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Tonsils and adenoids are on the body’s first line of 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 determing 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 surgery

Children

• 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 prior to surgery.
• Generally, after midnight prior to 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 surgery

• There are several postoperative symptoms that 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 symptoms

Tonsillitis 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 symptoms

If your or your child’s adenoids are enlarged, it may be hard to breathe through the nose. Other signs of constant enlargement are:

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:

1. The first is oral preparation, where food or liquid is manipulated and chewed in preparation for swallowing.
2. During the oral stage, the tongue propels the food or liquid to the back of the mouth, starting the swallowing response.
3. The pharyngeal stage begins as food or liquid is quickly passed through the pharynx, the canal that connects the mouth with the esophagus, into the esophagus or swallowing tube.
4. 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)

 

• 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 hoarse.
• Avoid speaking or singing when your voice is injured or hoarse

 

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.

Other causes

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 101°)
• 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?

Smell and taste also warn us about dangers, such as fire, poisonous fumes, and spoiled food. Certain jobs require that these senses be accurate-chefs and firemen rely on taste and smell. One study estimates that more than 200,000 people visit a doctor with smell and taste disorders every year, but many more cases go unreported.

Loss of the sense of smell may be a sign of sinus disease, growths in the nasal passages, or, in rare circumstances, brain tumors.

How do smell and taste work?

Smell and taste belong to our chemical sensing system (chemosensation). The complicated processes of smelling and tasting begin when molecules released by the substances around us stimulate special nerve cells in the nose, mouth, or throat. These cells transmit messages to the brain, where specific smells or tastes are identified.

Olfactory (small nerve) cells are stimulated by the odors around us-the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose, and they connect directly to the brain.

Gustatory (taste nerve) cells react to food or drink mixed with saliva and are clustered in the taste buds of the mouth and throat. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers, which send messages to the brain.

The common chemical sense, another chemosensory mechanism, contributes to our senses of smell and taste. In this system, thousands of free nerve endings-especially on the moist surfaces of the eyes, nose, mouth, and throat-identify sensations like the sting of ammonia, the coolness of menthol, and the "heat" of chili peppers.

Flavor

We can commonly identify four basic taste sensations:

• sweet
• sour
• bitter
• salty

Certain combinations of these tastes-along with texture, temperature, odor, and the sensations from the common chemical sense-produce a flavor. It is flavor that lets us know whether we are eating peanuts or caviar.

Many flavors are recognized mainly through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor, even though you can distinguish the food's sweetness or bitterness. This is because the familiar flavor of chocolate is sensed largely by odor. So is the well-known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor (e.g., an expert chef testing his own creation) will exhale through his nose after each swallow.

Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells.

What causes smell and taste disorders?

Scientists have found that the sense of smell is most accurate between the ages of 30 and 60 years. It begins to decline after age 60, and a large proportion of elderly persons lose their smelling ability. Women of all ages are generally more accurate than men in identifying odors.

Some people are born with a poor sense of smell or taste. Upper respiratory infections are blamed for some losses, and injury to the head can also cause smell or taste problems.

Loss of smell and taste may result from polyps in the nasal or sinus cavities, hormonal disturbances, or dental problems. They can also be caused by prolonged exposure to certain chemicals such as insecticides and by some medicines.

Tobacco smoking is the most concentrated form of pollution that most people will ever be exposed to. It impairs the ability to identify odors and diminishes the sense of taste. Quitting smoking improves the smell function.

Radiation therapy patients with cancers of the head and neck later complain of lost smell and taste. These senses can also be lost in the course of some diseases of the nervous system.

Patients who have lost their larynx (voice box) commonly complain of poor ability to smell and taste. Laryngectomy patients can use a special "bypass" tube to breathe through the nose again. The enhanced air flow through the nose helps smell and taste sensation to be re-established.

How are smell and taste disorders diagnosed?

The extent of loss of smell or taste can be tested using the lowest concentration of a chemical that a person can detect and recognize. A patient may also be asked to compare the smells or tastes of different chemicals, or how the intensities of smells or tastes grow when a chemical concentration is increased.

• Smell. Scientists have developed an easily administered "scratch-and-sniff" test to evaluate the sense of smell.
• Taste. Patients react to different chemical concentrations in taste testing; this may involve a simple "sip, spit, and rinse" test, or chemicals may be applied directly to specific areas of the tongue.

