Odynophagia - Causes, Symptoms, and Treatment

Odynophagia is a  medical condition when a person experiences pain while swallowing. This pain may be seen in the mouth, throat or food pipe when the person tries to swallow even saliva. Odynophagia can lead to weight loss, damage to the throat or other severe complications. It is hence best to consult an expert ENT specialist or throat surgeon immediately when a person experiences throat pain or swallowing difficulty.

Odynophagia vs. Dysphagia

Odynophagia and Dysphagia are both throat diseases but they are distinctly different. Odynophagia refers to painful swallowing while dysphagia refers to inability in swallowing.  Dysphagia may occur along with Odynophagia or both may occur separately. When they both occur together, the person is in sheer agony as he feels pain and is unable to swallow even water. Both these throat diseases are caused by infections and inflammations. But dysphagia is the  worst of the two as it may result in bacteria and irritation to the lungs, causing pneumonia. Dysphagia can also be caused by psychological factors like anxiety.

Causes of Odynophagia

Odynophagia or painful swallowing may be caused by

1. Common Infections - common cold, flu or strep throat
2. Throat inflammation due to tonsillitis, laryngitis, pharyngitis, oesophagitis etc.
3. Candida Infection-this yeast or fungal infection that occurs in your mouth may cause pain and swallowing difficulty.
4. GERD - Castro-esophageal reflux disease - This illness is due to the lower sphincter of the oesophagus not closing properly and allowing the stomach acid to leak back into the food pipe. This disease may cause Odynophagia along with chest pain or heartburn.
5. Ulcers - Ulcers formed in the mouth, throat or oesophagus may cause painful swallowing. This may be the result of untreated GERD or the prolonged use of anti-inflammatory drugs like Ibuprofen.
6. AIDS - HIV-affected patients often suffer from Odynophagia. Candida infection is one cause. The use of antiretroviral medications to cure HIV may cause acid reflux and bring in swallowing difficulty.
7. Cancer - Oesophageal cancer may be another cause for Odynophagia leading to tumours in  the throat. This cancer is caused by persistent smoking, tobacco use or alcoholism or even hereditary factors.
8. Radiation therapy - Person undergoing radiation therapy for HIV or cancer treatment are more prone to Odynophagia.
9. Weak immune systems - Persons with weak immunity who often catch colds and throat infections have swallowing difficulty.
10. Foods - Even eating very spicy foods, drinking very hot or very cold drinks continuously or eating food with sharp edges may damage the mucosal lining of the throat. This causes Odynophagia.

Symptoms of Odynophagia

• Dull or sharp stabbing pain in the mouth, throat or food pipe while swallowing
• Even liquids cause throat pain but dry solids make it worse.
• Weight loss due to reduced intake of food.
• Dehydration due to reduced intake of food
• Other symptoms like fever, fatigue, body ache etc.

Diagnosis of Odynophagia

Odynophagia is diagnosed by endoscopy. A small lighted camera or endoscope is placed inside the patient's throat by the doctor to take a look at your oesophagus. Tests are also taken by asking the patient to swallow.

Odynophagia Treatment

1. Medication

Odynophagia can be treated by using medication for

• Throat pain, tonsillitis, laryngitis, pharyngitis, oesophagitis
• GERD to prevent acid reflux from entering the throat
• Candida infection to rid the fungus
• HIV or cancer medication.

2. Surgery

If the patient has tumours in his throat, it may be a sign of oesophageal cancer. The throat surgeon may advise surgery after proper diagnosis and screening.

3. Rest

Sometimes painful swallowing resolves on its own if adequate rest is given to the throat.

Strep throat: Causes, diagnosis, and treatments

Monsoons and winter both usher in a spate of coughs, colds and sore throats among both children and adults.  Among these, sore throats are quite common and almost 15% of them are caused by a bacterial infection. A sore throat caused by the Streptococcus A bacteria is commonly called as "strep throat".

Strep throat is prevalent mostly among children of age 5-15. In children less than 3 yrs, this infection affects the ear as otitis media instead of affecting the throat. Anyway, strep throat might be accompanied by tonsillitis or sinus infection too. That is why it is best to consult an ENT hospital for strep throat treatment.

