GERD and LPR
What is GERD?Gastroesophageal reflux disease, often referred to as GERD, occurs when acid from the stomach backs up into the esophagus. Normally, food travels from the mouth, down through the esophagus and into the stomach. A ring of muscle at the bottom of the esophagus, the lower esophageal sphincter (LES), contracts to keep the acidic contents of the stomach from “refluxing” or coming back up into the esophagus. In those who have GERD, the LES does not close properly, allowing acid and other contents of the digestive tract to move up–to “reflux”–the esophagus.
When stomach acid touches the sensitive tissue lining the esophagus and throat, it causes a reaction similar to squirting lemon juice in your eye. This is why GERD is often characterized by the burning sensation known as heartburn.
In some cases, reflux can be silent, with no heartburn or other symptoms until a problem arises. Almost all individuals have experienced reflux (GER), but the disease (GERD) occurs when reflux happens often over a long period of time.
What is LPR?During gastroesophageal reflux, the contents of the stomach and upper digestive tract may reflux all the way up the esophagus, beyond the upper esophageal sphincter (a ring of muscle at the top of the esophagus), and into the back of the throat and possibly the back of the nasal airway. This is known as laryngopharyngeal reflux (LPR), which can affect anyone. Adults with LPR often complain that the back of their throat has a bitter taste, a sensation of burning, or something “stuck.” Some patients have hoarseness, difficulty swallowing, throat clearing, and difficulty with the sensation of drainage from the back of the nose (“postnasal drip”). Some may have difficulty breathing if the voice box is affected. Many patients with LPR do not experience heartburn.
In infants and children, LPR may cause breathing problems such as: cough, hoarseness, stridor (noisy breathing), croup, asthma, sleep-disordered breathing, feeding difficulty (spitting up), turning blue (cyanosis), aspiration, pauses in breathing (apnea), apparent life-threatening event (ALTE), and even a severe deficiency in growth. Proper treatment of LPR, especially in children, is critical.
What are the symptoms of GERD and LPR?The symptoms of GERD may include persistent heartburn, acid regurgitation, nausea, hoarseness in the morning, or trouble swallowing. Some people have GERD without heartburn. Instead, they experience pain in the chest that can be severe enough to mimic the pain of a heart attack. GERD can also cause a dry cough and bad breath. (Symtoms of LPR were outlined in the last section.)
While GERD and LPR may occur together, patients can also have GERD alone (without LPR) or LPR alone (without GERD). If you experience any symptoms on a regular basis (twice a week or more), then you may have GERD or LPR. For proper diagnosis and treatment, you should be evaluated by your primary care doctor or an otolaryngologist—head and neck surgeon (ENT doctor).
Who gets GERD or LPR?Women, men, infants, and children can all have GERD or LPR. These disorders may result from physical causes or lifestyle factors. Physical causes can include a malfunctioning or abnormal lower esophageal sphincter muscle (LES), hiatal hernia, abnormal esophageal contractions, and slow emptying of the stomach. Lifestyle factors include diet (chocolate, citrus, fatty foods, spices), destructive habits (overeating, alcohol and tobacco abuse) and even pregnancy. Young children experience GERD and LPR due to the developmental immaturity of both the upper and lower esophageal sphincters. It should also be noted that some patients are just more susceptible to injury from reflux than others. A given amount of refluxed material in one patient may cause very different symptoms in other patients.Unfortunately, GERD and LPR are often overlooked in infants and children, leading to repeated vomiting, coughing in GERD, and airway and respiratory problems in LPR, such as sore throat and ear infections. Most infants grow out of GERD or LPR by the end of their first year, but the problems that resulted from the GERD or LPR may persist.
What role does an ear, nose, and throat specialist have in treating GERD and LPR?A gastroenterologist, a specialist in treating gastrointestinal orders, will often provide initial treatment for GERD. But there are ear, nose, and throat problems that are caused by reflux reaching beyond the esophagus, such as hoarseness, laryngeal nodules in singers, croup, airway stenosis (narrowing), swallowing difficulties, throat pain, and sinus infections. These problems require an otolaryngologist—head and neck surgeon, or a specialist who has extensive experience with the tools that diagnose GERD and LPR. They treat many of the complications of GERD and LPR, including: sinus and ear infections, throat and laryngeal inflammation and lesions, as well as a change in the esophageal lining called Barrett’s esophagus, a serious complication that can lead to cancer.
