathing-related symptoms are present.


What are symptoms of LPR?

There are various symptoms of LPR. Adults may be able to identify LPR as a bitter taste in the back of the throat, more commonly in the morning upon awakening, and the sensation of a “lump” or something “stuck” in the throat, which does not go away despite multiple swallowing attempts to clear the “lump.” Some adults may also experience a burning sensation in the throat. A more uncommon symptom is difficulty breathing, which occurs because the acidic, refluxed material comes in contact with the voice box (larynx) and causes the vocal cords to close to prevent aspiration of the material into the windpipe (trachea). This event is known as “laryngospasm.”


Infants and children are unable to describe sensations like adults can. Therefore, LPR is only successfully diagnosed if parents are suspicious and the child undergoes a full evaluation by a specialist such as an otolaryngologist. Airway or breathing-related problems are the most commonly seen symptoms of LPR in infants and children and can be serious. If your infant or child experiences any of the following symptoms, timely evaluation is critical.


Chronic cough
Hoarseness
Noisy breathing (stridor)
Croup
Reactive airway disease (asthma)
Sleep disordered breathing (SDB)
Frank spit up
Feeding difficulty
Turning blue (cyanosis)
Aspiration
Pauses in breathing (apnea)
Apparent life threatening event (ALTE)
Failure to thrive (a severe deficiency in growth such that an infant or child is less than five percentile compared to the expected norm)
What are the complications of LPR?


In infants and children, chronic exposure of the laryngeal structures to acidic contents may cause long term airway problems such as a narrowing of the area below the vocal cords (subglottic stenosis), hoarseness, and possibly eustachian tube dysfunction causing recurrent ear infections, or persistent middle ear fluid, and even symptoms of “sinusitis.” The direct relationship between LPR and the latter mentioned problems are currently under research investigation.

How is LPR diagnosed?

Currently, there is no good standardized test to identify LPR. If parents notice any symptoms of LPR in their child, they may wish to discuss with their pediatrician a referral to see an otolaryngologist for evaluation. An otolaryngologist may perform a flexible fiberoptic nasopharyngoscopy/laryngoscopy, which involves sliding a 2 mm scope through the infant or child’s nostril, to look directly at the voice box and related structures or a 24 hour pH monitoring of the esophagus. He or she may also decide to perform further evaluation of the child under general anesthesia. This would include looking directly at the voice box and related structures (direct laryngoscopy), a full endoscopic look at the trachea and bronchi (bronchoscopy), and an endoscopic look at the esophagus (esophagoscopy) with a possible biopsy of the esophagus to determine if esophagitis is present. LPR in infants and children remains a diagnosis of clinical judgment based on history given by the parents, the physical exam, and endoscopic evaluations.

How is LPR treated?

Since LPR is an extension of GER, successful treatment of LPR is based on successful treatment of GER. In infants and children, basic recommendations may include smaller and more frequent feedings and keeping an infant in a vertical position after feeding for at least 30 minutes. A trial of medications including H2 blockers or proton pump inhibitors may be necessary. Similar to adults, those who fail medical treatment, or have diagnostic evaluations demonstrating anatomical abnormalities may require surgical intervention such as a fundoplication.

Adapted from: American Academy of Otolaryngology--Head and Neck Surgery

Croup and Your Child

Croup is an infection usually caused by one of the cold viruses. Croup causes the trachea (windpipe) and larynx (voice box) to swell. This infection usually lasts 5 to 6 days and is more common during the winter months and early spring.

Children who are 5 years old or younger are more likely to have croup. If your child was born prematurely, he or she is also at higher risk of getting croup.

How do I know if my child has croup?
If you're not sure if your child has croup, your doctor can diagnose it. The most common symptoms of croup are fever, hoarseness and a barking, hacking cough. Croup may also cause a crowing noise (called stridor) when the child breathes in through the narrowed windpipe. Croup symptoms tend to affect children 1 to 3 years old more severely and may worsen at night.


What should I do if my child has croup?
Most children with mild croup can be treated at home. You should make your child as comfortable as possible. Make sure that your child gets plenty of rest and plenty to drink. When your child has a croupy cough, it is very important to increase the amount of liquids that he or she drinks. Cough medicines are generally not recommended. You may give your child acetaminophen (brand names: Children's Tylenol, Infants' Tylenol) for his or her chest discomfort or discomfort due to fever.

If your child has a mild attack of stridor, try having him or her breathe moist air. This is called mist treatment. You can give your child a mist treatment at home by:

Having your child breathe through a warm, wet washcloth placed over the nose and mouth.