What is strep throat?

Strep throat is a bacterial throat infection caused by Streptococcus A bacteria. It is spread by

• Airborne droplets when an infected person coughs or sneezes
• Touching the items touched by the infected person like clothes, utensils, doorknobs etc.

Strep throats are not serious and usually get cured within a week. But if left untreated, it may lead to complications like rheumatic fever or kidney inflammation. Therefore it is best to take immediate ENT treatment for strep throat.

Symptoms of Strep throat

• Sore, red throat with white patches on tongue
• High fever more than 101˚F
• Headaches
• Swollen lymph nodes near the throat
• Red spots on the palate or roof of the mouth
• Chills
• Trouble in swallowing 
• Loss of appetite
• Nausea or vomiting
• Body ache 

When to see the ENT specialist for strep throat?

Head to an ENT hospital if 

• a sore throat does not subside within 2 days
• a sore throat is accompanied by rashes 
• a sore throat is accompanied by swollen lymph glands near the neck
• there is difficulty in breathing or swallowing
• fever is above 101˚F

Strep throat diagnosis

After a physical examination of the patient, the ENT doctor may order for one of these tests

Rapid Antigen Test

The ENT specialist does a throat swab and gets an Antigen Test done on the sample. If the test is negative, he suggests throat culture.

Throat culture

The ENT specialist dabs a sterile swab over the back of the throat and the tonsils to get a sample of the throat secretion. This sample is then sent to the lab for testing.

Strep throat treatment

At home

• Gargle with salt water 3-4 times daily.
• Drink lots of water to wet your sore throat.
• Drink warm liquids like tea or lemon water
• Drink cold liquids to numb the throat
• Suck on throat lozenges
• Use a cool mist humidifier and clean it daily.
• Eat soothing foods like soups, broths, cereal, porridge etc. which are easy to swallow.
• Avoid spicy foods and acidic drinks like orange juice.
• Stay from irritants like cigarette smoke.
• Stay away from school or work at least for 24 hours as strep throat is contagious.

At the ENT hospital

• The ENT specialist recommends antibiotics to cure the infection and analgesics to relieve the pain.
• Antibiotics like Penicillin or Amoxycillin are usually suggested.
• Some patients may be allergic to Penicillin. For such patients, Azithromycin, Clarithromycin or Cephalosporins are suggested.
• The doctor recommends a suitable diet to help quicken the process of remedy.

Caution

Never take OTC (over-the-counter) medication for strep throat. Some patients may be allergic to penicillin and such allergy is evident only by doing a skin test. Penicillin allergy can result in mild reactions like rashes and itching to adverse effects like Anaphylaxis which is life-threatening. this is why it is always best to consult an ENT hospital for strep throat treatment.

Do not ignore strep throat as it may lead to sinusitis, tonsillitis, ear infections, scarlet fever or pneumonia. Consult an expert ENT hospital for quick relief from strep throat infection.

What is REM sleep?

Good sleep is very important for maintaining health. Most of us experience sleeping issues at some point of time in life. This may be temporary and caused due to travel, ailments, mental stress or hurdles that change the normal routines. Yet many people experience long term difficulties in falling asleep as they struggle with sleep disorders. These disorders are conditions that affect an individual’s ability to sleep regularly and peacefully for getting sufficient rest.

Prolonged sleeping problems must be scrutinized for any underlying medical conditions by consulting an ENT doctor (ENT-Ear Nose Throat). Diagnosis may be done by undertaking sleep studies to identify the cause of sleep disturbances in a Sleep Laboratory at an ENT Hospital which is also usually equipped with an Audiology Lab. Commonly diagnosed sleep disorders include snoring, sleep apnea and REM sleep Behavioural Disorder (RBD).

Let us discuss REM sleep and RBD here.

REM sleep (Paradoxical/Desynchronized Sleep)

During sleep, the brain transits through five distinct stages. One of them is Rapid Eye movement (REM) sleep which occurs at intervals during the night. This phase is characterised by vivid dreaming, lower muscle tone, faster pulse rates and breathing. The skeletal muscles appear to be paralyzed. The other four phases are termed as Non-REM (NREM) sleep. During REM sleep, the behaviour of the brain and body is very different than those during other sleep phases.