Your primary care physician or pediatrician will often refer a case of LPR to an otolaryngologist—head and neck surgeon for evaluation, diagnosis, and treatment.
How are GERD and LPR diagnosed and treated?GERD and LPR can be diagnosed or evaluated by a physical examination and the patient’s response to a trial of treatment with medication. Other tests that may be needed include an endoscopic examination (a long tube with a camera inserted into the nose, throat, windpipe, or esophagus), biopsy, x-ray, examination of the esophagus, 24 hour pH probe with or without impedance testing, esophageal motility testing (manometry), and emptying studies of the stomach. Endoscopic examination, biopsy, and x-ray may be performed as an outpatient or in a hospital setting. Endoscopic examinations can often be performed in your ENT’s office, or may require some form of sedation and occasionally anesthesia.
Most people with GERD or LPR respond favorably to a combination of lifestyle changes and medication. Medications that could be prescribed include antacids, histamine antagonists, proton pump inhibitors, pro-motility drugs, and foam barrier medications. Some of these products are now available over the counter and do not require a prescription.
Children and adults who fail medical treatment or have anatomical abnormalities may require surgical intervention. Such treatment includes fundoplication, a procedure where a part of the stomach is wrapped around the lower esophagus to tighten the LES, and endoscopy, where hand stitches or a laser are used to make the LES tighter.
Adult lifestyle changes to prevent GERD and LPR
● Avoid eating and drinking within two to three hours prior to bedtime● Do not drink alcohol● Eat small meals and slowly● Limit problem foods:● Caffeine● Carbonated drinks● Chocolate● Peppermint● Tomato● Citrus fruits● Fatty and fried foods● Lose weight● Quit smoking● Wear loose clothing
Oral lesions (mouth sores) make it painful to eat and talk. Two of the most common recurrent oral lesions are fever blisters (also known as cold sores) and canker sores. Though similar, fever blisters and canker sores have important differences.
What are fever blisters?Fever blisters are fluid-filled blisters that commonly occur on the lips. They also can occur on the gums and roof of the mouth (hard palate), but this is rare. Fever blisters are usually painful; pain may precede the appearance of the lesion by a few days. The blisters rupture within hours, then crust over. They last about seven to ten days.
Why do fever blisters reoccur?Fever blisters result from a herpes simplex virus that becomes active. This virus is latent (dormant) in afflicted people, but can be activated by conditions such as stress, fever, trauma, hormonal changes, and exposure to sunlight. When lesions reappear, they tend to form in the same location.
Are fever blisters contagious?Yes, the time from blister rupture until the sore is completely healed is the time of greatest risk for spread of infection. The virus can spread to the afflicted person’s eyes and genitalia, as well as to other people.
How are fever blisters treated?Treatment consists of coating the lesions with a protective barrier ointment containing an antiviral agent, for example 5% acyclovir ointment. While there is no cure now, scientists are trying to develop one, so hopefully fever blisters will be a curable disorder in the future.
Tips to prevent spreading fever blisters● Avoid mucous membrane contact when a lesion is present.● Do not squeeze, pinch, or pick the blisters.● Wash hands carefully before touching eyes, genital area, or another person.● Note: Despite all caution, it is possible to transmit herpes virus even when no blisters are present.
What are canker sores?Canker sores (also called aphthous ulcers) are different than fever blisters. They are small, red or white, shallow ulcers occurring on the tongue, soft palate, or inside the lips and cheeks; they do not occur in the roof of the mouth or the gums. They are quite painful, and usually last 5-10 days.
Who is most likely to get canker sores, and what causes them?Eighty percent of the U.S. population between the ages of 10 to 20, most often women, get canker sores. The best available evidence suggests that canker sores result from an altered local immune response associated with stress, trauma, or irritation. Acidic foods (e.g., tomatoes, citrus fruits, and some nuts) are known to cause irritation in some patients.
Are canker sores contagious? How are they treated?Because they are not caused by bacteria or viral agents, they are not contagious and cannot be spread locally or to anyone else. Treatment is directed toward relieving discomfort and guarding against infection. A topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%®) is helpful.
When should a physician be consulted?Consider consulting a physician if a mouth sore has not healed within two weeks. Mouth sores offer an easy way for germs and viruses to get into the body, so it is easy for infections to develop.
