Sore throat, a lancinating discomfort

With the help of the throat you eat, talk and breathe. The throat is a jack of all trades, but the mucous membrane is easily affected by unwanted invaders such as a virus. The consequences are obvious: Sore throat, a miserable feeling and an insatiable thirst. While you try to swallow the sore throat with hot drinks and bags of licorice, the body is working hard to show the culprit the door. Strep throat infections occur regularly in everyone and rarely indicate anything serious.

The throat is all-round

The throat is the tube that runs from the back of the nose and mouth down to the trachea and esophagus. The throat is suitable for many purposes. First of all, it is also used for breathing. Air passes through the throat into the trachea on its way to the lungs. When swallowing, the chewed food mixed with saliva enters the throat, from there into the esophagus towards the stomach. The throat is also important when speaking. At the top of the trachea is the voice box (larynx), which is used for speaking. Air passing over the vocal cords causes them to vibrate, producing sound that modulates the mouth into speech. The throat is therefore all-round, but susceptible to infections that can spread to neighboring areas, such as trachea and sinuses. The phenomenon of sore throat is therefore very common. As many as 12% of doctor visits concern a sore throat. On average, doctors see a patient with throat complaints twice a week. Sore throat is never a diagnosis, but is almost always a consequence of something else, e.g. bronchitis, flu, respiratory infections, etc.

What strep throat is

A sudden inflammation of the part between the tonsils and the larynx, called the pharynx, resembles an acute inflammation of the tonsils because both diseases are caused by the same bacteria and viruses. A small difference is that true tonsillitis (inflammation of the tonsils) is sometimes more serious. Colloquially, but also among doctors, this is referred to as ‘strep throat’. If the condition becomes chronic, this usually occurs because surrounding parts such as the respiratory system, the sinuses or the mouth are chronically affected. The sore throat is then secondary. A throat infection can also occur without an infection, in which case the throat has become irritated by excessive or incorrect use of the voice, too much throat clearing, too dry ambient air, irritating substances, post nasal drip, tickly cough, alcohol use or cigarette smoke.

Symptoms of laryngitis

The main symptom of acute laryngitis is pain when swallowing , accompanied by the desire to swallow constantly because the throat feels thick and rough. The pain, which can be very sharp, can be in the center, but also more on the left or right. It can extend to the neck or ears. The sore throat will be worst in the early morning because less swallowing occurs during the night. This is because nasal breathing is usually not successful due to swollen mucous membranes and the air is therefore mainly inhaled through the throat. The throat becomes drier and swallowing becomes an anxious affair. There may be a suffocating, oppressive feeling and the throat may feel as if it is being stabbed with knives with each swallow. Mild fever and general malaise may also occur. The throat appears red and raw upon inspection. Sometimes there are white, yellow or greenish spots, a white coating and/or a lot of mucus.

Causes of laryngitis

If resistance is reduced, infections lurk. The cause of laryngitis is in most cases of viral origin. This concerns one of the many cold viruses and in a few cases the Epstein Barr virus (glandular fever/infectious mononucleosis). If the disease is caused by bacteria, it is usually one of the types of streptococci . This is called angina. A doctor can never say with certainty whether the throat infection is caused by a virus or bacteria.

Examine throat

During a throat examination, the aim is to open the mouth as wide as possible and extend the tongue as far as possible. The doctor can hold the tongue with gauze. A heated mirror is then placed in the throat and the doctor uses the light from the forehead lamp to examine the throat and larynx. If the doctor only uses a spatula, only the top of the throat can be viewed. By continuing to breathe calmly, the gag reflex can be suppressed. Don’t panic and know that there is enough room left to breathe. Choking is impossible. At the doctor’s request, you should say “iiiii” or “aaaa” and hold it for a few seconds. This way the doctor can view the laryngeal valve, the vocal cords and even the entrance to the esophagus. The mobility of the vocal cords can be examined when you say ‘hey, hey’ on request. The entire investigation takes a few minutes.

Treatment of laryngitis

In case of laryngitis, the throat needs rest and fluid . The body regulates this itself. It makes you tired so you naturally rest, and it makes you extremely thirsty to combat the sore throat. Drink as much as possible, preferably warm drinks such as tea and soup. It is possible to ‘drink away’ a severe sore throat almost completely. This takes a number of hours. There are numerous lozenges and gargles available to soothe the throat, but these will not work any better than sucking on licorice or even candy. Aspirin or paracetamol can be taken to reduce the fever so that the symptoms are more tolerable.
If the sore throat lasts longer than a week, a visit to the doctor is advisable. This may provide antibiotics, which only work for bacterial infections and only after a few days. Antibiotics are not a miracle cure, they shorten the inflammation by at most 2 days. The risk of receiving antibiotics is greatest when the risk of complications due to other existing diseases has increased, or if there is a serious clinical picture. A serious throat infection is when the patient feels very ill, cannot function and the swallowing complaints do not improve despite own measures. The prognosis of strep throat is nevertheless favorable, regardless of the cause.

Other causes of sore throat

In case of severe swallowing problems, excessive mucus production and problems with opening the mouth, an abscess or infiltrate of the tonsils may occur, although rare. In these cases, the tonsils are red and swollen and sometimes slightly displaced. In small children with a sore throat, it is also advisable to visit a doctor, especially in the case of a skin rash accompanying the sore throat (scarlet fever). Swollen and painful lymph nodes in the neck, sore throat and tiredness may indicate mononucleosis, which can occur in young adults. If, in addition to a sore throat, mainly hoarseness occurs, it must be determined whether there is an inflammation or tumor of the larynx. The risk of this is increased in smokers and people who overuse their vocal cords. A sore throat can also occur with the flu, but is less prominent. Headache, cough, aches and pains throughout the body and fever are the other symptoms.

Tonsillectomy

The tonsils are glandular swellings on either side of the throat that help repel and destroy micro-organisms. However, these tonsils themselves can also become inflamed. The chance of this happening is high if the tonsils show white points, are red and thick and the neck glands are swollen. If the tonsils continue to have problems and infections occur about five times a year (or three times a year over the past two years), a tonsillectomy may offer a solution. In children in the Netherlands, the removal of the tonsils (tonsillectomy) is combined with removal of the tonsils (adenotomy) in 90% of cases. It is one of the most frequently performed operations. Until forty years ago, this operation was performed almost routinely, as a general health measure to prevent complications, but it has been abandoned. The procedure is usually done between the ages of 3 and 5, which coincides with the peak of childhood respiratory infections. After this age, these infections decrease, so positive results from tonsillectomies are often wrongly attributed to the operations themselves.

How does tonsil surgery work?

The removal of the tonsils in children is also called clipping the tonsils. The tonsils are loosened from the underlying layer using a special instrument. In older children and adults this happens step by step and is also called peeling . The procedure is performed under anesthesia to prevent gagging, coughing and bleeding. It is a major procedure for adults. They must expect a recovery time of at least two weeks, children shorter. To relieve sore throat after the procedure, ice water is often ‘prescribed’. This has a mild anesthetic effect on the affected area.

Lump in the throat

A lump in the throat does not hurt but is annoying. Complaints may include: A mucus plug in the throat that cannot be swallowed, a feeling as if there is a bone or grain in the throat or a burning, irritated throat. There is a tendency to scrape, cough or swallow often in an attempt to remove the ‘obstacle’. A lump in the throat is common and harmless. If hoarseness or hoarseness occurs, or if the symptom occurs mainly during meals, there may be an abnormality that explains the lump in the throat. In most cases, a lump in the throat is caused by mucus production from the sinuses that seeps down the back of the throat wall (post nasal drip). Other possibilities are: enlarged thyroid gland, wear and tear of the cervical vertebrae, allergy, enlarged tonsil, problems with the larynx, angina pectoris, Zenker diverticulum or a malignant process.

Home remedies for sore throat

There are many ways to treat a sore throat, sometimes old-fashioned. Take, for example, gargling with lukewarm salt water or drinking (chamomile) tea with honey, sage or ginger. Another tip is to create heat by wearing a thick woolen scarf with a rolled-up plastic bag over it at night. This creates a warming effect that viruses usually flee from. Another version for the night is the chopped onion or the bruised white cabbage leaf tied in a large cloth around the neck. Eating lemons is also associated with healing. Just eat this one. Pure berry juice is an option to either drink or gargle with. This would kill bacteria. Finally, there is a tip that says that gargling with young gin gives a pleasant biting sensation that makes viruses and bacilli go away. None of the tips mentioned have a proven effect. Maybe it would be better to get through the day with pots full of tea and lots of licorice?
“My sore throats are always worse than anyone’s.” ~Jane Austen

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