There are physiological similarities to the waking phase in REM sleep with rapid, low-voltage and desynchronized brain waves. This cycle is typically characterized by an abundance of a neurotransmitter called acetylcholine and almost a near absence of other mono amine neurotransmitters like histamine, serotonin, and nor epinephrine.

RBD is a type of sleep disorder that involves unusual actions or behaviours during the REM phase. Here strange or dangerous events occur that disturb or intrude sleep. Other related manifestations include nocturnal dissociative disorder and walking, talking or terrors in sleep. People with this order don’t experience the temporary muscle paralysis as in REM cycle. These are either incomplete or may be completely absent. So, the person with RBD physically enacts his dreams, sometimes in dramatic or violent ways.

RBD Symptoms:

• Physical agitation, active movement of limbs, getting up and executing actions of ‘wakefulness’
• Talking, shouting, screaming, hitting or punching during sleep.
• Injury of self or bed-partners
• Making violent movements while witnessing frightened dreams

Common Causes for RBD:

• Degenerative neurological diseases including Parkinson’s Disease, Dementia, Multiple System Atrophy, Shy-Drager syndrome and Narcolepsy
• Cognitive problems, stress, anxiety, executive functioning disorders, low attention scores, apathy
• Reaction to certain drugs or sudden withdrawal of some medications
• Sleep Apnea also affects REM memory and REM Sleep

RBD Treatment:

Medication:

• Most RBD cases are treated by drugs like low doses of Clonazepam that suppresses the muscular activity and relaxes the body during the sleep duration. However, this drug must be with caution patients with Dementia, Gait Disorders and Obstructive Sleep Apnea. OSA requires sleep apnea treatment that may involve lifestyle changes or using treatment options like Airway Therapy, Surgery or Oral Appliances.
• Patients not responding to Clonazepam may be treated with anti-depressants or melatonin for reducing violent behaviour.

Improving Sleeping Habits:

• Adopting healthy sleep patterns for ensuring predictable sleep-wake cycles, reducing sleep deprivation and avoiding alcohol consumption helps in RBD Treatment. Other strategies for safe sleeping include
• Using a floor mattress with cushions all around
• Installing padded bedrails for avoiding  injuries
• Sleeping on the floor(for RBD sleep walkers)
• Not keeping furniture and sharp objects near the bed
• Removing dangerous objects from the bedroom

Thus RBD may be successfully handled by ENT treatment by usage of appropriate medication and adoption of healthy sleeping habits.

All about Coughs and their Causes

Cough is a reaction of the human body to clear the throat which may be obstructed by irritating substances. These substances   may be foreign particles, microbes, fluids, pollens or mucus which irritate the body cells. They prevent   clear passage of air from nose or mouth to the lungs during breathing. The result is the rapid expulsion of air from the lungs due to high pressure which manifests as Cough (also called Tussis). Cough may be voluntary or involuntary.

What causes Coughing?

Acute Cough lasts for durations less than three weeks. It occurs due to

• Infectious causes  like common cold and flu, sinus infections and respiratory infections including bronchitis and pneumonia
• Non-infectious reasons as existence of chronic ailments like asthma, emphysema and also because of allergic environmental factors.

Sub-Acute Cough lasts anywhere between three and eight weeks and improves subsequently.

Chronic Coughs are persistent episodes of cough that last for more than eight weeks. It is caused due to

• Throat Infections caused by sore throats including Laryngitis, Tonsillitis and Pharyngitis
• Throat Diseases resulting in damage of  vocal chords
• Post nasal drips where there is excessive mucus dripping down the throat from the back of the nose
• Gastro Esophageal Reflux Disease(GERD)
• Asthma
• Certain medications like ACE inhibitors(ACE -Angiotensin Converting Enzyme)used for primarily treating hypertension and heart problems
• Severe ailments in adults like tuberculosis, fungal infection of lungs, oral cancer and lung cancer

When to seek medical attention?

