Throat disorders

Throat disorders are mainly related to the beginning of the pharynx and larynx and the anterior external part of the throat. The pharynx is the front part of the throat and the entrance to the larynx and pharynx, which are important parts of both the respiratory and digestive systems. Separate diseases of the throat are mainly related to its inner mucous membrane and some of the organs that are located there, in particular the tonsils and the vocal cords. However, a number of diseases and illnesses are also related to the pharynx, larynx and oral cavity, for example.

The throat is anatomically the part of the oral cavity that forms the entrance to the pharynx and larynx, being located at the front of the neck. The throat includes the laryngeal vocal cords and the tonsils of the Waldeyer's tonsillar ring, which includes the palatine tonsils, nasopharyngeal tonsils, and lingual tonsils. These parts are closely related to the oral cavity at the same time, and thus various inflammatory and non-inflammatory diseases, cancerous and non-cancerous diseases, and various disorders of function or tissues are tied to similar problems in the oral cavity.

Thus, throat disorders include diseases related to the larynx, but also, for example, sometimes to the pharynx, of course, to the oral cavity, and in certain cases also to the Eustachian tube. The tonsils also affect the nasopharyngeal region, while the vocal cords are directly embedded in the larynx as part of it. The role of the tonsils as part of the lymphatic system is an immune response and the production of the body's defence cells, while the vocal cords have a phonetic function and are used to produce speech and sounds.

Position of the vocal cords and their function

The vocal cords are located in the larynx and are a composite structure consisting of the vocal cord muscle, the cartilaginous cartilages called, vocal cord ligaments and the vocal cord cilia. The fissure in the middle of the two vocal cords is bounded by the inner surfaces of the cricoid cartilages, and it is the antero-posterior movement of these cartilages as they move away from or towards each other that produces the sound itself. Subsequently, by passage and resonance through the larynx, pharynx, oral cavity, nasal cavity and paranasal sinuses, the colour of the voice is produced.

The sound is produced in the vocal folds by the airflow, and the sound has different frequencies. It is lowest in men, and this is also due to the larger and more spacious larynx and longer vocal cords, with men having the deepest voice. In children, on the other hand, the resonant frequency of the oscillating vocal cords is the highest at over 300 Hz and therefore their voice is the least deep. Due to the elastic cartilage and the elasticity of the vocal cord cilia and membranes, it is possible to change the tone of the voice by force of will.

Benign and malignant tumours of the vocal cords

Several types of benign malignancies affect the vocal cords, either specifically or within the entire larynx. Malignant tumours include those that metastasize to affect other tissues and form cancer. These are malignant tumours causing multiple cancers such as glotic, supraglotic and infraglotic cancers of the larynx. Directly glotic cancers originate in the vocal cords, usually affecting first one and then the other vocal cord and then metastasising to other tissues.

There are several types of benign tumours and false tumours. These are benign tumours arising from infections or from prolonged or acute intense irritation of the larynx and vocal cords. The best known benign tumour is the papilloma, which arises from the superficial epithelium of the larynx and is caused by a viral herpetic infection. Although it is not malignant and does not metastasize to other tissues, it tends to return after surgical removal.

False tumours include polyps, cysts, ulcers and various nodules. They appear in the larynx or directly on the vocal cords and are formations that cause problems with speech and sometimes, in severe forms, with breathing. Nodules are found on both sides of the vocal cords, while polyps usually arise unilaterally. With cysts, submucous and hard deposits are formed on the larynx and vocal cords; on the contrary, if a person is afflicted by ulcers, they are clearly visible and are disorders of erosion of the vocal cords.

Inflammatory and other diseases

Very often, the larynx and vocal cords are affected by various inflammatory types of diseases, whether acute or chronic inflammation. These are, for example, oedematous, suppurative or ulcerative inflammation, acute inflammation of the larynx, obstructive inflammation, epiglottitis or laryngitis, which is the most common inflammation affecting the larynx and vocal cords, and which takes both acute and chronic forms. Laryngitis as such arises either from a viral or other infection and is manifested by hoarseness and weakening of the voice.

Chronic laryngitis can even lead to atrophy or hypertrophy of the vocal cords and some structures in the larynx, as well as long-term inflammation of the lining and mucosa. This leads, in the case of untreated inflammation and in the case of a severe course, even to long-term and not only short-term and temporary loss of voice. In addition to inflammation, the larynx and vocal cords are affected by stenosis, various types of necrotizing and abscess-like local lesions, cellulitis, ulcers, pachydermias, spasms or perichondritis, for example.

