THROAT OR NECK LUMPS

Finding an unusual lump in the head, throat or neck region can be very concerning and we tend to naturally worry about the worst-case scenario, however, this is not always the outcome.

It is important that if you develop an unexplained lump in the head or neck region that you seek a medical opinion as soon as possible. Even if you are a non-smoker and non-drinker, neck lumps especially which don’t go away need to be evaluated by an experienced Head and Neck Surgeon.

There are many causes of neck lumps. Benign (non-cancerous) causes can include inflamed or reactive lymph nodes and congenital (present from birth) cysts. Malignant (cancerous) lumps in the neck most commonly represent cancer which has spread from the mouth, tonsil, tongue or larynx or from skin cancer.

SORE THROAT

A sore throat is pain, scratchiness or irritation of the throat that often worsens when you swallow. Most commonly it is caused by a viral infection (pharyngitis), such as a cold or the flu. A sore throat caused by a virus resolves on its own. 

A sore throat which persists and does not improve with common treatments such as antibiotics and pain relief needs to be evaluated by an experienced ENT Surgeon. This can sometimes represent something more sinister. Smokers and drinkers are at greatest risk of developing a Head and Neck cancer.

TONSILLITIS

Tonsillitis is inflammation of the tonsils which can cause swollen tonsils, sore throat, difficulty swallowing and tender lymph nodes on the sides of the neck. Tonsillitis is mostly caused by common viruses, but bacterial infections also can be the cause. It is most common in children between preschool ages and the midteens.

Appropriate treatment for tonsillitis depends on the cause, so it’s important to get a prompt and accurate diagnosis. A Tonsillectomy to remove tonsils, is a common treatment however is usually only performed when tonsillitis occurs frequently or doesn’t respond to other treatments or causes serious complications such as an abscess.

SLEEP PROBLEMS

Sleep problems or conditions result in changes in the way we sleep. This can have far-reaching effects on our general health including heart health and neurological function as well as impact our ability to drive safely.

Sleep problems may present in several ways but some of the more common symptoms include: excessive daytime sleepiness, irregular breathing, snoring or increased movements during sleep and difficulties falling asleep and waking several during the night. Mood disturbance and headaches can also occur.

Common sleep disorders include:

• Insomnia: difficulty falling asleep or staying asleep throughout the night.

• Sleep apnoea: involves abnormal patterns of breathing during sleep and abnormal airflow with blockage.

• Restless legs syndrome (RLS): a type of sleep movement disorder in which there is an urge to move the legs while trying to fall asleep.

• Narcolepsy: a condition defined by extreme sleepiness during the day and falling asleep suddenly during the day.

Treatment involves a multidisciplinary approach including a sleep physician (doctor) and an Ear, Nose and Throat Surgeon who specialises in sleep disorders. The approach to sleep problems varies between children and adults. A sleep study is commonly used in adults to define the problem. Several treatment options are available including non-surgical and surgical. These treatment options need to be tailored specifically to the individual depending on several factors.

HOARSE VOICE

A hoarse voice is a common condition often experienced in conjunction with a dry or scratchy throat. If your voice is hoarse, you may have a raspy, weak, or airy quality that prevents you from making smooth or strong vocal sounds.

This symptom commonly stems from an issue with the vocal cords and may involve an inflamed larynx (voice box), known as laryngitis or may be due to a lesion on the vocal cords either non-cancerous or sometimes if you smoke, cancerous. Evaluation of the vocal cords requires an experienced Head and Neck Surgeon who is able to visualise this area with a special flexible camera. 

THYROID PROBLEMS

The Thyroid gland is part of our bodies endocrine (hormone) system and sits in front of our windpipe (trachea) in the lower part of our neck, just below the Adam’s apple (Thyroid prominence). It is approximately 5cm long and has a butterfly-shaped appearance. Its main role is to release hormones which regulates several of our bodies functions including breathing, heart rate, body weight, muscle growth and strength, our nervous system, body temperature, menstrual cycle and cholesterol just to mention a few.

Thyroid issues can be related to either its function (overactive or underactive), excess growth (Goitre) or due to concern for cancer. Symptoms related to its activity are split into either

Overactivity (Hyperthyroidism)

• Shaking/hand trembling

• Nervousness

• Hyperactivity

• Hair loss

• Weight loss

• Irritability 

• Anxiety or mood change

• Gastrointestinal changes such as diarrhoea

• Missed or abnormal menstrual cycles

Underactivity (Hypothyroidism)

• Difficulty sleeping

• Weight gain

• Tiredness and fatigue

• Dry skin or hair

• Depression

• Cold sensitivity 

• Gastrointestinal upset such as constipation

• Joint and muscle pain

• Frequent, heavy periods

If you experience any of these problems it is simple to get a blood test to evaluate your Thyroid hormone levels.

Enlargement of the thyroid can sometimes cause compressive symptoms such as difficulty breathing especially when lying flat, difficulty swallowing (dysphagia), shortness of breath and neck pressure or fullness. An ultrasound of the thyroid is the gold standard for assessing size.

Thyroid nodules are common and found in up to 70-80% of people on ultrasound. About 5% of these may represent a cancer and often patients may not have any symptoms. Evaluation and treatment of thyroid nodules should be performed by an experienced Head and Neck Surgeon.

PARATHYROID PROBLEMS

The Parathyroid glands, like the Thyroid, are part of our Hormone (Endocrine) system. About 85% of us have 4 small glands which are commonly located in the neck behind the thyroid gland. They are typically the size of a grain of rice and weigh on average about 0.5 grams.

The parathyroid glands only purpose is to regulate the calcium levels in our bodies. They are able to monitor the levels of calcium in our bloodstream and adjust it accordingly if it goes high or low.

Calcium has several important functions in our bodies including:

• Help create electrical energy for our nervous system

• Help create electrical energy for our muscular system.

• Provide strength for our bones (skeletal system)

Problems with the parathyroid glands are most commonly related to excess benign (non-cancerous) growth of one or sometimes more of the glands. This is known as a Parathyroid Adenoma. This may be discovered incidentally on routine blood tests. Others may develop symptoms of excess calcium including: bone pain, fatigue, excess urination, mood change, kidney stones, constipation or if it has been elevated for some time osteoporosis (weak/brittle bones).

Treatment of a parathyroid adenoma is surgery to remove the culprit gland/s. An experienced Head and Neck Surgeon who performs this surgery regularly should do the surgery as sometimes the enlarged glands can be difficult to locate.

SALIVARY GLAND TUMOURS

Our Salivary glands make saliva which aids in digestion, keeps our mouth moist and supports healthy dentition (teeth). We have three pairs of major salivary glands; the parotid, submandibular and sublingual glands. The parotid glands are located in front of the ear down to the jaw. The submandibular and sublingual glands are located under the jaw. We also have thousands of minor salivary glands located in our lips, inside the cheeks and throughout the mouth and throat.

Salivary gland enlargement can be benign due to infection from stones blocking the passage of saliva or because of generalised inflammation from another condition. Salivary gland tumours (growths) are either benign (non-cancerous) or malignant (cancerous). Most are non-cancerous and occur most commonly in the Parotid gland. Cancerous tumours in Australia are most likely due to skin cancers which have spread from the scalp or face to the Parotid gland. However, there are cancers which also begin in the salivary gland.

Treatment of Salivary gland tumours is usually with surgery to remove the tumour. If there is salivary gland cancer other additional treatments may be required.

Salivary gland stones can be removed depending on size to reduce the chance of further blockage and infection. If too big for removal and infections occur frequently then surgery can be offered to remove the salivary gland.