Running hot water in your shower with the bathroom door closed. Once the room has become steamy or has fogged up, sit with your child in the room for about 10 minutes.

Cool air may also help reduce the swelling in your child's airways. In cooler months, taking your child outside for a few minutes may bring some relief.


What if home treatment doesn't work?
Most children with croup will get better with treatment at home. But if your child's croup symptoms are severe or don't seem to be responding to home treatment, call your doctor. He or she may prescribe medication to help reduce the swelling in your child's airways.

When should I call the doctor?
Watch your child closely and call your doctor if:

Your child starts drooling or has trouble swallowing.
Your child's lips and skin are bluish or turn dark.
Your child's breathing doesn't sound better after mist treatment.
Your child is cranky or constantly uncomfortable.
Your child's breathing becomes more difficult.
Your child seems to feel worse.
You are worried.

Adapted from: American Academy of Family Physicians

Strep Throat

A sore, scratchy throat is often the first sign that you're getting sick, and it's a common reason people see their doctors. Most sore throats, such as those that accompany a cold or the flu, are caused by viral infections and usually go away on their own within a few days.

Only a small portion of sore throats are the result of strep throat. But it's important to identify this bacterial throat infection for a number of reasons. Unlike other causes of sore throat, strep throat is treatable. The bacteria that cause strep throat respond quickly to antibiotics, and treatment stops the infection from spreading to other people.

If not treated, strep throat infections can sometimes cause complications such as rheumatic fever. Rheumatic fever can cause painful and inflamed joints and a rash, and can even result in damage to heart valves. Another potential complication of strep throat infections is kidney inflammation.

Strep throat is most common in children between the ages of 5 and 15, but it affects people of all ages. In addition to throat soreness, signs and symptoms typically include a fever plus tender and swollen lymph glands (nodes) in the neck. Younger children may also complain of abdominal pain.

If you or your child has signs or symptoms of strep throat, see your doctor. A quick test can result in diagnosis of strep throat in most cases, so that treatment can start promptly.

Signs and symptoms
In general, signs and symptoms of strep throat include:

Throat pain
Difficulty swallowing
Red and swollen tonsils, sometimes with white patches or streaks of pus
Swollen, tender lymph glands (nodes) in your neck
Fever
Headache
Rash
Stomachache and sometimes vomiting, especially in younger children

It's possible for you or your child to have many of these signs and symptoms, but not have strep throat. The cause of these signs and symptoms could be a virus, tonsillitis or other illnesses. That's why your doctor generally tests specifically for strep throat.

It's also possible to have the bacteria that cause strep in your throat without having a sore throat. Some people are carriers of strep, which means they can pass the bacteria on to others, but the bacteria no longer make them sick.

Causes
The cause of strep throat is bacteria known as Streptococcus pyogenes, or group A beta-hemolytic streptococcus.

Streptococcal bacteria are highly contagious. They can spread through airborne droplets when someone with the infection coughs or sneezes. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose or mouth. Kitchen utensils and bathroom objects are other common sources of infection transmission.

Risk factors
Strep throat occurs most commonly in children between the ages of 5 and 15.

Children with recurrent strep throat whose tonsils are intact are more than three times as likely to develop subsequent episodes of strep throat as are children who've had their tonsils removed, according to a 2006 Mayo Clinic study.

While strep throat can occur at any time of the year, it tends to circulate in late fall, winter and early spring. Strep bacteria flourish wherever groups of people are in close contact. That's why the infection spreads easily among family members, in schools and in child care settings.

When to seek medical advice
Call your doctor if you or your child has any of these signs and symptoms:

A sore throat without a cold or runny nose
A sore throat accompanied by tender, swollen lymph glands (nodes)
A sore throat that lasts longer than 48 hours
A fever higher than 103 F in older children, or any fever lasting longer than 48 hours
Rash
Joint pain
Problems breathing or difficulty swallowing anything, including saliva
Call your doctor if you or your child doesn't feel better after taking antibiotics for 24 to 48 hours. Sometimes problems occur even after you or your child has finished treatment for strep throat.

Call your doctor if your child develops a fever — or has pain or swelling in the joints, shortness of breath or a rash — after a strep infection, even as long as three weeks after a strep infection. These can be indicators of rheumatic fever. Cola-colored urine after a strep throat infection may indicate kidney inflammation.