People who consume alcohol, smokers, smokeless tobacco users, chemotherapy or radiation patients, bone marrow or stem cell recipients, or patients with weak immune systems should also consider having regular oral screenings by a physician. The first sign of oral cancer is a mouth sore that does not heal.
What kind of screenings are performed?The physician will most likely examine the head, face, neck, lips, gums, and high-risk areas inside the mouth, such as the floor of the mouth, the area under the tongue, the front and sides of the tongue, and the roof of the mouth or soft palate. If a suspicious lesion is found, the physician may recommend collecting and testing soft tissue from the oral cavity.
What are other types of oral lesions to be concerned about?Leukoplakia - A thick, whitish-color patch that forms on the inside of the cheeks, gums, or tongue. These patches are caused by excess cell growth and are common among tobacco users. They can result from irritations such as ill-fitting dentures or the habit of chewing on the inside of the cheek. Leukoplakia can progress to cancer.
Candidiasis - A fungal infection (also called moniliasis or oral thrush) that occurs when yeast reproduce in large numbers. It is common among denture wearers and most often occurs in people who are very young, elderly, debilitated by disease, or who have a problem with their immune system. People who have dry mouth syndrome are very susceptible to candidiasis. Candida may flourish after antibiotic treatment, which can decrease normal bacteria in the mouth.
Hairy tongue - A relatively rare condition caused by the elongation of the taste buds. It can be caused by poor oral hygiene, chronic oral irritation, or smoking.
Torus palatinus - A hard bony growth in the center of the roof of the mouth (palate). It commonly occurs in females over the age of 30 and rarely needs treatment. A torus palatinus is often seen in patients who suffer from tooth grinding. Occasionally it is removed for the proper fitting of dentures.
Oral cancer - It may appear as a white or red patch of tissue in the mouth, or a small ulcer that looks like a common canker sore. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. Other symptoms include a lump or mass that can be felt inside the mouth or neck; pain or difficulty in swallowing, speaking, or chewing; any wart-like mass; hoarseness that lasts for more than two weeks; or any numbness in the oral/facial region.
Tips to prevent mouth sores● Stop smoking.● Reduce stress.● Avoid injury to the mouth caused by hard tooth brushing, hard foods, braces, or dentures.● Chew slowly.● Practice good dental hygiene, including regular visits to the dentist.● Eat a well-balanced diet.● Identify and eliminate food sensitivities.● Drink plenty of water.● Avoid very hot food or beverages.● Follow nutritional guidelines for multivitamin supplements.
Infections from viruses or bacteria are the main cause of sore throats and can make it difficult to talk and breathe. Allergies and sinus infections can also contribute to a sore throat. If you have a sore throat that lasts for more than five to seven days, you should see your doctor. While increasing your liquid intake, gargling with warm salt water, or taking over-the-counter pain relievers may help, if appropriate, your doctor may write you a prescription for an antibiotic.
What are the causes and symptoms of a sore throat?
Infections by contagious viruses or bacteria are the source of the majority of sore throats.
Viruses: Sore throats often accompany viral infections, including the flu, colds, measles, chicken pox, whooping cough, and croup. One viral infection, infectious mononucleosis, or "mono," takes much longer than a week to be cured. This virus lodges in the lymph system, causing massive enlargement of the tonsils, with white patches on their surface. Other symptoms include swollen glands in the neck, armpits, and groin; fever, chills, and headache. If you are suffering from mono, you will likely experience a severe sore throat that may last for one to four weeks and, sometimes, serious breathing difficulties. Mono causes extreme fatigue that can last six weeks or more, and can also affect the liver, leading to jaundice-yellow skin and eyes.
Bacteria: Strep throat is an infection caused by a particular strain of streptococcus bacteria. This infection can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Symptoms of strep throat often include fever (greater than 101°F), white draining patches on the throat, and swollen or tender lymph glands in the neck. Children may have a headache and stomach pain.
Tonsillitis is an infection of the lumpy-appearing lymphatic tissues on each side of the back of the throat.
Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it.
The most dangerous throat infection is epiglottitis, which infects a portion of the larynx (voice box) and causes swelling that closes the airway. Epiglottitis is an emergency condition that requires prompt medical attention. Suspect it when swallowing is extremely painful (causing drooling), when speech is muffled, and when breathing becomes difficult. Epiglottitis may not be obvious just by looking in the mouth. A strep test may overlook this infection.
