Dr. Grossan's Ear, Nose and Throat Consultant Pages

      Throat Topics


Do you have Halitosis (Bad Breath)?

Bad breath is particularly bothersome because people rarely know they have it unless they are told of it. Yet it can spoil one's social and even economic life. And mouth washes are not always useful. When bacteria stagnate, or remain in one place, they multiply and give off toxins and odors. So the treatment/ prevention is to avoid having bacteria accumulate in one spot. In the nose this means salt water nose spray or Pulsating Nasal Irrigation if you have crusts and other sources of odor. For the throat, check the teeth. Any open cavities? Any gum disease? I strongly recommend eating yogurt in order to bring in the good bacteria that make the mouth healthier. If the gums are red and swollen, better brushing and flossing is a must. A common cause of breath problems are the deep holes in the tonsils, known as crypts. These holes are supposed to be there, they provide areas where the good white cells of the body can fight the bad bacteria. Then the dead bacteria and dead white cells are extruded and swallowed. Sometimes the holes are too wide or crooked and the material gets to accumulate and cause odor. Here, pulsatile throat irrigation can be very effective because the pulsation removes the dead material.

The mouth may be extra dry for lack of fluids. Try increasing fluid intake. Indigestion may be a factor. An excellent remedy is to take protelytic enzyme tablets for digestion. (Papain and bromelain, in combination, and with calibrated enzyme activity are best.) If you are milk intolerant, there are lactase tablets for digesting milk and milk products. If you have an acid stomach check with your doctor about reducing excess acid with Tagamet or Zantac. It is best not to self diagnose on hyperacidity in the stomach.

The mouth wash people spend millions trying to convince every living soul that they have bad breath. As a result I see patients in consultation who DON'T have any unpleasant odor, they just have seen too many advertisements. so unless someone is complaining, if you don't have nasal problems, or dental disease or unusual material out of your tonsils, I would recommend doing nothing. On the other hand, my patients like to use pulsatile throat irrigation before a heavy date "to be sure".

Click Here to return to the top of this document.

Back to The On-Line ENT-Consultant Home Page

Frequent Sore Throats

Everyone gets a sore throat at some time. The nose and throat are constantly defending against outside elements and bacteria. When bacteria settle in the nose, the bacteria are seized and dragged off to "battle stations" or lymph glands where the good white cells are kept. More good blood comes to the area. There, the concentration of good white cells can overwhelm the bacteria. But when the lymph material swells, this causes a painful throat. The throat infection may be from a bacteria or a virus. It may be part of a generalized infection

There are 3 parts to the throat: the part behind the nose at the top of the throat called the nasopharynx where the tubes that run from the ears to the nose open, the middle throat where the tonsils are located and where you can often look at the throat, called the oropharynx and the lower part, behind and below the tongue, where the larynx or voice box is, the laryngopharynx.

When the top one third of the throat is affected, the ears may be infected too because the infection travels up the eustachian tube into the middle ear. When the lower 1/3 of the throat is infected, you may be hoarse because the larynx is swollen and can't function see Laryngitis or hoarseness. Many people get hoarse because they gargle with a sore throat, which is like rubbing your eyes when they are infected.

When you feel a sore throat coming on, aspirin chewing gum, any flavor is recommended. Ice drinks are best when there is swelling or pain.

The throat is especially painful when the uvula, the part that hangs down the middle of the throat from the soft palate, swells . The uvula can also swell as an allergic reaction, just as the eye or nose can. Ice is good, as well as an antihistamine. Sometimes crackers or tostados can scratch the uvula and cause swelling. Swelling of the uvula doesn't serve any useful purpose.

The uvula functions to rise up when you swallow to keep food from going up into the nose. Infection can come here as well as to the tonsils or the back of the throat, except that swelling of the uvula is quite frightening because of fear it will obstruct the air way. It rarely does, but it feel like it.

With a sore throat, the uvula is often involved. Gargling will cause it to swell. Drinking very hot fluids will swell the uvula as well, causing discomfort. Warm drinks help the throat heal and ice drinks take the pain down. Do both

Swelling of the throat for whatever cause is helped by ice drinks and proteolytic enzyme tablets with papin and bromelain (make sure you use a formula with calibrated enzyme activity), one three times a day dissolved in the mouth between the cheeks and the gums. In the emergency room the doctor may give a cortisone or similar injection.