Screening and diagnosis
Doctors usually diagnose the cause of a sore throat on the basis of a physical exam and lab tests. During the exam, your doctor looks for signs and symptoms of strep throat, such as fever and enlarged lymph nodes, and will probably use a tongue depressor to get a good look at the throat and tonsils.

He or she will check for redness, swelling and white streaks or pus on the tonsils. There also may be tiny red spots on the soft or hard palate — the area at the back of the roof of the mouth. Although these signs indicate an infection, there's no way to tell by just looking whether it's viral or bacterial. In fact, some viral throat infections look worse than infections caused by streptococcal bacteria.

For that reason, your doctor is likely to use one or more of the following tests to check for the presence of bacteria, including streptococcal bacteria:

Throat culture. For this test, a sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It's not a painful procedure, but it may cause brief gagging. The sample is then cultured in a laboratory for the presence of bacteria, but results may take as long as two days.

Rapid antigen test. Because of the waiting period for a throat culture, your doctor may also order a rapid antigen test on the swab sample. This test can detect strep bacteria in minutes by looking for foreign substances (antigens) in the throat. If you or your child tests positive for strep bacteria, antibiotic treatment can begin right away. But rapid strep tests have a downside. They may miss some strep throat infections. For this reason, many doctors still use throat cultures, especially if results of the rapid test are negative.

Rapid DNA test. Newer rapid tests use DNA technology to detect strep throat in a day or less from a throat swab. These tests are as accurate as throat cultures and the results are available sooner

Complications
Although strep throat itself isn't dangerous, it may lead to serious complications if left untreated. These complications include other infections, such as:

Tonsillitis or a collection of pus around the tonsils caused by infection (peritonsillar abscess)
Sinus infection (sinusitis)
Ear infection
Scarlet fever, an illness characterized by a rash
Strep throat may also lead to inflammation of the kidney (glomerulonephritis) and rheumatic fever.

Rheumatic fever causes inflammatory deposits (nodules) to form in various tissues, including the joints, skin and muscles. These nodules also may form on the heart muscle, the lining of the heart and especially the heart valves, causing scarring that can interfere with the flow of blood inside the heart. Although surgery can sometimes repair scarred valves, the damage may be permanent. In some cases this damage may lead to heart failure. However, the risk of developing severe complications from strep throat is low in the United States.

Treatment
If you or your child has strep throat, your doctor will likely prescribe an oral antibiotic such as penicillin, amoxicillin (Amoxil, Trimox), azithromycin (Zithromax), clarithromycin (Biaxin), clindamycin (Cleocin) or a brand of cephalosporin (Keflex, Ceclor). Penicillin may be given by injection in some cases — such as if you have a young child who is having a hard time swallowing or is vomiting from strep throat.

These antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to classmates or family members.

Once treatment begins, you or your child should start feeling better in just a day or two. Call your doctor if you or your child doesn't feel better after taking antibiotics for 24 to 48 hours. If children on antibiotic therapy feel well and don't have a fever, they often can return to school or child care when they're no longer contagious — usually 24 hours after beginning treatment. But be sure to finish the entire course of medicine. Stopping medication early may lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.

In addition to antibiotics, your doctor may suggest ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) to relieve throat pain and reduce fever. Because of the risk of Reye's syndrome, a potentially life-threatening illness, don't give aspirin to young children. Be careful with acetaminophen, too. Taken in large doses, it can cause serious problems. Talk to your doctor or pharmacist if you have questions.

Prevention
Proper hand cleaning is the best way to prevent all kinds of infections. That's why it's important to clean your own hands regularly and to teach your children how to clean their hands properly, using soap and water or an alcohol-based hand sanitizer.

In addition, teach your children to cover their mouths when they cough or sneeze. And if you or your child does have strep throat, don't share drinking glasses or eating utensils. Wash those items carefully in hot, soapy water or in a dishwasher.

For some children who struggle with recurrent strep throat, removing the tonsils (tonsillectomy) may provide relief. The decision to remove a child's tonsils must be weighed against various factors, however, including the risks of anesthesia and bleeding after the procedure and missed school days to recover from the procedure.

Self-care
In most cases, antibiotics will quickly wipe out the bacteria behind the infection. In the meantime, try these tips to relieve symptoms of strep throat:

Get plenty of rest. Sleep helps your body fight infection. If you have strep throat, stay home from work if you can. If your child is ill, keep him or her at home until there's no sign of fever and he or she feels better.

Drink plenty of water. Keeping a sore throat lubricated and moist eases swallowing. Drinking plenty of water also helps prevent dehydration.