Various paralyses of the vocal cords often occur as a result of non-inflammatory processes, but these cause obstruction or impairment of the function of individual parts of the vocal cords. Pathologies include not only abscess deposits, but also, for example, leukokeratosis or leukoplakia, which in extreme cases can turn into a malignant tumour. The larynx is also affected by cellulitis or granulomas, as well as various types of oedema, which cause swelling of the mucous membrane and problems with the voice and sometimes even breathing.

Functions and structure of tonsils

The tonsils are a paired organ located in the throat and nearby sinuses, but they are essentially part of the lymphatic system. The tissue of the tonsils is the same as that of the lymph nodes, and the tonsils can be cervical (palatine), nasal (nasopharyngeal) and lingual. They are part of the immune system and this is their primary function as they trap infections from the oral cavity or from the nasopharynx or Eustachian tube, while also hosting inflammatory immune responses.

The palatine tonsils are located between the palatine arches at the back of the throat and are covered with mucous membrane, while the tonsil tissue is very soft to the touch. The nasal tonsils are located above the cervical tonsils in the nasopharyngeal cavity and are also close to the mouth of the Eustachian tube. These tonsils are also made up of soft lymphoid tissue and, unlike the cervical tonsils, the nasal tonsils begin to shrink from puberty in adolescent children and disappear in adulthood unless prevented by pathological causes.

Enlarged and inflamed tonsils

The tonsils and nasal tonsils are most often affected by various types of inflammation and associated tonsillar enlargement, which subsequently makes breathing difficult, either through the nasopharynx or the oral cavity. Inflammation comes in various acute and chronic forms, such as gangrenous, infectious, follicular, ulcerative and non-specific acute tonsillitis or tonsillitis. Tonsillitis itself is a very common inflammation, which can occur in both acute and chronic forms, differing in both symptoms and course of the disease.

Angina can either be a disease in itself, or it can be a symptomatic condition that is concomitant with another infectious disease, or it can arise in bleeding disorders. This inflammation affects the palate as well as the lingual and nasopharyngeal tonsils, and angina is most often manifested by sore throat, pain when swallowing, the appearance of white plugs directly on the tonsils, increased fever, and sometimes pain in the ears radiating from the throat.

Chronic tonsillitis is most often an inflammation of the tonsils, and the discomfort is not so acute and intense and is more likely to be a mild scratching in the throat, difficulty swallowing and bad breath. While conservative treatment in the form of antibiotics or symptomatic treatment is preferred for acute tonsillitis, if the tonsillitis is caused by viruses, chronic tonsillitis warrants surgery to completely remove the tonsils, which are the source of frequent infections and inflammation.

In some cases, inflammation with necrotizing and necrotizing tissue, i.e. peritonsillar abscess, is also formed. This sometimes occurs not only in the tonsils but also in other mucous membranes of the oral cavity. ‌Tonsillar hypertrophy, adenoid hypertrophy, or the formation of adenoid vegetations are also very common, and more often on the nasopharyngeal tonsils. These also enlarge in some ear infections. In this case, too, the solution is to remove them.

Obstructions, tumours and other problems

Both the cervical and nasal tonsils, like other tissues in the oral cavity, are affected by various tumours or deposits arising from the epithelium and mucosa of the tonsils. Very often, for example, cysts are formed as a result of infections and inflammation, when obstructions occur, resulting in a formation in the submucosal space that is a mild obstruction. A common example is a retention cyst, which may not be externally manifest and occurs quite frequently in children. The solution for most cysts is to incise them, empty the contents and remove them.

In addition to cysts, various types of abscesses arise on the tonsils and in their vicinity, which arise from inflammation that causes tissue death in the local lesion, the sheathing of this lesion and the formation of an abscess. Similar to cysts, the solution here is incision, drainage and removal of the lesion. There are also ulcers on the tonsils, which form on the surface, or lumps of tissue that can harden and form calcified tonsil stones, which form a hard obstruction, for example, when breathing.

But the most dangerous are tumours, which can be benign or malignant. These tumours are most often tumours of the oral cavity or nasopharynx, which generally affect the mucosal tissue in these cavities and can thus also arise in the tonsils. Most cases are malignant and tend to metastasize to other tissues, and histologically most cases are squamous cell carcinoma, a painful tumour of the palatine tonsils.

This type of tumour is manifested by pain in the throat, including when swallowing, problems with swallowing and, in later stages, when a larger obstruction develops, problems with speech, and can sometimes extend from the tonsils and oral cavity to the larynx, thus invading the larynx and possibly the vocal cords as well. It is important to diagnose and irradiate the tumour relatively quickly or, if the tumour can be removed, to proceed surgically. Men are more likely to have this tumour, especially as it is also associated with excessive drinking and smoking.