If your throat stays sore and you feel "real sick" all over, you do need to be checked.

If you have trouble opening your mouth and your voice sounds like you have a potato in it, you may have a serious throat abscess and this is a "must see the doctor" condition.

If you get frequent sore throats and frequent hoarseness you should try pulsatile throat irrigation on a daily basis. This washes away surface bacteria and massages the area so that fresh blood comes in and stale old blood leaves.

Many patients are frightened when they see white spots on the tonsils. This is perfectly O.K. These are the dead white cells and dead bacteria that accumulate in the holes of the tonsils called crypts. Here the tonsils are just doing their job. If breath odor is a problem , see above.

Click Here to return to the top of this document.

Asthma or Ventricular Dysphonia?

This is an uncommon condition that few persons would ask me about. The reason for including ventricular dysphonia here is that when this is misdiagnosed, the results can be tragic and ruin a person's life.

This condition takes place when people speak and breathe incorrectly. Normally the vocal cords open wide as you inhale and come together as you exhale. When you speak, the air easily passes out between the vocal cords, and the cords vibrate to make the speech sound. In some cases, however, the speech is made with the ventricular bands, above the vocal cords, not the vocal cords proper. As the bands come together during inhalation, it sounds squeaky, raspy, almost a grunting. A wheeze is heard that sounds just like asthma. Because of the narrowing of the opening, less air reaches the lungs. Louie Armstrong had a ventricular dysphonia voice, as do a lot of ventriloquists, but fortunately no signs of asthma.

In 1983, physicians at National Jewish Hospital For Asthma in Denver reported this condition that may mimic asthma. They called it Vocal Cord Dysfunction, VCD. VCD causes asthma-like symptoms because of an abnormal closing of the vocal cords. VCD can cause difficult breathing and even wheezing. Based on these symptoms, many people with VCD may be diagnosed with asthma and treated with asthma medications, including oral steroids.

The problem is that the only symptoms of VCD are an unusual voice and wheezing. Even the pulmonary function studies are nearly normal. The diagnosis of VCD consists of recognizing the voice characteristics, looking with an instrument, the flexible laryngoscope, and seeing the ventricular bands come together to make the unusual voice. Unfortunately, patients often show up in the emergency room and tell the doctor they have asthma. Since they sound like asthma, they are often given all kinds of serious medication, including steroids. Until the condition is diagnosed, they may be on cortisone for a long time and on high doses because they are not getting well, and this can lead to complications.

Another problem is that the ordinary way of viewing the larynx, with the doctor holding the tongue and inserting the mirror in the back of the throat may not give the diagnosis because he doesn't see the true function of the cords as he would with the special flexible laryngoscope. (a telescope that passes easily to the larynx)

Once you are diagnosed with VCD, you can begin a specific treatment program. Speech therapy is a very important part of the treatment for VCD or ventricular dysphonia. Special exercises increase your awareness of abdominal breathing and relax your throat muscles. This enables you to have more control over your throat. You will learn to practice these exercises while you are symptom-free in order to effectively use the exercises during VCD episodes. These exercises help overcome the abnormal vocal cord movements and improve airflow into your lungs. The patient is taught to make a breathy sigh to uncover his normal voice. Another important part of treatment is supportive counseling. Counseling can help you adjust to a new diagnosis and a new treatment program. Counseling can also help you identify and deal positively with stress which may be an underlying factor in VCD. Most people with VCD find counseling to be very beneficial.

Very few cases of asthma are ventricular dysphonia, as are very few cases of laryngitis, but the results of misdiagnosing this condition are so serious, I feel it is beneficial to make patients aware of it. If you suspect this condition, Jewish Hospital in Denver has the most experience with this condition. In other areas an ear nose and throat specialist has the necessary instruments for diagnosing this problem.

Click Here to return to the top of this document.

Back to The On-Line ENT-Consultant Home Page

Last Update 2003 October 8

Murray Grossan M.D.