THE THROAT AND VOICE BOX (LARYNX)
Anatomy of the neck
What we call the throat is an extension of the mouth. Now the mouth is quite easy to examine providing you have what all Ear, Nose and Throat Surgeons use, namely a headlight. This makes comprehensive examination of the mouth possible and impossible unless you have it. One needs 2 free pairs of hands to examine the tongue and the floor of the mouth thoroughly. That’s only possible if you have a headlight.
It’s easy to miss diseases or something as simple as tonsillitis unless you have good light. The same comment will apply to tongue examination and here it’s very important that it be fully assessed to avoid missing unpleasant conditions such as cancer. Noting the presence of a very long soft palate might be important in assessing a snorer as the palate if often one of the dominant features as is the position of the tongue and the nature of the bite.
But around the corner from the tongue is a hidden space that contains not only the throat but also the voice box. This area can be very silent in that tumours and cancers can quietly grow here and not produce any symptoms until they’re quite large. It’s a dangerous silent area.
Simply looking into the mouth and getting patients to say “aah” gives one absolutely no information about this area. What is needed is either a Fibre Optic Scope passed through to the nose or a head light with a laryngeal mirror. This enables a good view to be had of the pharynx (lower throat) and also the voice box.
The voice box is an incredibly sophisticated area protected by the strong thyroid cartilage you feel in your neck which shelters the 2 very sensitive vocal cords which are controlled by the most delicate sets of paired muscle.
Any person who presents with a change of voice must be seen by an Ear, Nose and Throat Surgeon for examination of the vocal cords and larynx area. This is done as described above. Any other examination is absolutely valueless. Every ENT Surgeon has seen patients whose hoarseness has been misdiagnosed because no one has ever had a good look at the voice box.
Diagnosed early cancer of the larynx has an extremely high success rate being cured often by no more than radiotherapy.The more advanced cases require a combination of surgery and radiotherapy and can often lead to the entire voice box having to be removed together with parts of the neck. The implications of this kind of surgery are very obvious.
As regards singers, exactly the same comments apply as the need to be able to examine the vocal cords visually. This will give a lot of information about what is causing the hoarseness and what needs to be done.
In many of these cases it’s simply a question of vocal technique being incorrect or in some cases, the need to remove large nodules or polyps. Obviously in the case of singers one is extremely conservative in whatever surgery is being offered.
Hoarseness can also be caused by reflux of acid from a deficient valve in the junction of the oesophagus and the stomach. Acid comes up into the throat, can irritate the larynx and produce hoarseness. This is something which has become relatively recently noted and as such reflux is always something that one is going to consider in a hoarseness patient.
This can be diagnosed by a combination of X Rays, sometimes direct examination of the oesophagus and acid studies. There are reports that the acid from the stomach can reflux as high as the actual nose….
Again this contains significant structures. The biggest gland in the neck is the thyroid gland. There are also many lymph glands in the neck and a large muscle stretching from the ear down to the chest bone. Again as regards examining the neck, the ENT Surgeon is likely best equipped because of his ability to examine both the inside and the outside.
A mass presenting in the neck could well be due to pathology in the actual larynx or pharynx and that is something that only the ENT Surgeon will be able to easily recognise. The ENT Surgeon is thus well qualified to offer a comprehensive opinion or necessary treatment on pathology of the neck.