Allergies to pollens and molds such as cat and dog dander and house dust are common causes of sore throats.
Irritation caused by dry heat, a chronic stuffy nose, pollutants and chemicals, and straining your voice can also irritate your throat.
Reflux, or a regurgitation of stomach acids up into the back of the throat, can cause you to wake up with a sore throat.
Tumors of the throat, tongue, and larynx (voice box) can cause a sore throat with pain radiating to the ear and/or difficulty swallowing. Other important symptoms can include hoarseness, noisy breathing, a lump in the neck, unexplained weight loss, and/or spitting up blood in the saliva or phlegm.
HIV infection can sometimes cause a chronic sore throat, due not to HIV itself but to a secondary infection that can be extremely serious.
When should I see a doctor?
Whenever a sore throat is severe, persists longer than the usual five-to-seven day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your physician:
● Severe and prolonged sore throat● Difficulty breathing● Difficulty swallowing● Difficulty opening the mouth● Joint pain● Earache● Rash● Fever (over 101Â°)● Blood in saliva or phlegm● Frequently recurring sore throat● Lump in neck● Hoarseness lasting over two weeks●
How will I be tested for a sore throat?
To test for strep throat, your doctor may want to do a throat culture, a non-surgical procedure that uses an instrument to take a sampling of the infected cells. Because the culture will not detect other infections, when it is negative, your physician will base his/her decision for treatment on the severity of your symptoms and the appearance of your throat on examination.
What are my treatment options?
A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:
● Increase your liquid intake.● Warm tea with honey is a favorite home remedy.● Use a steamer or humidifier in your bedroom.● Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water.● Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat®, Tempra®) or ibuprofen (Motrin IB®, Advil®).
If you have a bacterial infection your doctor will prescribe an antibiotic to alleviate your symptoms. Antibiotics are drugs that kill or impair bacteria. Penicillin or erythromycin (well-known antibiotics) are prescribed when the physician suspects streptococcal or another bacterial infection that responds to them. However, a number of bacterial throat infections require other antibiotics instead.
Antibiotics do not cure viral infections, but viruses do lower the patient's resistance to bacterial infections. When such a combined infection occurs, antibiotics may be recommended. When an antibiotic is prescribed, it should be taken as the physician directs for the full course (usually 7-10 days). Otherwise the infection may not be completely eliminated, and could return. Some children will experience recurrent infection despite antibiotic treatment. When some of these are strep infections or are severe, your child may be a candidate for a tonsillectomy.
How can I prevent a sore throat?
● Avoid smoking or exposure to secondhand smoke. Tobacco smoke, whether primary or secondary, contains hundreds of toxic chemicals that can irritate the throat lining.● If you have seasonal allergies or ongoing allergic reactions to dust, molds, or pet dander, you're more likely to develop a sore throat than people who don't have allergies.● Avoid exposure to chemical irritants. Particulate matter in the air from the burning of fossil fuels, as well as common household chemicals, can cause throat irritation.● If you experience chronic or frequent sinus infections you are more likely to experience a sore throat, since drainage from nose or sinus infections can cause throat infections as well.● If you live or work in close quarters such as a child care center, classroom, office, prison, or military installation, you are at greater risk because viral and bacterial infections spread easily in environments where people are in close proximity.● Maintain good hygiene. Do not share napkins, towels, and utensils with an infected person. Wash your hands regularly with soap or a sanitizing gel, for 10-15 seconds.● If you have HIV or diabetes, are undergoing steroid treatment or chemotherapy, are experiencing extreme fatigue or have a poor diet, you have reduced immunity and are more susceptible to infections.
Difficulty in swallowing (dysphagia) is common among all age groups, especially the elderly. The term dysphagia refers to the feeling of difficulty passing food or liquid from the mouth to the stomach. This may be caused by many factors, most of which are temporary and not threatening. Difficulties in swallowing rarely represent a more serious disease, such as a tumor or a progressive neurological disorder. When the difficulty does not clear up by itself in a short period of time, you should see an otolaryngologist-head and neck surgeon.