Eat soothing foods. Foods that are easy on a sore throat include broths, soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You may even want to puree foods in the blender to make them easier to swallow. Very cold foods such as sherbet, frozen yogurt or frozen fruit pops also may be soothing. Avoid spicy foods or acidic foods such as orange juice.

Gargle with warm salt water. For older children and adults, gargling several times a day can help relieve throat pain. Mix 1/4 teaspoon of table salt in 8 ounces of warm water. Be sure to tell your child to spit out the liquid after gargling.

Use a humidifier. Adding moisture to the air can help ease discomfort. Moisture keeps mucous membranes in your throat from becoming dry and even more irritated. Choose a cool-mist humidifier and clean it daily, because bacteria and molds can flourish in some humidifiers. Saline nasal sprays also help to keep mucous membranes moist.

Stay away from irritants. Cigarette smoke can irritate a sore throat and increase the likelihood of infections such as tonsillitis. In addition, avoid fumes from paint or cleaning products, which can be irritating to your throat and lungs.

Plan low-key activities for a sick child. If your child tests positive for strep throat, he or she should take antibiotics for at least 24 hours before returning to school or child care. When staying home with your child, plan some low-key activities that you both can enjoy. These can be things you don't normally have time to do, such as reading a favorite book aloud.

Adapted from: Mayo Foundation for Medical Education and Research

Peritonsillar Abscess (Quinsy)

The peritonsillar space lies between each tonsil and the wall of the throat. An infection can cause a pus-filled swelling (abscess) to develop in this space. Peritonsillar abscesses, also called quinsy, usually occur as a complication of tonsillitis. They are most often caused by "strep throat" bacteria (group A beta-hemolytic streptococci).

If a peritonsillar abscess is not treated promptly, the infection can spread to the neck, roof of the mouth and lungs. Swelling can push the tonsil into the center of your throat and move the uvula (the flap of tissue hanging in the back of your throat) from the center toward the unaffected side of your throat. In severe cases, swelling can make breathing difficult or can close your airway.

Peritonsillar abscesses are most often found in older children, adolescents and young adults. They are less common than in the past because tonsillitis is now often treated with antibiotics, which destroy the infection-causing bacteria.

Symptoms
Symptoms include:

A very sore throat
Difficulty swallowing or opening the mouth wide
Swollen glands in the neck
Headache
Chills or fever
Swelling of the face
Specific changes in speech, sometimes called "hot potato voice" because it sounds as if you're talking around a mouthful of hot mashed potatoes
Diagnosis

Your doctor will examine your throat, mouth and neck, and swab your throat. Material on the swab is sent to the laboratory, which can identify the type of bacteria causing the infection. Your doctor may look at your throat by using a small telescope on flexible lighted tube, called an endoscope. He or she may order an X-ray or computed tomography (CT) scan to better see the extent of infection in the soft tissues of the neck.

Expected Duration
After treatment, symptoms should disappear within five to seven days.

Prevention
Tonsillitis should be diagnosed and treated as soon as possible to help prevent a peritonsillar abscess from developing.

Treatment
Your doctor will prescribe antibiotics to treat the infection. In severe infections, antibiotics may be given intravenously (into a vein). Usually, you will need to take antibiotics for at least 10 days. It is important to take all the medication prescribed, even if you start feeling better.

Many abscesses do not respond to antibiotics alone and need to be drained. This can be done with a needle or by making a small incision in the abscess and suctioning out the fluid. This can be done in a doctor's office or emergency room, but occasionally may need to be done in an operating room, especially if the infection has extended down into your neck. Your doctor will provide sedation and pain medication to make you comfortable during this procedure. Because the symptoms make it difficult to eat or drink, some people need intravenous fluids (injected into a vein) to treat or prevent dehydration.

If tonsillitis or a peritonsillar abscess keeps coming back, you may need to have your tonsils surgically removed in a procedure called a tonsillectomy.

When To Call A Professional
Call your doctor if:

You have a severe sore throat, especially with a fever, or have been exposed to someone with strep throat
You have a sore throat combined with difficulty swallowing, a change in voice or swelling of the face
If you have been treated for a peritonsillar abscess, but you still have symptoms after two to three days, visit your doctor again.

Adapted from: Harvard Medical School, InteliHealth

Laryngitis

Laryngitis is an inflammation of your voice box (larynx) due to overuse, irritation or infection. The larynx is a framework of cartilage, muscles and mucous membranes that forms the entrance of your windpipe (trachea). Inside the larynx are your vocal cords — two folds of mucous membrane covering muscle and cartilage.

