About
Your throat is a tube that carries food to your oesophagus and air to your trachea (windpipe) through the larynx (voicebox). The medical name for your throat is the pharynx. It is divided into three sections: The nasopharynx (behind the nose), the oropharynx (at the back of your mouth) and the hypopharynx (around the voice box leading to the oesophagous).
Causes
Throat problems are very common and include a sore throat, difficulty swallowing or both. These symptoms are usually associated with a viralrespiratory tract infection (common cold) or tonsillitis. If a sore throat persists, especially pain on swallowing for more than two weeks you should be reviewed by your local doctor. If it does not improve referral to an ENT head and neck surgeon should be organised. Other problems include difficulty swallowing and regurgitation of food. The throat problems I typically see include benign conditions such as a pharyngeal pouch (Zenker’s diverticulum), muscular disorders and benign cysts or lumps. Cancerous or malignant lesions can involve any part of the throat especially the back of the tongue, tonsils, sidewalls of the throat next to the voicebox (pyriform fossa) and top part of the voicebox (supraglottic). The level of suspicion that the problem may be related to a cancer increases if the pain is worsening and is associated with increasing difficulty swallowing, weight loss and unexplained earache due to referred pain. C
Diagnosis
This requires the taking of a careful history and then a thorough examination of the mouth and throat which includes the use of a flexible telescope. Based on the history and examination imaging may be organised to help confirm the diagnosis and provide extra information required for treatment. Sometimes I will ask a speech pathologist to be involved as they are experts in assessing swallowing function using real-time x-rays known as a modified barium swallow (MBS) or video fluoroscopic swallowing study (VFSS).
Treatment
This ultimately depends on the final diagnosis. Typically surgery will be performed through the mouth (transorally) or as an open operation through the neck (transcervical). When performing transoral operations I utilise the carbon dioxide (CO2) laser or da Vinci robot to excise both benign and malignant tumours. Open operations require a cut in the neck to access the involved area. These days I will always opt for a minimally invasive approach transorally if it is appropriate. Open operations remain very important in the management of throat cancers and benign problems such as a pharyngeal pouch (Zenker’s diverticulum).
Examination and Treatment
In my Practice I use a special telescope to examine your throat and larynx. The telescope contains a video camera which records to a computer. I use it to perform a direct video nasolaryngoscopy. This is also sometimes called a flexible nasolaryngoscopy, a flexible laryngoscopy or a flexible nasoendoscopy.
Direct video nasolaryngoscopy is a minor procedure which gives me a magnified, high definition, live action view of your nose, throat and larynx. The video camera is linked to a screen and the examination is recorded so we can look at the images together. All Otolaryngology Head and Neck Surgeons perform nasolaryngoscopies to examine patients but my practice is one of only a handful in Australia which uses video nasolaryngoscopy.
The great advantage of videoscopes over standard flexible fibreoptic telescopes is that they provide a superior (4K) magnified image on a wide screen. The videos I record during your consultations are saved to your medical record used to track your progress following treatment. I originally used fibreoptic telescopes in my practice but I changed over to video in 2013. This was because I recognised that the superior image offered by video significantly improves my ability to identify pre-cancerous and cancerous changes in the lining of the throat and voicebox.