Can smell and taste disorders be treated?

Sometimes a certain medication is the cause of smell or taste disorders, and improvement occurs when that medicine is stopped or changed. Although certain medications can cause chemosensory problems, others-particularly anti-allergy drugs-seem to improve the senses of taste and smell. Some patients, notably those with serious respiratory infections or seasonal allergies, regain their smell or taste simply by waiting for their illness to run its course. In many cases, nasal obstructions, such as polyps, can be removed to restore airflow to the receptor area and can correct the loss of smell and taste. Occasionally, chemosenses return to normal just as spontaneously as they disappeared.

What can I do to help myself?

If you experience a smell or taste problem, try to identify and record the circumstances surrounding it. When did you first become aware of it? Did you have a "cold" or "flu" then? A head injury? Were you exposed to air pollutants, pollens, danders, or dust to which you might be allergic? Is this a recurring problem? Does it come in any special season, like hayfever time?

Bring all this information with you when you visit a physician who deals with diseases of the nose and throat (an otolaryngologist-head and neck surgeon). Proper diagnosis by a trained professional can provide reassurance that your illness is not imaginary. You may even be surprised by the results. For example, what you may think is a taste problem could actually be a smell problem, because much of what you think you taste you really smell.

Diagnosis may also lead to treatment of an underlying cause for the disturbance. Many types of smell and taste disorders are reversible. But, if yours is not, it is important to remember that you are not alone. Thousands of other patients have faced the same situation.

 

 

Diseases of the thyroid gland are very common, affecting millions of Americans. The most common thyroid problems are:

• an overactive gland, called hyperthyroidism (e.g., Graves’ disease, toxic adenoma or toxic nodular goiter)
• an underactive gland, called hypothyroidism (e.g., Hashimoto’s thyroiditis)
• thyroid enlargement due to overactivity (as in Graves’ disease) or from under-activity (as in hypothyroidism). An enlarged thyroid gland is often called a “goiter”.

Patients with a family history or who had radiation therapy to the head or neck as children for acne, adenoids, or other reasons are more prone to develop thyroid malignancy.

If you develop significant swelling in your neck or difficulty breathing or swallowing, you should call your surgeon or be seen in the emergency room.

What treatment may be recommended?

Depending on the nature of your condition, treatment may include the following:

• Hypothyroidism treatment:
  • thyroid hormone replacement pills
• Hyperthyroidism treatment:
  • medication to block the effects of excessive production of thyroid hormone
  • radioactive iodine to destroy the thyroid gland
  • surgical removal of the thyroid gland

Goiters (lumps):

If you experience this condition, your doctor will propose a treatment plan based on the examination and your test results. He may recommend:

• A fine needle aspiration biopsy—a safe, relatively painless procedure. With this procedure, a hypodermic needle is passed into the lump, often after administration of local anesthesia into the skin, and tissue fluid samples containing cells are taken. Often several passes with the needle are required. Sometimes ultrasound may be used to guide the needle into the nodule. There is little pain afterward and very few complications from the procedure occur. This test gives the doctor more information on the nature of the lump in your thyroid gland and specifically may help to differentiate a benign from a malignant thyroid mass.
• Thyroid surgery—may be required when:
  • the fine needle aspiration is reported as suspicious for or suggestive of cancer
  • the trachea (windpipe) or esophagus are compressed because both lobes are very large

Historically, some malignant thyroid nodules have shown a reduction in size with the administration of thyroid hormone. However, this treatment, known as medical “suppression” therapy, has proven to be an unreliable treatment method.

What is thyroid surgery?

Thyroid surgery is an operation to remove part or all of the thyroid gland. It is performed in the hospital, and general anesthesia is usually required. Typically the operation removes the lobe of the thyroid gland containing the lump and possibly the isthmus. A frozen section (an immediate microscopic reading) may or may not be used to determine if the rest of the thyroid gland should be removed.

Sometimes, based on the result of the frozen section, the surgeon may decide not to remove any additional thyroid tissue, or proceed to remove the entire thyroid gland, and/or other tissue in the neck. This is a decision usually made in the operating room by the surgeon, based on findings at the time of surgery. Your surgeon will discuss these options with you preoperatively.

There may be times when the definite microscopic answer cannot be determined until several days after surgery. If a malignancy is identified in this way, your surgeon may recommend that the remaining lobe of the thyroid be removed at a second procedure. If you have specific questions about thyroid surgery, ask your otolaryngologist and he or she will answer them in detail.

What happens after thyroid surgery?

During the first 24 hours: After surgery, you may have a drain (a tiny piece of plastic tubing), which prevents fluid and blood from building up in the wound. This is removed after the fluid accumulation has stabilized, usually within 24 hours after surgery. Most patients are discharged later the same day or the day following the procedure.

Complications are rare but may include:

• bleeding
• a hoarse voice
• difficulty swallowing
• numbness of the skin on the neck
• vocal cord paralysis
• low blood calcium

At home: Following the procedure, if it is determined that you need to take any medication, your surgeon will discuss this with you, prior to your discharge.

Medications may include:

• thyroid hormone replacement
• calcium and/or vitamin D replacement

Some symptoms may not become evident for two or three days after surgery. If you experience any of the following, call your surgeon:

• numbness and tingling around the lips and hands
• increasing pain
• fever
• swelling
• wound discharge

If a malignancy is identified, thyroid replacement medication may be withheld for several weeks. This allows a radioactive scan to better detect any remaining microscopic thyroid tissue, or spread of malignant cells to lymph nodes or other sites in the body.

How is a diagnosis made?

The diagnosis of a thyroid function abnormality or a thyroid mass is made by taking a medical history and a physical examination. Specifically, your doctor will examine your neck and ask you to lift up your chin to make your thyroid gland more prominent. You may be asked to swallow during the examination, which helps to feel the thyroid and any mass in it. Other tests your doctor may order include:

• evaluation of the larynx/vocal cords with a mirror or a fiberoptic telescope
• an ultrasound examination of your neck and thyroid
• blood tests of thyroid function
• a radioactive thyroid scan
• a fine needle aspiration biopsy
• a chest X-ray
• a CT or MRI scan

 

What Is FNA?

Fine needle aspiration (FNA) is a technique that allows a biopsy of various bumps and lumps. It allows your otolaryngologist to retrieve enough tissue for microscopic analysis and thus make an accurate diagnosis of a number of problems, such as inflammation or even cancer.

FNA is Used for diagnosis in:

• Neck lymph nodes
• Neck cysts
• Parotid gland
• Thyroid gland
• Inside the mouth
• Any lump that can be felt

Why is it important?

A mass or lump sometimes indicates a serious problem, such as a growth or cancer*. While this is not always the case, the presence of a mass may require FNA for diagnosis. Your age, sex, and habits, such as smoking and drinking, are also important factors that help diagnosis of a mass. Symptoms of ear pain, increased difficulty swallowing, weight loss, or a history of familial thyroid disorder or of previous skin cancer (squamous cell carcinoma) may be important as well.

* When found early, most cancers in the head and neck can be cured with relatively little difficulty. Cure rates for these cancers are greatly improved if people seek medical advice as soon as possible. So play it safe. If you have a lump in your head and neck area, see your otolaryngologist right away.

What are some areas that can be biopsied in this Fashion?

FNA is generally used for diagnosis in areas such as the neck lymph nodes or for cysts in the neck. The parotid gland (the mumps gland), thyroid gland, and other areas inside the mouth or throat can be aspirated as well. Virtually any lump or bump that can be felt (palpated) can be biopsied using the FNA technique.

How is it done?

Your doctor will insert a small needle into the mass. Negative pressure is created in the syringe, and as a result of this pressure difference between the syringe and the mass, cellular material can be drawn into the syringe. The needle is moved in a to and fro fashion, obtaining enough material to make a diagnosis. This procedure is generally accurate and frequently prevents the patient from having an open, surgical biopsy, which is more painful and costly. The procedure generally does not require anesthesia. It is about as painful as drawing blood from the arm for laboratory testing (venipuncture). In fact, the needle used for FNA is smaller than that used for venipuncture. Although not painless, any discomfort associated with FNA is usually minimal.

What are the complications of this procedure?

No medical procedure is without risks. Due to the small size of the needle, the chance of spreading a cancer or finding cancer in the needle path is very small. Other complications are rare; the most common is bleeding. If bleeding occurs at all, it is generally seen as a small bruise. Patients who take aspirin, Advil®, or blood thinners, such as Coumadin®, are more at risk to bleed. However, the risk is minimal. Infection is rarely seen.