Normally your vocal cords open and close smoothly, forming sounds through their movement and vibration. But in laryngitis, your vocal cords become inflamed or irritated. They swell, causing distortion of the sounds produced by air passing over them. As a result, your voice sounds hoarse. In some cases of laryngitis, your voice can become so faint as to be undetectable.

Laryngitis may be short-lived (acute) or long-lasting (chronic). Although acute laryngitis usually is nothing more than an irritation and inflammation from a virus, persistent hoarseness can signal a more serious problem.

Signs and symptoms
Laryngitis often makes you feel the need to constantly clear your throat. Other signs and symptoms may include:

Hoarseness
Weak voice
Tickling sensation and rawness of your throat
Sore throat
Dry throat
Dry cough

Causes
Usually a viral infection causes acute laryngitis. A bacterial infection such as diphtheria also may be the cause, but this is rare. Acute laryngitis may also occur during the course of or after another illness, such as a cold, flu or pneumonia.

Common causes of chronic laryngitis include constant irritation from excessive alcohol, heavy smoking or reflux of stomach acid into the esophagus and throat, a condition called gastroesophageal reflux disease (GERD).

In adults, other causes of chronic hoarseness may include:

Sores (contact ulcers) on the vocal cords
Growths (polyps or nodules) on the vocal cords
Loosening of vocal cords due to aging
Vocal cord paralysis, which can result from injury, stroke or a lung tumor

Risk factors
The following factors place you at greater risk of developing laryngitis:

Having a respiratory infection, such as a cold, influenza, bronchitis or sinusitis
Exposure to irritating substances, such as cigarette smoke, excessive alcohol, stomach acid or workplace chemicals
Overusing your voice, by speaking too much, speaking too loudly, shouting or singing

When to seek medical advice
Laryngitis is usually a temporary problem that either improves by itself or clears after treatment. You can manage most acute cases of laryngitis with self-care steps, such as resting your voice, drinking plenty of fluids and sucking on lozenges. If hoarseness lasts for more than two weeks in an adult or more than one week in a child, see your doctor.

If your child develops laryngitis and has a high fever, won't eat or drink, is drooling excessively, or has trouble breathing, see your doctor right away. Children younger than age 4 who have laryngitis may have croup — inflammation of the larynx and the airway just beneath it. Croup causes a loud barking cough and typically a hoarse voice.

Screening and diagnosis
The primary sign of laryngitis is hoarseness. Changes in your voice can vary with the degree of infection or irritation, ranging from mild hoarseness to almost total loss of your voice. Your doctor may ask whether you smoke or if you have any health conditions — such as a cold, influenza or allergies — that may be causing vocal irritation. Your doctor may also ask you whether any overuse of your vocal cords — such as singing or shouting — may have irritated your vocal cords.

If you have chronic hoarseness, your doctor may want to listen to your voice and to visualize your vocal cords or refer you to an ear, nose and throat specialist (otolaryngologist). Your doctor can use these techniques to help diagnose laryngitis:

Laryngoscopy. Your doctor can visually examine your vocal cords in a procedure called laryngoscopy, by using a light and a tiny mirror to look into the back of your throat. Or your doctor may use fiber-optic laryngoscopy. This involves inserting a thin, flexible tube (endoscope) with a tiny camera and light through your nose or mouth and into the back of your throat. Then your doctor can watch the motion of your vocal cords as you speak.

Biopsy. If your doctor sees a suspicious area, your doctor may do a biopsy — taking a sample of tissue for examination under a microscope.

Treatment
Treatment depends on the cause of the laryngitis. The best treatment for the most common cause, a virus, is to rest your voice as much as possible and avoid clearing your throat. If an inhaled irritant is to blame, avoid the irritant. It may also help to inhale steam from a bowl of hot water or warm shower.

If your infant or toddler has laryngitis associated with croup, your child's doctor may prescribe a corticosteroid such as dexamethasone.

For chronic laryngitis associated with other conditions, such as heartburn, smoking or alcoholism, managing the underlying condition is necessary for improvement.

If you smoke, stop. In addition, if you're a smoker and develop persistent hoarseness, see your doctor and get a thorough examination of your vocal cords to be sure cancer isn't present. Detected early, cancer of the larynx generally can be successfully treated with surgery or radiation.

If alcohol consumption is responsible for your laryngitis, stop drinking. If you can't voluntarily give up alcohol, get treatment to help.

Prevention
To prevent dryness or irritation to your vocal cords:

Don't smoke, and avoid secondhand smoke. Smoke dries your throat and irritates your vocal cords.