How do we swallow?People normally swallow hundreds of times a day to eat solids, drink liquids, and swallow the normal saliva and mucus that the body produces. The process of swallowing has four related stages:
● The first stage is the oral preparation stage, where food or liquid is manipulated and chewed in preparation for swallowing.● The second stage is the oral stage, where the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.● The third stage is the pharyngeal stage which begins as food or liquid is quickly passed through the pharynx, the region of the throat which connects the mouth with the esophagus, then into the esophagus or swallowing tube.● In the final, esophageal stage, the food or liquid passes through the esophagus into the stomach.Although the first and second stages have some voluntary control, stages three and four occur involuntarily, without conscious input.
What are the symptoms of swallowing disorders?
Symptoms of swallowing disorders may include:
● Drooling● A feeling that food or liquid is sticking in the throat● Discomfort in the throat or chest (when gastro esophageal reflux is present)● A sensation of a foreign body or "lump" in the throat● Weight loss and inadequate nutrition due to prolonged or more significant problems with swallowing● Coughing or choking caused by bits of food, liquid, or saliva not passing easily during swallowing, and being sucked into the lungs● Voice change
How are swallowing disorders diagnosed?When dysphagia is persistent and the cause is not apparent, the otolaryngologist-head and neck surgeon will discuss the history of your problem and examine your mouth and throat. This may be done with the aid of mirrors. Sometimes a small tube (flexible laryngoscope) is placed through the nose and the patient is then given food to eat while the scope is in place in the throat. These procedures provide visualization of the back of the tongue, throat, and larynx (voice box). These procedures are called FEES (Fiber optic Endoscopic Evaluation of Swallowing) or FEESST (Flexible Endoscopic Evaluation of Swallowing with Sensory Testing). If necessary, an examination of the esophagus, named TransNasal Esophagoscopy (TNE), may be carried out by the otolaryngologist. If you experience difficulty swallowing, it is important to seek treatment to avoid malnutrition and dehydration.
How are swallowing disorders treated?Many of these disorders can be treated with medication. Drugs that slow stomach acid production, muscle relaxants, and antacids are a few of the many medicines available. Treatment is tailored to the particular cause of the swallowing disorder.
Gastro esophageal reflux can often be treated by changing eating and living habits in these ways:
● Eat a bland diet with smaller, more frequent meals.● Eliminate tobacco, alcohol and caffeine.● Reduce weight and stress.● Avoid food within three hours of bedtime.● Elevate the head of the bed at night.● If these don't help, antacids between meals and at bedtime may provide relief.
Many swallowing disorders may be helped by direct swallowing therapy. A speech pathologist can provide special exercises for coordinating the swallowing muscles or stimulating the nerves that trigger the swallow reflex. Patients may also be taught simple ways to place food in the mouth or position the body and head to help the swallow occur successfully.
Some patients with swallowing disorders have difficulty feeding themselves. An occupational therapist or a speech language pathologist can aid the patient and family in feeding techniques. These techniques make the patient as independent as possible. A dietician or nutritional expert can determine the amount of food or liquid necessary to sustain an individual and whether supplements are necessary.
Once the cause is determined, swallowing disorders may be treated with:
● medication● swallowing therapy● surgery● Surgery is used to treat certain problems. If a narrowing exists in the throat or esophagus, the area may need to be stretched or dilated. If a muscle is too tight, it may need to be dilated or released surgically. This procedure is called a myotomy and is performed by an otolaryngologist-head and neck surgeon.
Many diseases contribute to swallowing disorders. If you have a persistent problem swallowing, see an otolaryngologist-head and neck surgeon.
What causes swallowing disorders?Any interruption in the swallowing process can cause difficulties. Eating slowly and chewing thoroughly can help reduce problems with swallowing. However, difficulties may be due to a range of other causes, including something as simple as poor teeth, ill fitting dentures, or a common cold. One of the most common causes of dysphagia is gastro esophageal reflux. This occurs when stomach acid moves up the esophagus to the pharynx, causing discomfort. Other causes may include: hypertension; diabetes; thyroid disease; stroke; progressive neurologic disorder; the presence of a tracheotomy tube; a paralyzed or unmoving vocal cord; a tumor in the mouth, throat, or esophagus; or surgery in the head, neck, or esophageal areas.
