Strep throat – Diagnosis and treatment

Diagnosis

Your doctor will conduct a physical exam, look for signs and symptoms of strep throat, and probably order one or more of the following tests:

• Rapid antigen test. Your doctor may perform a rapid antigen test on a swab sample from your throat. This test can detect strep bacteria in minutes by looking for substances (antigens) in the throat. If the test is negative but your doctor still suspects strep, he or she might do a throat culture.
• Molecular (polymerase chain reaction, or PCR) test. This test is also done using a swab sample from your throat.
• Throat culture. A sterile swab is rubbed over the back of the throat and tonsils to get a sample of the secretions. It’s not painful, but it may cause gagging. The sample is then cultured in a laboratory for the presence of bacteria, but results can take as long as two days.

Treatment

Medications are available to cure strep throat, relieve its symptoms, and prevent its complications and spread.

Antibiotics

If your doctor diagnoses you or your child with strep throat, your doctor will likely prescribe an oral antibiotic. If taken within 48 hours of the onset of the illness, antibiotics reduce the duration and severity of symptoms, as well as the risk of complications and the likelihood that infection will spread to others.

With treatment, you or your child should start feeling better in a day or two. Call your doctor if there’s no improvement after taking antibiotics for 48 hours.

Children taking an antibiotic who feel well and don’t have a fever often can return to school or child care when they’re no longer contagious — usually 24 hours after beginning treatment. But be sure to finish all the medicine. Stopping early can lead to recurrences and serious complications, such as rheumatic fever or kidney inflammation.

Symptom relievers

To relieve throat pain and reduce fever, try over-the-counter pain relievers, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others).

Use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.

Lifestyle and home remedies

In most cases, antibiotics will quickly wipe out the bacteria causing the infection. In the meantime, try these tips to relieve symptoms of strep throat:

• Get plenty of rest. Sleep helps your body fight infection. If you have strep throat, stay home from work if you can. If your child is ill, keep him or her at home until there’s no sign of fever, and he or she feels better and has taken an antibiotic for at least 24 hours.
• Drink plenty of water. Keeping a sore throat lubricated and moist eases swallowing and helps prevent dehydration.
• Eat soothing foods. Easy-to-swallow foods include broths, soups, applesauce, cooked cereal, mashed potatoes, soft fruits, yogurt and soft-cooked eggs. You can puree foods in a blender to make them easier to swallow. Cold foods, such as sherbet, frozen yogurt or frozen fruit pops also may be soothing. Avoid spicy foods or acidic foods such as orange juice.
• Gargle with warm salt water. For older children and adults, gargling several times a day can help relieve throat pain. Mix 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water. Be sure to tell your child to spit out the liquid after gargling.
• Honey. Honey can be used to soothe sore throats. Don’t give honey to children younger than 12 months.
• Use a humidifier. Adding moisture to the air can help ease discomfort. Choose a cool-mist humidifier and clean it daily because bacteria and molds can flourish in some humidifiers. Saline nasal sprays also help keep mucous membranes moist.
• Stay away from irritants. Cigarette smoke can irritate a sore throat and increase the likelihood of infections such as tonsillitis. Avoid fumes from paint or cleaning products, which can irritate the throat and lungs.

Preparing for your appointment

What you can do

When you make the appointment, ask if there’s anything you need to do in advance, such as fasting before having a specific test. Make a list of:

• Symptoms you or your child has, including any that seem unrelated to the reason for your appointment
• Key personal information, including major stresses, recent life changes, family medical history and possible sources of recent infection
• All medications, vitamins or other supplements you or your child takes, including the doses
• Questions to ask your doctor

Take along a family member or friend, if possible, to help you remember the information you’re given.

For strep throat, some basic questions to ask your doctor include:

• What’s likely causing these signs and symptoms?
• What are other possible causes?
• What tests are needed?
• What treatment approach do you recommend?
• How soon do you expect symptoms to improve with treatment?
• How long will this be contagious? When is it safe to return to school or work?
• What self-care steps might help?
• Is there a generic alternative to the medicine you’re prescribing?

Don’t hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask a number of questions, including:

• When did the symptoms begin?
• Have the symptoms changed over time?
• How severe are the symptoms?
• Have you or your child been exposed to anyone with strep throat in the last couple of weeks?
• Does anything seem to make the symptoms better or worse?
• Have you or your child been diagnosed with strep throat in the past? When? How was it treated?
• Have you or your child been diagnosed with any other medical conditions?

What you can do in the meantime

If you think you or your child might have a strep infection, take steps to relieve symptoms and avoid spreading infection:

• Keep your hands clean, cover your mouth when you cough or sneeze, and don’t share personal items.
• Gargle with 1/4 teaspoon (1.5 grams) of table salt in 8 ounces (237 milliliters) of warm water.
• Rest, drink fluids, eat soft foods and take pain relievers, such as ibuprofen (Advil, Motrin IB, others) or acetaminophen (Tylenol, others) to help ease symptoms.

Dec. 17, 2020

Know the signs and symptoms of when a sore throat is something more serious.

A sore throat, while annoying, usually isn’t something more severe and can be managed through at-home treatments. The trick is however, knowing when it may be something else and seeing a healthcare provider.
 