Drink plenty of water. Fluids help keep the mucus in your throat thin and easy to clear.

Limit alcohol and caffeine to prevent a dry throat. If you have laryngitis, avoid both substances.

Avoid clearing your throat. This does more harm than good, because it causes an abnormal vibration of your vocal cords and can increase swelling. Clearing your throat also causes your throat to secrete more mucus and feel more irritated, making you want to clear your throat again.

Self-care
The following self-care steps may relieve the symptoms of laryngitis and reduce strain on your voice:

Moisten your throat. Try sucking on lozenges, gargling with salt water or chewing a piece of gum.

Use a humidifier. Keep the air throughout your home moist.

Avoid talking or singing too loudly or for too long. If you need to speak before large groups, try to use a microphone or megaphone.

Give your voice a break. Rest your voice when possible.

Seek voice training. Consider this if you're a singer or if your voice quality is important.

Avoid whispering. This puts even more strain on your voice than does normal speech.

Adapted from: Mayo Foundation for Medical Education and Research

Other Throat Disorders - Hoarseness

Hoarseness is a general term that describes abnormal voice changes. When hoarse, the voice may sound breathy, raspy, strained, or there may be changes in volume (loudness) or pitch (how high or low the voice is). The changes in sound are usually due to disorders related to the vocal cords that are the sound producing parts of the voice box (larynx). While breathing, the vocal cords remain apart. When speaking or singing, they come together, and as air leaves the lungs, they vibrate, producing sound. Swelling or lumps on the vocal cords prevent them from coming together properly and changes the way the cords vibrate, which makes a change in the voice, altering quality, volume, and pitch.

What Are The Causes Of Hoarseness?

Acute Laryngitis: There are many causes of hoarseness. Fortunately, most are not serious and tend to go away in a short period of time. The most common cause is acute laryngitis, which usually occurs due to swelling from a common cold, upper respiratory tract viral infection, or irritation caused by excessive voice use such as screaming at a sporting event or rock concert.

Vocal Nodules: More prolonged hoarseness is usually due to using your voice either too much, too loudly, or improperly over extended periods of time. These habits can lead to vocal nodules (singers’ nodes), which are callous-like growths, or may lead to polyps of the vocal cords (more extensive swelling). Both of these conditions are benign. Vocal nodules are common in children and adults who raise their voice in work or play.

Gastroesophageal Reflux: A common cause of hoarseness is gastro-esophageal reflux, when stomach acid comes up the swallowing tube (esophagus) and irritates the vocal cords. Many patients with reflux-related changes of voice do not have symptoms of heartburn. Usually, the voice is worse in the morning and improves during the day. These people may have a sensation of a lump in their throat, mucus sticking in their throat or an excessive desire to clear their throat.

Smoking: Smoking is another cause of hoarseness. Since smoking is the major cause of throat cancer, if smokers are hoarse, they should see an otolaryngologist.

Other Causes: Many unusual causes for hoarseness include allergies, thyroid problems, neurological disorders, trauma to the voice box, and occasionally, the normal menstrual cycle.

Who Can Treat My Hoarseness?

Hoarseness due to a cold or flu may be evaluated by family physicians, pediatricians, and internists (who have learned how to examine the larynx). When hoarseness lasts longer than two weeks or has no obvious cause it should be evaluated by an otolaryngologist--head and neck surgeon (ear, nose and throat doctor). Problems with the voice are best managed by a team of professionals who know and understand how the voice functions. These professionals are otolaryngologist--head and neck surgeons, speech/language pathologists, and teachers of singing, acting, or public speaking. Voice disorders have many different characteristics that may give professionals a clue to the cause.

How Is Hoarseness Evaluated?
An otolaryngologist will obtain a thorough history of the hoarseness and your general health. Your doctor will usually look at the vocal cords with either a mirror placed in the back of your throat, or a very small, lighted flexible tube (fiberoptic scope) may be passed through your nose in order to view your vocal cords. Videotaping the examination or using stroboscopy (slow motion assessment) may also help with the analysis.

These procedures are not uncomfortable and are well tolerated by most patients. In some cases, special tests (known as acoustic analysis) designed to evaluate the voice, may be recommended. These measure voice irregularities, how the voice sounds, airflow, and other characteristics that are helpful in establishing a diagnosis and guiding treatment

When should I see an otolaryngologist (ENT doctor)?
Hoarseness lasting longer than two weeks especially if you smoke
Pain not from a cold or flu
Coughing up blood
Difficulty swallowing
Lump in the neck
Loss or severe change in voice lasting longer than a few days

How Are Vocal Disorders Treated?