Swallowing difficulty can also be connected to some medications including:
● Nitrates● Anticholinergic agents found in certain anti-depressants and allergy medications● Calcium tablets● Calcium channel blockers● Aspirin● Iron tablets● Vitamin C● Antipsychotic● Tetracycline (used to treat acne)
Tonsils and Adenoids
Tonsils and adenoids are on the body's first line of the defense-our immune system. They "sample" bacteria and viruses that enter the body through the mouth or nose at the risk of their own infection. But at times, they become more of a liability than an asset and may even trigger airway obstruction or repeated bacterial infections. Your ear, nose, and throat specialist can suggest the best treatment options.
What are tonsils and adenoids?Two masses of tissue that are similar to the lymph nodes or "glands" found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.
What affects tonsils and adenoids?The most common problems affecting the tonsils and adenoids are recurrent infections (throat or ear) and significant enlargement or obstruction that causes breathing, swallowing, and sleep problems.
Abscesses around the tonsils, chronic tonsillitis, and infections of small pockets within the tonsils that produce foul-smelling, cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen. Tumors are rare but can grow on the tonsils.
When should I see a doctor?You should see your doctor when you or your child suffer the common symptoms of infected or enlarged tonsils or adenoids.
Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a small mirror or a flexible lighted instrument to see these areas.
Other methods used to check tonsils and adenoids are:
● Medical history● Physical examination● Throat cultures/Strep tests - helpful in determining infections in the throat● X-rays - helpful in determining the size and shape of the adenoids● Blood tests - helpful in determining infections such as mononucleosis
● How are tonsil and adenoid diseases treated?Bacterial infections of the tonsils, especially those caused by streptococcus, are first treated with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended if there are recurrent infections despite antibiotic therapy, and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children.
Chronic infection can affect other areas such as the eustachian tube - the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and potential hearing loss. Recent studies indicate adenoidectomy may be a beneficial treatment for some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
In adults, the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients, especially those with infectious mononucleosis, severe enlargement may obstruct the airway. For those patients, treatment with steroids (e.g., cortisone) is sometimes helpful.
How to prepare for surgeryChildren● Talk to your child about his/her feelings and provide strong reassurance and support● Encourage the idea that the procedure will make him/her healthier.● Be with your child as much as possible before and after the surgery.● Tell him/her to expect a sore throat after surgery.● Reassure your child that the operation does not remove any important parts of the body and that he/she will not look any different afterward.● If your child has a friend who has had this surgery, it may be helpful to talk about it with that friend.
Adults and children● For at least two weeks before any surgery, the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye's syndrome).
● If the patient or patient's family has had any problems with anesthesia, the surgeon should be informed. If the patient is taking any other medications, has sickle cell anemia, has a bleeding disorder, is pregnant, has concerns about the transfusion of blood, or has used steroids in the past year, the surgeon should be informed.● A blood test and possibly a urine test may be required before surgery.● Generally, after midnight before the operation, nothing may be taken by mouth (including chewing gum, mouthwashes, throat lozenges, toothpaste, water.) Anything in the stomach may be vomited when anesthesia is induced, and this is dangerous.● When the patient arrives at the hospital or surgery center, the anesthesiologist or nursing staff may meet with the patient and family to review the patient's history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
After the operation, the patient will be taken to the recovery area. Recovery room staff will observe the patient until discharged. Every patient is unique, and recovery time may vary.
Your ENT specialist will provide you with the details of preoperative and postoperative care and answer any questions you may have.
After surgerySeveral postoperative symptoms may arise. These include, but are not limited to, swallowing problems, vomiting, fever, throat pain, and ear pain. Occasionally, bleeding may occur after surgery. If the patient has any bleeding, your surgeon should be notified immediately.
Any questions or concerns you have should be discussed openly with your surgeon.
Tonsillitis and its symptomsTonsillitis is an infection in one or both tonsils. One sign is swelling of the tonsils. Other signs or symptoms are:
● Redder than normal tonsils● A white or yellow coating on the tonsils● A slight voice change due to swelling● Sore throat● Uncomfortable or painful swallowing● Swollen lymph nodes (glands) in the neck● Fever● Bad breath
Enlarged adenoids and their symptomsIf your or your child's adenoids are enlarged, it may be hard to breathe through the nose. Other signs of constant enlargement are:
● Breathing through the mouth instead of the nose most of the time● Nose sounds "blocked" when the person speaks● Noisy breathing during the day● Recurrent ear infections● Snoring at night● Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea)