symptoms of nose and throat disorders
ear, nose, and throat disorders
Sore Throat
Not every sore throat requires immediate evaluation by a doctor. The following information can help people decide whether a doctor’s evaluation is needed and help them know what to expect during the evaluation. In people with a sore throat, certain symptoms and characteristics are cause for concern. They include Squeaking sound when breathing in ( Stridor ) Any sign of difficulty breathing (particularly when children sit upright and lean forward, with their neck tilted back and jaw thrust forward to try to help them breathe better) Drooling Muffled, “hot potato” voice (speaking as if a hot object is being held in the mouth) Visible bulge in the back of the throat People who have warning signs should go to the hospital right away. People with a sore throat but no warning signs should call their doctor. People who have typical cold symptoms and mild to moderate discomfort may be advised to stay at home and Treatment with over-the-counter (OTC) remedies. People with severe pain and/or other symptoms (such as fever, extreme fatigue, or a productive cough) typically should be seen right away. Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination helps them decide what, if any, tests need to be done (see table). During the medical history, doctors ask about the following: Symptoms of a runny nose, cough, and difficulty swallowing, speaking, or breathing Whether the person has had any general feeling of severe fatigue before the sore throat (suggesting mononucleosis) Whether the person has had a previous episode of mononucleosis (people rarely get mononucleosis twice) Whether people have any risk factors for gonorrhea (such as recent oral-genital sexual contact) or HIV infection (such as unprotected sex, multiple sex partners, or intravenous drug abuse) During the physical examination, doctors focus on the nose and throat. However, if doctors suspect epiglottitis in children (because there are warning signs and no evidence of a cold), they do not examine the throat in their office because inserting a tongue depressor may cause a spasm that triggers complete airway blockage. If epiglottitis is not suspected, doctors do the following: Look in the mouth to see whether the throat and/or tonsils are red, whether there are white patches (exudate) on the tonsils, and whether there are any bulges suggesting an abscess Examine the neck for enlarged, tender lymph nodes Feel the abdomen for an enlarged spleen, which may occur in people with mononucleosis The need for tests depends on what doctors find during the history and physical examination, particularly whether warning signs are present. Possible tests include Rapid strep screening (for children) Throat culture (for adults) Flexible fiberoptic laryngoscopy X-rays of the neck A doctor's first concern is to recognize which people might have epiglottitis. Stridor and drooling are warning signs, particularly in people who appear ill or with difficulty breathing. In such cases, people should not have x-rays. Instead, the doctor looks down the throat with a thin, flexible viewing tube inserted through the nose (flexible fiberoptic laryngoscopy). Because children are more likely to have sudden, complete blockage of their airway when their throat is examined, doctors minimize this danger by doing this examination only in the operating room, where advanced airway equipment and personnel are available. Adults who do not appear seriously ill and have no respiratory symptoms may have neck x-rays to look for a swollen epiglottis or have flexible fiberoptic laryngoscopy done in the emergency department or a specialist's office. Despite what many people think, it is difficult for doctors to distinguish a strep throat from a sore throat caused by a virus based only on appearance. Both may cause a very red throat with white patches. Thus, unless people clearly have just a cold, doctors usually do tests to diagnose strep throat. There are two types of test, a rapid strep antigen test and a throat culture. Both tests are done on a sample taken from the back of the throat with a swab. The rapid strep antigen test can be done in the doctor's office in about 20 minutes. The rapid test is usually done only in children. If results are positive, children are treated for strep throat with antibiotics. If results are negative, another sample is sent to the laboratory for culture (growing microorganisms on a special gel so that there are enough to identify). If adults need testing for strep throat, doctors usually do only a throat culture because adults may have another bacterial infection that would not be identified by the rapid antigen test. An abscess is often noticeable during the doctor's examination. The doctor can both diagnose and treat the abscess by inserting a small needle into the swollen area after spraying the throat with an anesthetic. If pus comes out, an abscess is confirmed, and the doctor removes as much pus as possible. If the location and extent of an abscess are unclear, computed tomography (CT) of the neck is performed. Doctors do blood tests for mononucleosis or HIV only when they suspect people have one of these infections. 