Throat and face

Acute tonsillitis (angina) manifests as severe throat pain, difficulty swallowing, fever and swollen neck lymph nodes. The tonsils are reddened and often covered with whitish coatings.

In the case of recurrent tonsillitis (more than 5–6 episodes per year) or complications such as a peritonsillar abscess, removal of the tonsils (tonsillectomy) may be recommended. In children with enlarged adenoids that lead to obstructed nasal breathing, chronic middle ear effusion or middle ear ventilation problems, adenoidectomy (removal of the adenoids) is a common procedure.

A tonsillectomy is performed under general anaesthesia and requires a hospital stay of 2–4 days. Adenoid surgery is usually performed on an outpatient basis. Both procedures require a recovery period of about 2 weeks on a soft diet.

Hoarseness (dysphonia) occurs when the vocal cords in the larynx can no longer vibrate freely and evenly. Short-term hoarseness after a cold is harmless and usually disappears within 1–2 weeks.

Hoarseness lasting longer than 3 weeks should be examined by a specialist. Possible causes include: vocal cord nodules (singer’s nodules), vocal cord polyps, reflux laryngitis (heartburn), vocal cord paralysis, chronic laryngitis or, in rare cases, malignant tumours.

Diagnosis is made by laryngoscopy, in which the vocal cords are viewed directly. Treatment ranges from voice hygiene and speech therapy through medication to microsurgical procedures on the larynx.

The thyroid gland lies in the front of the neck below the larynx and produces vital hormones for metabolism. Thyroid disorders are very common and affect women significantly more often than men.

Typical findings are: nodule formation (nodular goitre), over- or underactivity, inflammation (thyroiditis) and, in rare cases, malignant tumours. The ENT assessment includes palpation, high-resolution ultrasound (sonography), blood tests of the thyroid values and, for suspicious nodules, fine-needle aspiration (FNA) to obtain a tissue sample.

Thanks to their certificate of proficiency in neck ultrasound, Dr. Zehnder and Dr. Schlumpf can carry out the complete thyroid diagnostics including ultrasound-guided fine-needle biopsy in the practice. Further treatment takes place in close collaboration with endocrinologists and surgeons.

Humans have three paired major salivary glands (parotid, submandibular, sublingual) as well as numerous minor salivary glands in the oral mucosa. Disorders can manifest as swelling, pain or dry mouth.

Salivary stones (sialolithiasis) are the most common cause and usually form in the submandibular gland. They cause recurrent, meal-related swelling and pain. Smaller stones can be removed conservatively or by duct endoscopy (sialendoscopy).

Inflammation (sialadenitis) can be acute (bacterial) or chronic. Salivary gland tumours are rare, but a painless, slowly growing lump should always be assessed.

Diagnostics include ultrasound, fine-needle biopsy if necessary and, if required, MRI or CT. For chronic complaints or tumours, surgical removal of the salivary gland may be necessary.

The globus sensation describes a foreign-body or tightness feeling in the throat, as if something were “stuck”, although there is no actual obstruction. Swallowing food and drink is usually unaffected.

Possible causes are: gastro-oesophageal reflux (silent reflux), muscle tension in the neck, thyroid enlargement, psychological strain or stress, and more rarely mucosal changes in the throat or cervical spondylosis.

The assessment includes an endoscopic examination of the pharynx and larynx, ultrasound of the neck and, if necessary, a gastroscopy. Although the globus sensation rarely has a serious cause, a specialist examination is useful to rule out treatable causes and to reassure the patient.

Difficulty swallowing (dysphagia) is a symptom to be taken seriously that can have a wide variety of causes. A distinction is made between pain on swallowing (odynophagia) and transport disorders in which food “gets stuck”.

Possible causes are: inflammation in the throat, narrowing of the oesophagus, tumours, neurological diseases, reflux disease, diverticula (Zenker’s diverticulum) or changes after radiotherapy.

The assessment is carried out by endoscopic examination of the pharynx and larynx, supplemented if necessary by a flexible endoscopic evaluation of swallowing (FEES), a barium swallow (videofluoroscopy) or an oesophagoscopy. Early assessment is important in order to quickly identify treatable causes.

Swellings and lumps in the neck are a common reason for consultation. The causes are varied and range from harmless lymph node enlargements during infections through thyroid nodules and cysts to rare tumours.

In children and young adults, these are usually reactive lymph node enlargements during infectious diseases or congenital neck cysts (lateral or median neck cysts). In older adults, a malignant cause (lymphoma, metastasis) must be ruled out, especially with painless, increasing swellings.

Diagnostics include palpation, high-resolution ultrasound and, if necessary, an ultrasound-guided fine-needle biopsy (FNA) to obtain a tissue sample. CT or MRI may be required in addition. Treatment depends on the cause.

The face and neck are particularly exposed to the sun, which is why skin changes and skin tumours frequently occur here. The most common malignant skin tumours are basal cell carcinoma and squamous cell carcinoma, which are very treatable when detected early.

Suspicious changes (new or growing lesions, non-healing wounds, changes in existing moles) should be assessed by a specialist at an early stage. Surgical removal is performed with a safety margin, predominantly under local anaesthesia.

The resulting defects are covered with local skin flaps or skin grafts, with particular emphasis on an aesthetically pleasing result. Follow-up depends on the tumour type and includes regular clinical checks.

Peripheral facial palsy manifests as acute one-sided weakness of the facial muscles: a drooping eyelid, incomplete eye closure, a drooping corner of the mouth and slurred speech. The most common form is idiopathic Bell’s palsy, presumably caused by viral activation.

The prognosis is usually good with timely treatment with corticosteroids — about 85% of patients recover completely. Other causes such as Lyme disease, otitis media, zoster oticus or tumours must be ruled out by a comprehensive ENT examination.

In the case of incomplete recovery, rehabilitative measures (physiotherapy, electrical stimulation) are available and, for permanent palsy, surgical reconstruction procedures.

Reconstructive facial surgery involves restoring form and function after tumour removal, injuries or congenital malformations in the facial area. The aim is to achieve an aesthetically and functionally good result.

The techniques include local skin flaps (rotation, transposition and advancement flaps), full-thickness skin grafts as well as partial nose and ear reconstructions. The choice of technique depends on the size and location of the defect, the surrounding skin and the aesthetic units of the face.

Depending on the extent, procedures are performed under local anaesthesia in the practice or under general anaesthesia in hospital.

Snoring is caused by the vibration of slackened soft tissue in the throat and can indicate obstructive sleep apnoea. The ENT examination focuses on identifying the site of obstruction: nose, palate, base of the tongue or a combination. The practice can provide a measuring device (respiratory polygraphy) which, after usually being worn once at home at night, can confirm or rule out a diagnosis of obstructive sleep apnoea syndrome (OSAS).

In addition to general measures (weight reduction, positional therapy), therapeutic options include surgical treatment: nasal septum correction, turbinate reduction, soft-palate tightening using laser or radiofrequency surgery. Interdisciplinary assessment with sleep physicians and pulmonologists is essential if sleep apnoea is suspected.

Injuries to the neck and face require careful initial assessment, as important structures (airways, vessels, nerves, salivary gland ducts) run close together here. Care includes wound treatment, fracture management and, if necessary, plastic surgical reconstruction.

Depending on the severity, treatment is carried out on an outpatient basis in the practice (minor soft-tissue injuries) or as an inpatient in hospital (complex fractures, vascular or nerve injuries). Prompt care is important for the functional and cosmetic result.

Taste disorders (dysgeusia) and burning tongue (burning mouth syndrome) can cause considerable distress. Possible causes are: vitamin deficiency (B12, iron, zinc), dry mouth, fungal infections of the oral mucosa (thrush), medication side effects, reflux disease, neurological disorders or hormonal changes.

The specialist assessment includes an inspection of the oral cavity and, if necessary, swabs and blood tests. Treatment depends on the identified cause.

Botulinum toxin (Botox®) is used to treat expression lines in the face, particularly forehead lines, frown lines and crow’s feet. The toxin temporarily inhibits muscle contraction and thereby smooths the overlying skin.

The treatment is carried out on an outpatient basis, takes about 15 minutes and requires no anaesthesia. The effect sets in after 3–7 days and lasts about 4–6 months. A top-up can be repeated as needed.

Surgical procedures on the lips are predominantly performed to remove tumours. Lip carcinoma (squamous cell carcinoma) most frequently occurs on the lower lip, often favoured by chronic sun exposure.

Covering the defect after tumour removal requires special care, as the lips play a central role both functionally (speaking, eating, drinking) and aesthetically. Reconstruction is carried out with direct closures or local skin flaps, usually under local anaesthesia.

Bad breath (halitosis) originates in the oral cavity in about 85% of cases and is caused by bacterial coating on the tongue, teeth and gums. Less commonly, ENT causes such as chronic sinusitis, tonsil stones (tonsilloliths) or gastrointestinal disorders are responsible.

Treatment includes thorough oral hygiene including tongue cleaning, regular dental visits and, if necessary, a specialist ENT assessment to rule out nasal or pharyngeal causes.

Changes in the oral mucosa are common and usually harmless (e.g. aphthae, bite injuries, denture pressure points). Whitish changes (leukoplakia) or non-healing wounds should, however, be assessed by a specialist, as in rare cases they can represent a precursor of malignant tumours.

Diagnostics include careful inspection and, if there is suspicion, a tissue sample (biopsy) for histological examination. Early detection and treatment of oral mucosal changes considerably improves the prognosis.

Excessive tearing (epiphora) can occur on both sides or one side and has various causes. A distinction is made between overproduction of tear fluid (e.g. due to irritation, allergies, dry eyes as a paradoxical reaction) and an outflow disorder of the tear ducts.

In the case of an outflow disorder — often due to narrowing or blockage of the nasolacrimal duct — the tear fluid builds up and runs over the cheek. The diagnosis is confirmed by irrigation of the tear ducts and, if necessary, a dacryocystography (contrast imaging).

Treatment is carried out in collaboration with the ophthalmologist. In the case of a narrowing of the nasolacrimal duct, endonasal tear-duct surgery (dacryocystorhinostomy) can be performed, in which a new connection between the tear sac and the nasal cavity is created surgically.