“Doc, I have a sore throat.
It’s killing me! What can you
do?” Aw yes, a frequent presenting problem for doctors and healthcare providers. Naturally, treatment varies depending on the cause and
type of problem and this topic can (and actual does) fill an entire textbook,
and so I’ve broken this into a series of blog entries/presentations which will address
some of the common and not-so common ailments of the throat. Some of this was gleaned from my prior
lectures for medical students and residents; so you’re in good company with our
future generation of doctors (unless I’ve completely screwed-up this topic and inadvertently
prevailed upon those poor trainees my flawed sense of “wisdom” which, I was
told, tends to border on insanity and/or illogic from time to time). Oh well…have a beer and read on…
First of all, what is the throat exactly? Yes, a seemingly stupid question, but there's an anatomic distinction we physicians make when defining the source of one’s
problem. That’s why docs spend their
first year studying lots and lots of anatomy.
The throat is what most of us call the oropharynx. “Pharynx” may
sound familiar to many of you, but there are distinctions: nasopharynx (naso-
is a prefix meaning "nasal”), oropharynx (oro = oral), and hypopharynx. (hypo =
“below”). Then there is the larynx with
the epiglottis which is an entirely different anatomic organ altogether. When using the term “pharynx”, most people
are referring to the oropharynx, a part of the pharynx that is visible when
looking into someone’s mouth. The
nasopharynx, hypopharynx and larynx are not easily seen, requiring gadgets such
as mirrors or scopes usually done only by ENT specialists. But many times the
source of a sore throat is not in the oropharynx but beyond it in those other
areas.
Right now, we’ll focus primarily on the oropharynx since
this is visible to most people when looking in the mirror. So go ahead and do this and you may notice
some interesting features.
From front to back, the oropharynx includes the space
between the retromolar trigone and circumvallate papillae all the way to the
back wall of called the posterior wall.
From top to bottom it includes the soft palate down to the lower part of
the base of tongue (to the vallecula, a smooth trough of tissue that blends the
front part of the epiglottis of the
larynx to the base of tongue). The space
above the oropharynx is the nasopharynx, below it is the hypopharynx and in
front of it is the oral cavity (i.e., the rest of the mouth).
There are a lot of reasons people can have a sore throat:
inflammation, infection, injury, tumors.
The most common is some sort of infection and so we’ll talk mostly of
these.
So what’s an infection?
This occurs when microorganisms invade the tissue of the throat (aka,
oropharynx) causing discomfort or pain.
Microoganisms (or microbes) include
viruses, bacteria, and fungi, i.e., nasty little critters invisible
with naked eye. These guys normally
inhabit the mucosa—the moist, pink tissue that lines the tissues found in the mouth,
throat, gut, trachea, and in the hinterlands down south called the
genitals—essentially any tube or tract that gives rise to any
orifice into or out of the body.
The numerous microbes live amongst themselves in a diverse
and peaceful harmony, in a collective tolerance that keeps one another in
check, some may argue even better than we humans on a global scale. But alas, when one species dominates, it starts invading territory,
crowding other species out, and damaging the very tissue they inhabit. This is an infection.
Viruses are things like the common cold or flu or
mononucleosis (mono). Treatment is
usually symptomatic (i.e., things to ease the discomfort and allow the body to
heal naturally). Viral infections
typically resolve on their own, sometimes medications such as antivirals or
steroids (to lower inflammation and help with symptoms) might be given. As with most things in medicine, the doc
needs to weight the benefits versus the potential risks when prescribing a
medication. Note: viruses do not respond to antibiotics—so give
your doc a break if she or he doesn’t prescribe you one.
Fungal infections are the least common. These include things such as thrush (candida
or “yeast” infection). Believe it or
not, fungi too normally live in your mouth and throat and other places such as
the gut and down yonder in genital country. Usually fungi over-populate when the
bacteria population dwindles, such as when antibiotics are given. Thus another reason antibiotics should be
used judiciously—the can cause secondary infections (ie, in this case, a fungal
infection).
Bacteria are another common cause of infections, and these
include tonsillitis, strep throat, and pharyngitis. Pharyngitis (-itis = “inflammation”) refers
to a generalized involvement of the oropharynx, where any of the structures
mentioned above can be involved.
Tonsillitis refers to infection of the tonsils, tough other parts of the
oropharynx are often involved as well. Strep throat is a particular type of tonsillitis, caused by a bacteria known as Group
A Streptococcus or Streptococcus pyogenes. We’ll talk more about infections in
subsequent sessions.
©Randall S. Fong, M.D.
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