The treatment of hoarseness depends on the cause. Most hoarseness can be treated by simply resting the voice or modifying how it is used. The otolaryngologist may make some recommendations about voice use behavior, refer the patient to other voice team members, and in some instances recommend surgery if a lesion, such as a polyp, is identified. Avoidance of smoking or exposure to secondhand smoke (passive smoking) is recommended to all patients. Drinking fluids and possibly using medications to thin the mucus are also helpful.

Specialists in speech/language pathology (voice therapists) are trained to assist patients in behavior modification that may help eliminate some voice disorders. Patients who have developed bad habits, such as smoking or overuse of their voice by yelling and screaming, benefit most from this conservative approach. The speech/language pathologist may teach patients to alter their method of speech production to improve the sound of the voice and to resolve problems, such as vocal nodules. When a patients' problem is specifically related to singing, a singing teacher may help improve the patients' singing techniques.


What Can I Do to Prevent and Treat Mild Hoarseness?

If you smoke, quit.
Avoid agents that dehydrate the body, such as alcohol and caffeine.
Avoid secondhand smoke.
Drink plenty of water.
Humidify your home.
Watch your diet–avoid spicy foods.
Try not to use your voice too long or too loudly.
Use a microphone if possible in situations where you need to project your voice.
Seek professional voice training.
Avoid speaking or singing when your voice is injured or hoars

Adapted from: American Academy of Otolaryngology--Head and Neck Surgery

The Throat

In anatomy, the throat is the part of the neck anterior to the vertebral column. It consists of the pharynx and larynx.

The throat contains various blood vessels, various pharyngeal muscles, the trachea (windpipe) and the esophagus. The hyoid bone and the Clavicle are the only bones located in the throat of mammals.

Throat Related Problems
There are diseases that seems to affect the throat. These include

Epiglottitis

Epiglottitis is a life-threatening condition that occurs when the epiglottis — a small cartilage "lid" that covers the windpipe — swells, blocking the flow of air into the lungs.

A number of factors can cause the epiglottis to swell, including burns from hot liquids, a direct injury to the throat, and various viral and bacterial infections. The most common cause of epiglottitis is infection with Haemophilus influenzae type b (Hib), the same bacterium that causes pneumonia and meningitis.

Routine Hib vaccination for infants has made epiglottitis an uncommon condition, but it remains a valid concern. If you suspect that you or someone in your family has epiglottitis, seek emergency help immediately. Prompt treatment can prevent life-threatening complications

Signs and symptoms
Epiglottitis caused by Hib infection usually begins with a fever and severe sore throat. Other signs and symptoms may develop within a matter of hours, including:

Difficult and painful swallowing
Drooling due to severe pain when swallowing
A muffled voice
Harsh, raspy breathing
Difficulty breathing
Anxiety
Blue skin or lips

Causes
Your voice box (larynx) is a framework of cartilage, muscle and mucous membrane that forms the entrance to your windpipe (trachea), the tube that connects your mouth and throat to your lungs. The epiglottis is a small, movable "lid" just above the larynx that prevents food and drink from entering your windpipe.

It does this by dropping down when you swallow, effectively sealing off the larynx. That's why you can't swallow and breathe at the same time. When you're not eating or drinking, the epiglottis is slightly lifted so that air can flow freely into your lungs. But if the epiglottis becomes swollen — either from infection or injury — the airway narrows and may become completely blocked.

Infection
The most common cause of swelling and inflammation of the epiglottis and surrounding tissues is infection with Haemophilus influenzae type b (Hib) bacteria. Hib isn't the germ that causes the flu, but it's responsible for other serious conditions — including respiratory tract infections and meningitis.

Hib spreads through infected droplets coughed or sneezed into the air. It's possible to harbor Hib in your nose and throat without becoming sick — though you still have the potential to spread the bacteria to others.

Other bacteria and viruses also can cause inflammation of the epiglottis, including:

Streptococcus pneumoniae (pneumococcus), the most common cause of meningitis
Streptococcus A, B and C, a group of bacteria that cause diseases ranging from strep throat to blood infections

Candida albicans, the fungus responsible for vaginal yeast infections, diaper rash and oral thrush
Varicella zoster, the virus responsible for chickenpox and shingles

Injury
Physical injury, such as a direct blow to the throat, can cause epiglottitis. So can scald burns to your face or burns from drinking very hot liquids.

