Difficulty swallowing. Dysphagia

Difficulty in swallowing also known as dysphagia is the disruption of the normal process of the transfer of food and liquids from the mouth to the stomach.

Often, dysphagia makes it difficult to obtain enough calories and  fluids to the body and can lead to serious medical problems (dehydration and weight loss).

Other symptoms that may accompany dysphagia:

• Cough  
• Hoarseness 
• Reflux of gastric fluids
• Weight Loss 
• Pneumonia due  to aspiration
• Dehydration

Causes of dysphagia:

Neurological disorders. Certain disorders, such as post-polio syndrome, multiple sclerosis, muscular dystrophy and Parkinson's disease, may first be noticed because of oropharyngeal dysphagia.
Neurological damage. Sudden neurological damage, such as from a stroke or brain or spinal cord injury, can cause difficulty swallowing or an inability to swallow.

Pharyngeal diverticula. A small pouch forms and collects food particles in your throat, often just above your esophagus, leading to difficulty swallowing, gurgling sounds, bad breath, and repeated throat clearing or coughing.
Cancer. Certain cancers and some cancer treatments, such as radiation, can cause difficulty swallowing.

Oesophageal disorders:

• Obstruction of foreign body
• Esophageal Stenosis
• Cancer of the esophagus
• Esophageal Achalasia
• Gastro-oesophageal reflux disease

Treatment

Treatment usually depends on the cause and type of dysphagia. The type of dysphagia will be clarified after the clinical and laboratory testing with endoscopy, an X-ray with a contrast material (barium X-ray) and a dynamic swallowing study if necessary.

Conservative treatments include: 

• Change in eating habits
• Drinking fluids
• Medication for gastro-oesophageal reflux 
• Exercises for sawallowing 

Surgical Methods 

Esophageal dilation. For a tight esophageal sphincter (achalasia) or an esophageal stricture, your doctor may use an endoscope with a special balloon attached to gently stretch and expand the width of your esophagus or pass a flexible tube or tubes to stretch the esophagus (dilatation).
Surgery. For an esophageal tumor, achalasia or pharyngeal diverticula, you may need surgery to clear your esophageal path.

Feeding tube.

Complications 

• Chronic dry cough 
• Aspiration pneumonia 
• Significant Weight Loss
• Dehydration

Vocal cord nodules

Vocal cord nodules are benign (noncancerous) growths on both vocal cords that are caused by vocal abuse. They are also known as "singers' nodules".

Over time, repeated abuse of the vocal cords results in soft, swollen spots on each vocal cord. These spots develop into harder, callous-like growths called nodules. The nodules will become larger and stiffer the longer the vocal abuse continues.

A change in voice quality and persistent hoarseness are often the first warning signs of a vocal cord lesion.

Other symptoms can include:

• Vocal fatigue 
• Unreliable voice 
• Delayed voice initiation
• Low, gravelly voice
• Low pitch
• Voice breaks in first passages of sentences
• Airy or breathy voice 
• Inability to sing in high, soft voice
• Increased effort to speak or sing
• Hoarse and rough voice quality
• Frequent throat clearing
• Extra force needed for voice

Treatment

The most common treatment options for benign vocal cord lesions include: voice rest, voice therapy, singing voice therapy, and phonomicrosurgery, a type of surgery involving the use of microsurgical techniques and instruments to treat abnormalities on the vocal cord.

Treatment options can vary according to the degree of voice limitation and the exact voice demands of the patient. For example, if a professional singer develops benign vocal cord lesions and undergoes voice therapy, which improves speaking but not singing voice, then surgery might be considered to restore singing voice. 

Successful and appropriate treatment is highly individual and includes consideration of the patient’s vocal needs and the clinical judgment of the otolaryngologist.

Hoarseness

Hoarseness refers to a difficulty making sounds when trying to speak. Vocal sounds may be weak, breathy, scratchy, or husky, and the pitch or quality of the voice may change.

Hoarseness is most often caused by a problem with the vocal cords, which are part of the voice box (larynx) in the throat. When the vocal cords become inflamed or infected, they swell. This can cause hoarseness.

The most common cause of hoarseness:

• Acute laryngitis 
• Infections of the upper respiratory 
• Severe cough 
• Vocal cord nodules 
• Vocal cord polyps 
• Reinke edema 
• Laryngopharyngeal reflux 
• Smoking 
• Allergies

Less common causes are:

• Malignant and benign tumors of the larynx 
• Malignancies of the lung, esophagus, or thyroid 
• Wounds and injuries 
• Hypothyroidism 
• Neurological diseases 
• Age 
• Myasthenia gravis

Consult you Otorhinolaryngologist if:

• You have trouble breathing or swallowing
• Hoarseness occurs with drooling, especially in a small child
• Hoarseness has lasted for more than 1 week in a child, or 2-3 weeks in an adult
• It's associated with coughing up blood
• It's associated with a lump in the neck

Diagnosis:

The ENT surgeon will conduct a mirror examination of the throat  and a laryngeal endoscopy examination.

Things to do at home to help relieve the problem include:

• Talk only when necessary, until hoarseness goes away.
• Drink plenty of fluids to help keep the airways moist. (Gargling does not help.)
• Use a vaporizer to add moisture to the air.
• Avoid actions that strain the vocal cords such as whispering, shouting, crying, and singing.
• Take medicines to reduce stomach acid if hoarseness is due to gastroesophageal reflux disease (GERD).
• Do NOT use decongestants which can dry out the vocal cords.
• If you smoke, cut down or stop at least until hoarseness goes away.

Other treatments may include voice therapy or surgical removal of laryngeal polyps or nodes if deemed necessary by the ENT surgeon.

Cough

A cough is an action the body takes to get rid of substances that are irritating to the air passages, which carry the air a person breathes in from the nose and mouth to the lungs. A cough occurs when cells along the air passages get irritated and trigger a chain of events. The result is air in the lungs is forced out under high pressure. A person can choose to cough (a voluntary process), or the body may cough on its own (an involuntary process).

Causes of Coughs

• Allergy and asthma 
• Sinusitis with postnasal drip 
• Laryngitis. Aside from coughing, laryngitis accompanied by voice alteration, hoarseness, throat constriction and difficulty breathing. 
• Pneumonia, acute bronchitis and other lung infections such as tuberculosis, pertussis 
• Chronic obstructive lung disease, chronic bronchitis and emphysema, in which the main culprit is smoking 
• Gastroesophageal reflux disease is characterized by the return fluid and contents from the stomach back into the esophagus. Due to failure of the lower esophageal sphincter. This condition causes dry cough, heartburn, bad smelling breath, difficulty swallowing. 
• Heart failure, congestive type 
• Lung cancer 
• Pulmonary embolism 
• Cystic fibrosis.

Consult a doctor if: 

• Coughing up blood. 
• Cough is associated with intense wheezing. 
• Difficulty in breathing. 
• Cough is associated with a fever and sputum production.
• Cough fails to get better after other symptoms go away or lessen.
• Cough changes in character.
• Cough is associated with chest pain.
• Accompanying weight loss.

For a quick recovery 

• Stop smoking. 
• Drink lots of water and fluids.
• Treatment to reduce acid reflux in GERD
• Lots of rest

Facial nerve Paralysis

Facial nerve Paralysis

Facial paralysis occurs when a person is no longer able to move some or all of the muscles on one side of the face. The facial nerve is the main nerve that innervates the muscles of the face and therefore enables facial expression.

Facial paralysis is almost always caused by:

• Damage or swelling of the facial nerve, which carries signals from the brain to the muscles of the face
• Damage to the area of the brain that sends signals to the muscles of the face

Fortunately, 85% of facial palsy is due to idiopathic palsy (Bell's Palsy). The etiology remains unclear although viral infections have been implicated and it occurs more frequently in pregnant women. The diagnosis of idiopathic paralysis is made by excluding all other causes. Healing occurs automatically within 6 months and usually no neurological signs remain.

Permanent paralysis is primarily due to:

• Injuries and fractures of the temporal bone
• Large facial traumas
• Tumors (neurofibromas, cholesteatomas, brain tumors, tumors  of the parotid gland, etc.) 
• Autoimmune diseases
• Metabolic diseases

Symptoms

• Sudden weakness or paralysis on one side of the face that causes it to droop. This is the main symptom. 
• It may make it hard for you to close the eye on that side of the face.
• Drooling.
• Eye problems, such as excessive tearing or a dry eye.
• Loss of ability to taste.
• Pain in or behind the ear.
• Numbness in the affected side of the face.
• Increased sensitivity to sound.

Treatment

For treatment to be effective it should be started immediately or at the latest within the first three days of symptoms. Treatment includes medication and physical therapy. The medication consists of antibiotics and cortisone. Antibiotics to fight infection and cortisone to reduce the swelling of the nerve and thus the depressurisation. Supplemental vitamins administered to the patient, especially B complex to strengthen the nerve and eye drops to protect the corneas.

Clinical studies also show that acupuncture is at least as effective as corticosteroids and may improve the recovery of patients with palsy Bell, either as monotherapy or in combination with medication.

Voice Care/Vocal Hygeine

Vocal Hygeine

Careers that depend on a person’s use of their voice, may include: a teacher, attorney, corporate trainer or an entertainer.

For a professional voice user, it is of the utmost importance to take good care of the voice. The following are some helpful hints to help maintain good vocal hygiene:

1. Hydration
It cannot be overemphasized how important it is to maintain good water intake. 6 to 8 eight glasses of water a day, are recommended to maintain adequate hydration. Good water intake helps keep the lubricating mucus on the vocal cords thin, creating the ideal environment for the vocal cords to work.

2. Thick Mucus
Increasing water intake, as outlined above, will frequently help take care of problems with thick mucous. Despite these measures, some people continue to have the sensation of thick mucous in their throat or on their vocal cords. In many instances, this is due to backflow of stomach acid into the throat - so called gastroesophageal reflux disease, or GERD.

3. Throat Clearing
This is a common problem with many professional voice users. It is often seen in people with excessive mucous or GERD (reflux disease). Throat clearing is extremely traumatic to the vocal cords, leading to excessive wear and tear. The following strategies are helpful to avoid this: swallowing, a sip of water, or silent clearing of the throat without allowing the vocal cords to touch.

4. Gastroesophageal Reflux Disease (GERD)
Although the reflux of stomach contents into the esophagus and throat commonly leads to heartburn, many patients never experience this symptom. Treatment of this condition involves changes in diet and lifestyle, as well as medications to reduce the acid production from the stomach.

5. Vocal Abuse/Overuse

It has been said, "everything in moderation". Avoiding lengthy conversations on the phone and resting the voice for ten minutes every 2-3 hours will go a long way towards easing the strain on the voice.
Talking at a low to moderate volume; this will sometimes mean using different strategies when there is excessive background noise (cars, parties, airplanes, restaurants).
Shouting and screaming should be avoided. There are much better ways to get people's attention, and these methods will not traumatize the vocal cords as screaming will. Examples would include using a whistle or the clapping of hands.
Needless to say, smoking is one of the worst things for the voice. Irritation to the vocal cords from cigarette smoke can lead to chronic laryngitis, vocal cord polyps, or cancer of the larynx.

6. Drugs that Affect the Voice
Antihistamines/Decongestants: These drugs are commonly found in cold preparations and allergy medications. They will result in a drying effect on the vocal cords which is detrimental. Other medications that cause the drying of the vocal cords are all diuretics and local anesthetics.

7. Work Environment
Smoke filled and dusty environments should be avoided. Traveling to dry environments may also cause voice problems. It is best to keep a humidifier on at night, and to maintain good water intake. Airplanes are also notoriously dry environments.

Cancer of the Mouth

Oropharyngeal Carcinoma

The harmful effects of smoking are well-established and is confirmed daily as new statistics come to light.

As is known smoking is implicated in the cancer of the larynx, oropharynx, esophagus, causing 50-75% mortality. They usually occur after the age of 40 years.

The majority of these cancers of the mouth and throat are caused by smoking, alcohol abuse, or both. 

Other factors that substantially increase the risk of cancer of the mouth:

• Immunodeficiency 
• Malnutrition 
• Poor oral hygiene 
• Shoddy dentures that do not fit well 
• Excessive exposure to ultraviolet radiation from the sun that is responsible for causing cancer especially of the lips 
• Occupational exposure to toxins
• Viral Infections 

Signs and Symptoms:

• Sore mouth that does not heal or that bleeds easily 
• White or red lesions in the mouth that do not heal 
• Presence of a lump or bulge
• Pain in mouth,  throat,tongue 
• Difficulty chewing or swallowing 
• Loss of teeth 

The sooner these symptoms and lesions are evaluated by an ear-nose and throat surgeon the greater the chance of  a successful therapy.

.
The survival rates of patients with cancer of the mouth or throat decreases dramatically once there are metastatic lesions.

Treatment
Oropharynx: Treatment options depend on the stage and aggressiveness of the disease, the location of the tumor and the general health of the patient. Treatment options include surgery, radiotherapy and chemotherapy.

Hypopharynx: Treatment options depend on the stage of disease, to preserve as much as possible the patient's ability to speak, eat and breath, and the general health of the patient. The treatment options include surgery, radiotherapy, chemotherapy.

Smoking cessation is the ultimate preventitive method, as it significantly reduces the risk of cancer, heart disease and lung disease, regardless of age.

Salivary Gland Disorders

Salivary glands make as much as a quart of saliva each day. Saliva is important to lubricate the mouth, help with swallowing, protect the teeth against bacteria, and aid in the digestion of food. 

The three major pairs of salivary glands are:

• parotid glands on the insides of the cheeks
• submandibular glands at the floor of the mouth
• sublingual glands under the tongue

There are also several hundred minor salivary glands throughout the mouth and throat. Saliva drains into the mouth through small tubes called ducts.

Often, they can be afflicted by various diseases such as inflammation (viral or bacterial), autoimmune diseases, salivary gland stones, or neoplastic diseases.

Childhood mumps, certain bacterial infections (for example, of the tonsils or teeth), and other diseases that are typically more common among adults (such as AIDS, Sjögren syndrome, diabetes mellitus, sarcoidosis, and bulimia) often cause swelling of the major salivary glands)

The most common reasons for which a patient will make a visit to the doctor are: 

• The swelling of the salivary gland  
• Pain 
• Fever 
• Purulent discharge mouth

Swelling  occurs:
Salivary gland stones:
A stone can form from salts contained in the saliva. Stones are particularly likely to form when people are dehydrated or take drugs that decrease saliva production. People with gout are also more likely to form stones. Salivary gland stones are most common among adults. 

Tumours:
Swelling also can result from cancerous (malignant) or noncancerous (benign) tumors in the salivary glands. Swelling resulting from a tumor is usually firmer than that caused by an infection. If the tumor is cancerous, the gland may feel stone-hard and may be fixed firmly to surrounding tissues.

Treatment

The infections are treated with antibiotics and antiinflammatory drugs.
The salivary stones, can be identified and removed using very thin endoscopes, without requiring surgery.
Benign tumors are removed surgically. The surgery is very delicate and requires skill and experience.
Malignant tumors other than surgical excision may require radiotherapy and chemotherapy.

Reflux of Gastric Fluid into the Larynx

The term Laryngopharyngeal Reflux (LPR) refers to the backflow of food or stomach acid all of the way back up into the larynx (the voice box) or the pharynx (the throat). LPR (silent reflux) can occur during the day or night, even if a person who has LPR hasn't eaten a thing.

Silent Reflux Can Cause:

• Hoarseness
• A "lump" in the throat
• Trouble swallowing
• Chronic cough
• Too much throat mucus
• Heartburn

There are many symptoms of LPR, all of which relate to sensations in the throat. Fifty percent of people with LPR do not have symptoms of heartburn or indigestion.

Diagnosis of LPR:

Most often, the ENT surgeon can diagnose LPR through a combination of a medical history and symptom score and a thorough clinical examination of  your throat and vocal cords with a rigid or flexible endocope. The voice box is typically red, irritated, and swollen from acid reflux damage. This swelling and inflammation will eventually resolve with medical treatment, although it may take a few months.

Treatment

Most of the time, LPR is well controlled with medications (Proton Pump Inhibitors, or PPI's), taken long periods of time.

Silent reflux treatment for adults may include these lifestyle modifications:

• Lose weight, if needed.
• Quit smoking, if you are a smoker.
• Avoid alcohol.
• Restrict chocolate, mints, fats, citrus fruits, carbonated beverages, spicy or tomato-based products, red wine, and caffeine.
• Stop eating at least three hours before going to bed.
• Elevate the head of the bed about 4 to 6 inches.
• Avoid wearing tight-fitting clothes around the waist.
• Try chewing gum to increase saliva and neutralize acid.

Mucocele in the floor of the Mouth. (Ranula)

A ranula is a type of mucocele found on the floor of the mouth. 

Ranulas present as a swelling of connective tissue consisting of collected mucin from a ruptured salivary gland duct. These lesions occur as the result of trauma or obstruction to the salivary gland excretory duct and spillage of mucin into the surrounding soft tissues.

Symptoms

Mucoceles often show up on the inside of your lower lips, your gums, the roof of your mouth, or under your tongue. Those on the floor of the mouth are called ranulas. These are rare, but because they are larger, they can cause more problems with speech, chewing, and swallowing.

Mucoceles may have these characteristics:

• Moveable and painless
• Soft, round, dome-shaped
• Pearly or semi-clear surface or bluish in color
• 2 to 10 millimeters in diameter

Treatment

Normally the ranula or mucoceles resolves spontaneously,  but in some cases they may persist and become enlarged and therfore are in need of surgical treatment. The ENT surgeon surgically removes the ranula with the use of a micromarsupialization technique and in some cases removal of the sublingual salivary gland as well may be necessary in order to prevent recurrence.

Sore Throat. Pharyngitis

A sore throat is pain, scratchiness or irritation of the throat that often worsens when swallowing.
A sore throat is the primary symptom of pharyngitis — inflammation of the pharynx, or throat. But the terms "sore throat" and "pharyngitis" are often used interchangeably.
The most common cause of a sore throat is a viral infection, such as a cold or the flu. A sore throat caused by a virus usually resolves on its own with at-home care. A bacterial infection, a less common cause of sore throat, requires additional treatment with antibiotic drugs. Most cases of pharyngitis occur during the colder months. The illness often spreads among family members.

Symptoms of pharyngitis

• Pain or a scratchy sensation in the throat
• Pain that worsens with swallowing or talking
• Difficulty swallowing
• Dry throat
• Sore, swollen glands in your neck or jaw
• Swollen, red tonsils
• White patches or pus on your tonsils
• Hoarse or muffled voice
• Refusal to eat (infants and toddlers)Other symptoms may include:
• Fever
• Headache
• Joint pain and muscle aches
• Skin rashes

Risk factors

Although anyone can get a sore throat, some factors make you more susceptible. These factors include:

• Age. Children and teens are most likely to develop sore throats. Children are also more likely to have strep throat, the most common bacterial infection associated with a sore throat.
• Tobacco. Smoking and secondhand smoke can irritate the throat. The use of tobacco products also increases the risk of cancers of the mouth, throat and voice box.
• Allergies. 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 are people who don't have allergies.
• 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.
• Chronic or frequent sinus infections. Chronic or frequent sinus infections increase the risk of sore throat, because drainage from the nose can irritate the throat or spread infection.
• Living or working in close quarters. Viral and bacterial infections spread easily anywhere people gather — child care centers, classrooms, offices, prisons and military installations.
• Lowered immunity. You're more susceptible to infections in general if your resistance is low. Common causes of lowered immunity include HIV, diabetes, treatment with steroids or chemotherapy drugs, stress, fatigue, and poor diet.

Lifestyle and home remedies

Regardless of the cause of your sore throat, at-home care strategies usually provide temporary relief. 

• Rest. Get plenty of sleep and rest your voice.
• Fluids. Drink plenty of water to keep the throat moist and prevent dehydration.
• Comforting foods and beverage. Warm liquids — broth, caffeine-free tea or warm water with honey — and cold treats such as ice pops can soothe a sore throat.
• Saltwater gargle. A saltwater gargle of 1 teaspoon (5 milliliters) of table salt to 8 ounces (237 milliliters) of warm water can help soothe a sore throat. Gargle the solution and then spit it out.
• Humidify the air. Use a cool-air humidifier to eliminate dry air that may further irritate a sore throat or sit for several minutes in a steamy bathroom.
• Avoid irritants. Keep your home free from cigarette smoke and cleaning products that can irritate the throat.
• Treat pain and fever. Ibuprofen (Advil, Motrin, others) or acetaminophen (Tylenol, others) may minimize throat pain. 

Treatment
Because viral illnesses are the most common cause of a sore throat, it is important not to use antibiotics to treat them. 

Antibiotics do not alter the course of viral infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.Viruses will run their own course and the infection usually will resolve when the body fights them off. Bacterial infections of the tonsils or adenoids are treated with antibiotics.

Chronic infections may require surgery to remove the tonsils or adenoids.

Ear Pathology associated with Scuba Diving

The freediving and scuba diving are activities that require a good physical condition and perfect condition of the ear, nose and paranasal sinuses. As is known to those skilled in diving more than 50% of a diver's emerging problems are related to an Otolaryngologist's area of epertise and more than 90% of these problems are related to the ears. 

Normally the air pressure in the ear is equilibrated to atmospheric pressure, by the Eustachian tube, which is normally closed and opens during swallowing, yawning or actively by using the Valsalva Maneuvre.

During scubadiving  the air pressure in the ear may sometimes not be equalised and this leads to overpressure of the middle ear. This will result in barotitis media which is the most frequently reported injury among divers. 

Predisposing factors for barotrauma: 

• Common cold (runny nose) 
• Allergic rhinitis 
• Nasal polyps 
• Septal deviation

External auditory meatus

Pain in the external ear is due to the negative pressure that occurs during the dive, which may result in small hemorrhages in the skin of the ear canal and the eardrum. Treatment is not usually necessary, however, diving should stop until healing is completed. 

Otitis externa is an inflammation of the ear canal caused by bacteria. If the ear remains moist from immersion in the water, this moisture, coupled with the warmth of the body, creates an inviting growth area for many microorganisms, especially opportunistic bacteria.

Middle ear 

Barotrauma of the middle ear is the most common injury reported by divers.
It should be highlighted that the first 10 to 11 meters below the surface, are the critical threshold for the pressure to equalize in the ears. The diver who can not achieve this equalisation in pressure, may encounter severe pain, hearing loss and vertigo either immediately after the dive or even a few days later.

Diving precautions

• Decongestant nasal spray (if the nasal passages are congested) 
• Systemic administration of decongestants 
• Valsalva Maneuvre
• Diving feet first

Reverse barotrauma: occurs when ascending to the surface if the Eustachian tube is blocked and causes:

• severe pain 
• dizziness. 
• bleeding in the ear, 
• trauma to the ear drum  
• permanent hearing loss. 

Inner ear

This injury generally occurs when divers attempt to forcefully equalize their ears. This "hard" blowing over-pressurizes the middle ear and can result in implosive or explosive damage to the round and oval windows. The symptoms caused by inner ear barotrauma are vertigo, vomiting, hearing loss and loud tinnitus.

PREVENTION

Most of these ear injuries can be avoided if the diver is precisely evaluated and screened for any predisposing factors before scubadiving. Emphasis should be placed on a healthy and functional Eustachian tube, nasal cavaties, paranasal sinuses and the nasopharynx.

• This screening examination should include the following tests: otoscopy, audiogram, Valsalva maneuvre, nasal and nasopharyngeal endoscopy.

Preventive measures during the dive include:

1. properly equalizing
2. never diving with a cold or other congestion, and
3. abstaining from diving if you cannot clear your ears.

Oral Ulcers

Aphthous mouth ulcers
Aphthous mouth ulcers are painful sores that can occur anywhere inside the mouth. They are the most common type of mouth ulcer. At least 1 in 5 people can develop aphthous mouth ulcers at some stage in their life. Women are affected more often than men. Aphthous ulcers usually first occur between the ages of 10 and 40 years. 

The cause is not known. They are not infectious, and you cannot 'catch' aphthous mouth ulcers. In most cases, the ulcers develop for no apparent reason in people who are healthy.

Several genetic and environmental factors have been implicated that favor the development of this condition:

• immunological and hormonal disorders 
• allergies 
• stress 
• heredity 
• microbial infections 
• trauma 
• smoking cessation 
• lack of certain vitamins and elements (B6, B12, folic acid and iron) 
• certain medications (steroids, anti-inflammatory)

Also, the existence of certain conditions such as:

• celiac disease, 
• Adamantiades-Bechet syndrome 
• cyclic neutropenia, 
• Crohn's disease and 
• HIV infection can lead to the induction of recurrent aphthous stomatitis

Clinical Presentation

Mouth ulcers are painful round or oval sores that form in the mouth, most often on the inside of the cheeks or lips.

They're usually white, red, yellow or grey in colour and are inflamed (red and swollen) around the edge.

Although mouth ulcers can be uncomfortable, especially when you eat, drink or brush your teeth, they are usually harmless.

Most mouth ulcers will clear up spontaneously within a week or two.

Treatment

Most mouth ulcers don't require specific treatment, as they will usually heal on their own within 10-14 days.

However, treatment may be necessary if the ulcers are severe, painful or interfere with your daily activities (such as eating). The treatment normally includes corticosteroids and antibiotics.

Self-help tips

If you have a mild mouth ulcer, there are some steps you can take yourself to help your ulcer heal more quickly:

• Use a soft toothbrush when brushing your teeth.
• Avoid hard, sharp, spicy and acidic foods and drinks until the ulcer heals – stick to soft foods that are easier to chew.
• Avoid specific foods that may trigger oral ulcers.
• Reduce your stress levels by doing an activity that you find relaxing, such as yoga, meditation orexercise. Read more about relaxation tips to avoid stress.

If your ulcer has a specific physical cause, such as a sharp tooth or filling cutting the inside of your cheek, it will usually heal naturally once the cause has been treated. If you suspect that a sharp tooth or filling has caused an ulcer, visit your dentist so that they can repair it.

Pyogenic Granuloma

Pyogenic granulomas are common skin and mucosal growths that are small and usually reddish in color. They tend to bleed because they contain a very large number of blood vessels. They’re also known as lobular capillary hemangiomas.

These growths mainly affect children and young adults, although they can develop in people of all ages. They are also fairly common in pregnant women—the hormone changes that occur during pregnancy can cause these growths to develop.

The aetiology is not fully understood: rapid growth occurs in response to an unknown stimulus that triggers endothelial proliferation and angiogenesis.

• Trauma and burns can provoke the sequence but frequently there is no identifiable cause.
• Other suggested causes include viral oncogenes, hormonal influences (pregnancy, oral contraceptive pill) and cytogenetic abnormalities.
• They have also been associated with certain medications.

Tips
Consult your doctor if you notice any rapid growth of skin or mucous membranes to the diagnosis. They are prone to easy bleeding, so that the dressing may need to treat the lesion.

Treatment

These lesions bleed easily so often tre
atment is urgently needed to control the hemorrhage. Treatment entails surgical excision under local anesthesia, cryotherapy, electrocautery or laser.

Oral thrush

Oral Candidiasis 

Oral thrush, also called oral candidiasis, is a condition in which the fungus Candida albicans accumulates on the lining of your mouth. Candida is a normal organism in the mouth, but sometimes it can overgrow and cause symptoms.

Oral thrush causes creamy white lesions, usually on the tongue or inner cheeks. Sometimes oral thrush may spread to the roof of the mouth, gums or tonsils, or the back of the throat.

Anyone can develop oral thrush, but the infection is more common in certain people. Risk factors include:

• Being an infant or elderly
• Having a weakened immune system
• Wearing dentures
• Having other health conditions, such as diabetes
• Taking certain medications, such as antibiotics or oral or inhaled corticosteroids
• Undergoing chemotherapy or radiation treatment for cancer
• Having conditions that cause dry mouth
• Smoking

Symptoms

Depending on the underlying cause, signs and symptoms may develop slowly or suddenly, and they may persist for days, weeks or months. 

Signs and symptoms may include:

• Creamy white lesions on your tongue, inner cheeks, and sometimes on the roof of your mouth, gums and tonsils
• Slightly raised lesions with a cottage cheese-like appearance
• Redness or soreness that may be severe enough to cause difficulty eating or swallowing
• Slight bleeding if the lesions are rubbed or scraped
• Cracking and redness at the corners of your mouth (especially in denture wearers)
• A cottony feeling in your mouth
• Loss of taste

In severe cases, the lesions may spread downward into the esophagus the long. If this occurs, there may be a difficulty in swallowing.

Prevention

These measures may help reduce the risk of developing candida infections:

• Rinse your mouth. If you have to use a corticosteroid inhaler, be sure to rinse your mouth with water or brush your teeth after taking your medication.
• Good oral hygeine. Brush your teeth at least twice a day and floss daily or as often as your dentist recommends.
• Clean your dentures. Clean your dentures daily. Ask your dentist for the best way to clean your type of dentures.
• Regular visits toi the dentist, specially if you have diabetes or wear dentures. 
• Try limiting the amount of sugar- and yeast-containing foods you eat. These may encourage the growth of candida.
• Maintain good blood sugar control if you have diabetes.Well-controlled blood sugar can reduce the amount of sugar in your saliva, discouraging the growth of candida.
• Treat any vaginal yeast infections that develop during pregnancy as soon as possible.
• QUIT SMOKING

Treatment

Adults with weakened immune systems are treated with antifungal medication. But Candida albicans can become resistant to many antifungal medications, especially in people with late-stage HIV infection. So a drug called amphotericin B may be used, but only when other drugs aren't effective, as it can cause serious side effects.

For mild oral thrush, the usual treatment that is tried first is miconazole mouth gel for seven days. Sometimes a two-week course is needed. Nystatin drops are another option if miconazole gel cannot be used

Common cold. The flu

Sniffles, sneezes and perhaps a sore throat and annoying cough, the common cold catches all of us from time to time. The common cold is a self-limited contagious illness that can be caused by a number of different types of viruses. The common cold is medically referred to as a viral upper respiratory tract infection occurring at any time of the year, but most commonly in the winter or rainy season.
Cold symptoms usually start about 2 or 3 days after you came in contact with the virus, although it could take up to a week. Symptoms mostly affect the nose.

The most common cold symptoms are:

• Nasal congestion 
• Runny nose 
• Scratchy throat 
• Sneezing 
• Adults and older children with colds generally have a low fever or no fever.

Depending on which virus caused your cold, you may also have:

• Cough 
• Decreased appetite 
• Headache 
• Muscle aches 
• Postnasal drip 
• Sore throat 
• Symptoms

Because so many different viruses can cause a cold and because new cold viruses constantly develop, the body never builds up resistance against all of them. For this reason, colds are a frequent and recurring problem. In fact, children in preschool and elementary school can have 6 to 12 colds per year while adolescents and adults typically have two to four colds per year.
This occurs mostly during the winter season due to closer contact in closed spaces that don't have the appropriate ventilation.

How is the common cold transmitted?

The common cold is spread either by direct contact with infected secretions from contaminated surfaces or by inhaling the airborne virus after individuals sneeze or cough. Person-to-person transmission often occurs when an individual who has a cold blows or touches their nose and then touches someone or something else. A healthy individual who then makes direct contact with these secretions can subsequently become infected, often after their contaminated hands make contact with their own eyes or nose. A cold virus can live on objects such as pens, books, telephones, computer keyboards, and coffee cups for several hours and can thus be acquired from contact with these objects.

Prevention!!!

• Wash your hands. Clean your hands thoroughly and often, and teach your children the importance of hand washing. 
• Scrub your stuff. Keep kitchen and bathroom countertops clean, especially when someone in your family has a common cold. Wash children's toys periodically. 
• Use tissues. Always sneeze and cough into tissues. Discard used tissues right away, and then wash your hands carefully. Teach children to sneeze or cough into the bend of their elbow when they don't have a tissue. That way they cover their mouths without using their hands. 
• Don't share. Don't share drinking glasses or utensils with other family members. Use your own glass or disposable cups when you or someone else is sick. Label the cup or glass with the name of the person with the cold. 
• Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold.

Treatment

The common cold does NOT need antibiotics!!!

You may not be able to cure your common cold, but you can make yourself as comfortable as possible. 

These tips may help: 

1. Drink lots of fluids. Water, juice, clear broth or warm lemon water are all good choices. They help replace fluids lost during mucus production or fever. Avoid alcohol and caffeine, which can cause dehydration, and cigarette smoke, which can aggravate your symptoms.
2. Try chicken soup. Generations of parents have spooned chicken soup into their sick children's mouths. Now scientists have put chicken soup to the test, discovering that it does seem to help relieve cold and flu symptoms in two ways. First, it acts as an anti-inflammatory by inhibiting the movement of neutrophils — immune system cells that help the body's response to inflammation. Second, it temporarily speeds up the movement of mucus through the nose, helping relieve congestion and limiting the time viruses are in contact with the nasal lining.
3. Get some rest. If possible, stay home from work if you have a fever or a bad cough, or are drowsy after the medications. This will give you a chance to rest as well as reduce the chances that you'll infect others. 
4. Wear a mask when you have a cold if you live or work with someone with a chronic disease or compromised immune system.
5. Adjust your room's temperature and humidity. Keep your room warm, but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing. Be sure to keep the humidifier clean to prevent the growth of bacteria and molds.
6. Soothe your throat. A saltwater gargle — 1/4 to 1/2 teaspoon (1.2 milliliters to 2.5 milliliters) salt dissolved in an 8-ounce (237 milliliters) glass of warm water — can temporarily relieve a sore or scratchy throat.
7. Use saline nasal drops. To help relieve nasal congestion, try saline nasal drops, they're effective, safe and nonirritating, even for children. In infants, experts recommend instilling several saline drops into one nostril, then gently suctioning that nostril with a bulb syringe (push the bulb in about 1/4 to 1/2 inch, or about 6 to 12 millimeters). Doing this before feeding your baby can improve your child's ability to nurse or take a bottle, and before bedtime it may improve sleep. Saline nasal sprays may be used in older children.