Generally coughs subside on their own. But it is advisable to seek medical attention by consulting the ENT (Ear Nose Throat) Specialist if it lasts for more than three weeks.

It is also important to visit the ENT hospital for check-up if following symptoms prevail-

• Coughing increases or there is no relief in prevailing symptoms
• Swelling or lumps are seen in the neck area
• Weight loss is experienced
• There is difficulty in swallowing or in breathing
• Permanent changes  occur in the voice
• Chest pain or discomfort is experienced
• Bouts  of fever continue
• Blood is expelled when coughing

Cough Treatment

There are a variety of ways for treating cough based on its cause.

Home Remedies

• Keeping yourself well hydrated
• Doing hot salt water  gargling
• Using nose decongestant sprays or cough drops for soothening the throat
• Avoiding pollutants like smoke, dust or other allergic substances and alcohol
• Consuming natural antidotes  like ginger, honey with lemon, pepper and hot tea

Medications

• Coughs occurring due to bacterial infections need throat treatment with antibiotics. However antibiotics are not effective for viral infections which need symptomatic treatment.
• Expectorant cough syrups (for wet cough) and cough suppressants containing codeine (for dry cough) may be prescribed for reducing coughs.

Diagnostic Tests

• Additional tests like Chest X-Ray (to ensure lungs are clear) and mucus/phlegm analysis (for signs of tuberculosis) may be done if no evident cough causes are found.
• Rarely, if a heart disorder is suspected as the cause of cough, an Echocardiogram is done to investigate the possibility.
• For more complicated and persistent cases, CT scan may be recommended for in depth view of chest and airways and checking for possibility of cancer. Appropriate treatment follows thereof.
• Further, if CT scan results do not portray the cause, the patient may be referred to Gastroenterologist or Pulmonary Specialist for investigating evidence of GERD.

Prognosis

Coughs are uncomfortable and annoying ailments which usually resolve quickly with simple remedies and medications. However if symptoms persist, it is important to take ENT treatment through physician consultation. 

Light - a Modern Sleep Problem

From childhood, we have been hearing our moms say "close your eyes and go to sleep!"  Why do we exactly close our eyes? Because darkness is essential for sleep as the absence of light signals the brain that it is time to rest by secreting a sleep hormone called Melatonin. Melatonin is secreted by the pineal gland only in darkness and this hormone is vital for relaxing the body.

After the advent of electricity, light has become a modern sleep problem as natural darkness has been replaced at night by artificial light, hampering sleep. Sleep deprivation increases the risk of diabetes, hypertension, depression and even cancer.

Causes of sleep deprivation can include high stress, poor diet, alcoholism or even a sleep disorder like acid reflux, sleep apnea etc. Of these Sleep apneas is most prevalent with over 100 million people suffering from it worldwide! Sleep apnea treatment is vital for maintaining good health and should be treated by consulting a good ENT hospital.

Sleep apnea and snoring

Sleep apnea is a sleep disorder with a fitful breathing which starts and stops often. Obstructive sleep apnea(OSA) is a condition where the throat muscles relax and cause a partial or complete obstruction of airways.

Obstructive sleep apnea is often accompanied by snoring. Snoring is caused due to the vibratory movement of the throat muscles due to the obstruction of air while breathing in sleep.

Snoring Treatment

45% of normal adults snore occasionally and 25% are habitual snorers. Snoring problem is frequent in males and obese people and often worsens with age. A cure for snoring can be found by

1. Lifestyle changes like reduction of weight, abstinence from alcohol and cigarettes, changing sleep position to sideways etc.
2. Orthopaedic Pillows to support head and neck and prevent jaw opening.
3. Dental appliances like Mandibular advancement splits for lowering the jaw and pulling the tongue forward to prevent snoring
4. CPAP - a Continuous Positive Airway Pressure mask placed over the nose or mouth to keep the airway open by pumping a controlled stream of air.
5. Surgery-UPPP-Uvulopalatopharyngoplasty to widen the airway by removing tissue at the back of the throat.

All such corrective measures can be taken only after analyzing the quality of the patient's sleep in a sleep laboratory.