You also may develop signs and symptoms similar to those of epiglottitis if you:

Swallow a chemical that burns your throat
Swallow a foreign object
Smoke drugs, such as crack cocaine and heroin

Risk factors
For most of the 20th century, epiglottitis was more common in children than in adults — especially children ages 2 to 7. But since routine childhood Hib immunizations began in 1985, the number of children with epiglottitis has dropped dramatically. Today the condition affects about one of every 100,000 adults a year and even fewer children.

It's difficult to predict who might develop epiglottitis, but certain factors increase the risk.

Sex. Epiglottitis affects more men than women.

Race. In the United States, blacks and Hispanics tend to develop epiglottitis more frequently than do whites. A difference in access to medical care — including childhood immunizations — may be responsible for the higher rates of epiglottitis in underserved populations.

Crowded conditions. Hib bacteria spread rapidly when people are in close contact. Hib infections are most prevalent in child care centers, but they also spread quickly in schools, in offices and within households.

Weak immune system. If your immune system has been weakened by illness or medication, you're more susceptible to the viral and bacterial infections that may cause epiglottitis.

When to seek medical advice
Epiglottitis is a medical emergency. If someone you know suddenly has trouble breathing and swallowing, call your local emergency number or go to the nearest hospital emergency department. Don't try to examine the person's throat yourself. This can make matters worse.

Screening and diagnosis
If the medical team suspects epiglottitis, no diagnostic tests will be done until your airways are open and it's certain you're receiving enough oxygen.

Once your condition is stable, the doctor may examine your throat using a flexible fiber-optic tube. A local anesthetic can help relieve any discomfort. Sometimes you may have a chest or neck X-ray as well. Because of the danger of sudden breathing problems, children may have X-rays taken at their bedside rather than in the radiology department — again, only after the airway is protected.

You're also likely to have a blood test and throat culture. For the culture, your epiglottis is wiped with a cotton swab and the tissue sample is checked for Hib.

Complications
Epiglottitis can lead to respiratory failure — a life-threatening condition in which the level of oxygen in the blood drops dangerously low or the level of carbon dioxide becomes excessively high.

Pulmonary edema, another life-threatening condition, can develop after airway treatment for epiglottitis. It occurs when the tiny air sacs in the lungs fill with fluid, preventing them from absorbing oxygen.

Sometimes the bacteria that cause epiglottitis cause infections elsewhere in the body, such as pneumonia, meningitis or a blood infection (sepsis).

Treatment
The first priority in treating epiglottitis is ensuring that you're receiving enough air. You may wear a mask that delivers oxygen to your lungs. Or you may have a breathing tube placed into your windpipe through your nose or mouth. The tube must remain in place until the swelling in your throat has decreased — sometimes up to two or three days.

In extreme cases or if more conservative measures fail, the doctor may create an emergency airway by inserting a needle directly into an area of cartilage in your trachea. This procedure allows air into your lungs while bypassing the larynx. The needle is removed as soon as the airway is open.

If your epiglottitis is related to an infection, you'll receive intravenous antibiotics once you're breathing freely. Until your doctor knows the results of your blood and tissue cultures, you're likely to be treated with a broad-spectrum drug. You may receive a different antibiotic later, depending on what's causing your epiglottitis.

Prevention
Immunization with the Hib vaccine is the most effective way to prevent epiglottitis in children younger than age 5. In the United States, children usually receive the vaccine in four doses: at ages 2 months, 4 months, 6 months and 12 to 15 months.

The Hib vaccine is generally not given to children older than age 5 or to adults because they're less likely to develop Hib infection. But the Centers for Disease Control and Prevention recommends the vaccine for older children and adults whose immune systems have been weakened by:

Sickle cell disease
HIV/AIDS
Spleen removal
Chemotherapy
Medications to prevent rejection of organ or bone marrow transplants

The most common side effects of the Hib vaccine include redness, warmth or swelling at the injection site, and a fever. Rarely, a serious allergic reaction may cause difficulty breathing, wheezing, hives, weakness, a rapid heartbeat or dizziness within minutes or a few hours after the shot. If you have an allergic reaction to the vaccine, seek medical help immediately.

Of course, the Hib vaccine doesn't offer guarantees. Immunized children have been known to develop epiglottitis — and many other germs can cause epiglottitis, too. That's where common-sense precautions come in. Don't share personal items. Wash your hands frequently. If soap and water aren't available, use an alcohol-based hand sanitizer.

Adapted from: Mayo Foundation for Medical Education and Research