Sleep Laboratory

An expert ENT hospital will have a well -equipped Sleep Laboratory with investigative tools and diagnostic equipment to identify the causes of sleep deprivation. The patient is asked to sleep in a pre-arranged, normally looking bedroom set up with all the diagnostic equipment within. Then polysomnography is conducted to analyze the sleep pattern of the patient. This is a specialized test to identify the sleep disorders like sleep apnea, narcolepsy, seizures, parasomnia etc.

Only very few professional ENT hospitals in India have Watchpat Polysomnography.

Watchpat Polysomnography

Watchpat Polysomnography is the latest medical equipment used to analyze the quality of sleep. This portable diagnostic device uses the tension of the tangential arteries to identify whether there is a blockage or shortness of breath even while the patient is asleep. It is much preferred for its infallible accuracy in its readings and extreme user-friendliness and ease of operation. Since Watchpat testing can be done in the convenience of the patient's own bedrooms, this device has proved to be a blessing in disguise for those patients who are unwilling to spend a night at the hospital. It is however advised to use the Watchpat Polysomnography device after a consultation with the ENT specialist.

"Sleep is nature's own medication to relax and rejuvenate our body. Silence your sleep problems by consulting the best ENT hospital in India and sleep well!"

5 Best Foods for Sore Throat

Sore throat (throat pain) is a common symptom characterized by ache, dryness or an itchy feeling in the throat region. It gives an uncomfortable feeling and may be contagious. Common symptoms of sore throat include throat discomfort, inflammation or ache, pain in the body, ear or head, fever, chills, cold, cough or sneezing, hoarseness in voice and difficulty in swallowing.

Based on the part affected, sore throat may be classified as:

• Pharyngitis (affects throat area behind the mouth)
• Tonsillitis (inflammation and redness of tonsils)
• Laryngitis (swelling and redness of the voice box)
• Epiglottis (causes blockage of air passage)

Causes of Sore Throat

• Throat infections caused by viruses including common cold and influenza
• Bacterial infections like strep throat
• Allergies triggered by immune systems as response to irritants like pollens and grass
• Dry air particularly in winter season
• Pollutants like smoke, alcohol and chemicals
• Any physical injury or trauma in throat/neck area
• Throat problems like straining of vocal chords or sticking of food during swallowing
• Throat Diseases including presence of tumour, cancer or Gastro- Oesophageal Reflux Disease (GERD) resulting in regurgitation of intestinal acid in throat

Sore Throat Treatment

Usually sore throat and associated symptom are treatable at home. However, it is important for patients to consult a physician in following scenarios-

1. Increased risk of developing complications due to weakening of immune system

2. Self-care measures don’t work and symptoms persist (especially in pregnant ladies)

3. Medical emergencies with severity of symptoms like

• Difficulty in swallowing or breathing
• Muffling in the voice
• Severe throat pain
• Drooling sensation
• Stridor (high-pitched sounds when breathing)
• Heart palpitations
• High fever
• Blood in the saliva
• Ear Ache

There are specialised treatments for Ear, Neck and Throat (ENT) problems. Therefore, it is crucial to consult the ENT doctors or visit the ENT hospital under above circumstances.

Home Remedies

• Doing warm water gargling with salt
• Consuming warm beverages (such as herbal tea, water with honey, warm soup broth) or eating a popsicle or an ice-cream
• Using a cool mist humidifier to moisten dry air
• Sucking a hard candy or lozenge
• Resting the throat till voice gets better
• For throat infections, it is important to drink plenty of fluids for avoiding dehydration and take sufficient rest for complete recovery.

Medication and Surgery

Analgesics provide pain relief and reduce fever. Throat lozenges and analgesic throat sprays also soothe sore throats. Antibiotics must be used only for throat infections caused by bacteria.

ENT doctors may recommend further diagnostic tests after doing physical examination. These include throat swab (for strep throat), throat culture and blood tests or CT scan for evaluating other causes like abscess, tumor or injury. Subsequently, surgical drainage of abscess or tonsillectomy (removal of tonsils) may be done for frequent infections, breathing difficulties and sleeping problems.

Foods for Sore Throat

1. Fruits 

• Bananas - Easily ingestible fruit that can be consumed directly or combined in smoothies with vitamin rich fruits like strawberries and blueberries.
• Pomegranate - An astringent with high anti-oxidant and immunity boosting properties.

2. Vegetables

• Cabbage - Has powerful anti-inflammatory and anti-oxidants properties. Is also rich in Sulphur, Vitamin C and Vitamin K and relieves headaches.
• Garlic - Potent immune booster with anti-viral and anti-bacterial properties
• Ginger - Immunity booster with surplus anti-oxidants
• Lemon - Rich in vitamin, has bacteria fighting properties

3. Spices

• Cinnamon -Wards off early signs of sore throats and evades cough
• Cloves-Fights respiratory infection and functions as a cough expectorant

4. Eggs – High protein soft foods containing omega-3s that prevent throat irritation

5. Soft foods with surplus of fibres, omegas and vitamins like Oat Meals and Cooked Pasta

5 Do’s and Don’ts of Cleaning Ears

At one point in time, every one of us is an archaeologist. Puzzled? Don't be, for I am not joking. Each and every one of us becomes an archaeologist when we clean our ears. We become so engrossed in ear cleaning that one would think we are excavating the tombs of Egypt. Yes, give us a pencil, bobby pin or even car keys! And we go digging deeper and deeper into the ear until we almost rip the ear drum apart!

Yes, I do admit that the circulatory motion of rotating the pointed object in your ear can have a pleasurable effect, but cleaning ears can become dangerous if done wrongly. So, let us pick up a few tips on cleaning ears.

5 Do's of Cleaning Ears

1. Know when to clean

The ear by itself, has a mechanism of filtering the dust and dirt by secreting earwax or cerumen and bringing it up to the surface. So most often just wiping the ears after a shower will do. Clean the ears only when you need to as in these cases when

 . Your hearing is dull
 . Your ears itch

Understand that ear wax is actually good for your ears. So, remove it only when you feel there is an earwax buildup or earwax blockages.

2. Wet your ears while showering

Wetting your ears while showering is a good thing as the hot water melts the ear wax and dissolves it right away. So, wiping your ears with a damp cloth is a must after a shower. This is natural cleaning, isn't it?

3. Use softening oils

If you are desperate to clean your ears at home, do it gently using softening oils like baby oil or mineral oil. Add few drops of oil into your ear with the ear canal facing the ceiling. After 5 minutes. tilt your head to drain it off and wipe out the excess oil. Repeat the same procedure for the other ear. Use warm water to flush out ear wax and excess oil.

4. Use ear-wax softening medication

Use medication available over-the-counter for softening ear wax. A few drops of this would be enough to dissolve the earwax blockages.

5. Consult an ENT specialist

Go for an ear check-up periodically and get your ears cleaned at an ENT hospital. Do not hesitate to contact an ENT specialist immediately in case of ear discharge, ear fullness or shooting pain in the ear.

5 Don'ts of Cleaning Ears

1. Don't clean your ears often

Cleaning ears once a month will suffice. Do not clean your ears frequently or rigorously as this will rid them of lubricating oils causing ear damage.

2. Do not put sharp objects in the ear

Do not use pens, pencils, car keys, bob pins or other sharp objects and damage your ears. 

3. Do not use ear buds or cotton swabs

Ear buds are long and your ear canal is short. So by pushing your ear buds in, you might be damaging your eardrum or pushing the earwax deeper and making it solidify. Use wax softening medication instead.

4. Do not use hydrogen peroxide

Some believe that hydrogen peroxide dilutes earwax buildup. On the contrary, it is a harmful chemical that may harm your ears.

5. Do not do ear-candling

Ear-candling is the process where a hot candle is taken near the ear to melt out the wax. Please do not follow this primitive and harmful method that might damage your ear.

Your ears are your only sound receivers that keep you connected with the vibrations of the outside world. Ears are small, sensitive and precious. Guard them with life by following these tips and always seek ENT treatment for ear cleaning and other ear problems.