Whenever a sore throat lasts longer than the five- to ten-day duration of a cold or flu, and is not associated with an avoidable allergy or irritation, you should seek medical attention. The following signs and symptoms should alert you to see your healthcare provider:

• Severe and prolonged sore throat
• Difficulty breathing
• Difficulty swallowing
• Difficulty opening the mouth
• Swelling of the face or neck
• Joint pain
• Earache
• Rash
• Fever (over 101°F)
• Blood in saliva or phlegm
• Frequently recurring sore throat
• Lump in neck
• Hoarseness lasting over two weeks

 
Here are some common illnesses that trigger a store throat.

• Your tonsils are located at the back of your mouth on each side of your throat. Tonsillitis is when the tonsils become infected by bacteria or a virus. It causes the tonsils to swell and can cause a sore throat and other symptoms. Signs of strep throat and tonsillitis are often alike.
• Strep throat is caused by a type of bacteria called streptococcus. The pain of strep throat often feels much like a sore throat caused by other bacteria or by viruses. If strep throat isn’t treated it can sometimes result in kidney inflammation or rheumatic fever. Rheumatic fever can lead to a rash, inflamed joints and, in severe cases, damage to the valves of the heart.
• Mononucleosis (mono) is a viral infection caused by the Epstein-Barr virus. One of the main signs of mono is a sore throat that may last for one to four weeks. Other symptoms include large swollen glands in the neck and armpits, fever, headache and feeling tired.

Diagnosis

Your healthcare provider may do a rapid strep test, a throat culture or both. A rapid strep test will give results fast (usually within about 15 minutes). But the test won’t tell if your sore throat is caused by a bacterium other than Streptococcus or if it’s caused by a virus. A throat culture takes longer (between 24 and 48 hours), but it’s more accurate. If your healthcare provider thinks you may have mono, he or she will probably do a blood test.
 

Treatment

If your sore throat is caused by bacteria, you may be prescribed an antibiotic. You will most likely begin to feel better in a few days, but it is very important to take all the antibiotics. This reduces the risk that your sore throat will return and also helps prevent antibiotic resistance.
 
Antibiotics don’t work against viruses. Infections caused by viruses usually just have to run their course. Most symptoms caused by a cold or flu-type virus go away in a week to 10 days. Symptoms caused by mono can last for four weeks or more. If you have mono, your health care provider will probably suggest that you get plenty of rest and that you avoid exercising too hard.
 
If a sore throat is a symptom of hay fever or another allergy, your provider can help you figure out how to avoid the things that trigger allergy flare up. You may also need to take medicine for your allergies.
 

Prevention

The best ways to avoid catching or passing the viruses and bacteria that can lead to a sore throat are to wash your hands regularly, avoid touching your eyes or mouth and cover your mouth when coughing or sneezing.
 
When your symptoms lead to more than a sore throat, it’s best to get it checked out. You’ll be on the road to recovery and will avoid getting others sick.

Sore Throat In Detail | KidsHealth NZ

Key points to remember about sore throats

• most sore throats are caused by viruses and need no treatment other than pain relief
• sometimes children can get strep throat (Group A streptococcus bacteria)
• a rare complication of strep throat is rheumatic fever which can cause permanent heart damage 
• Māori and Pacific children should see a doctor in the first 1 to 2 days of any sore throat

What causes a sore throat?

Sore throats are common in children. Causes can include:

• infection by viruses – the most common cause
• infection by Group A streptococcus bacteria (strep throat) – a less common cause

Less frequently, glandular fever (Epstein Barr virus) can cause a sore throat, enlarged glands in the neck, fever and tiredness, particularly in teenagers and young adults. Glandular fever is diagnosed with a blood test.

Can COVID-19 also cause a sore throat?

Yes. If your child has a sore throat, call Healthline in New Zealand (for free) on 0800 358 5453. They will give you advice about what to do. This will depend on current alert levels. 

If your Māori or Pacific child or teen has a sore throat, please also talk to your family doctor. Your child may need 2 swabs – a COVID-19 swab and a throat swab for strep throat. That’s because in New Zealand, Māori and Pacific children are at greatest risk of developing complications from strep throat. Your child may need 10 days of antibiotics for a suspected strep throat to prevent rheumatic fever. 

What are the complications of strep throat?

In at-risk people, untreated strep throat can lead to rheumatic fever. See the rheumatic fever page. 

What puts my child at risk of getting a sore throat?

Sore throats caused by viruses are common in all children. Strep throat is more common in school-age children. Strep throats are rare in children under 3.

In New Zealand, Māori and Pacific children are at greatest risk of developing complications from strep throat. Rheumatic fever occurs throughout New Zealand but is more common in Northland, the Auckland region, Waikato, Bay of Plenty, Rotorua, Tairawhiti (Gisborne and its surrounding area) and Porirua.

When should I seek help for my child with a sore throat?

It’s very difficult to tell the difference between a viral sore throat and strep throat. 

Māori and Pacific children and teenagers

If your Māori or Pacific child or teen has any sore throat, please take them to your family doctor or school clinic for a throat swab. Your child may need 10 days of antibiotics for a suspected strep throat to prevent rheumatic fever. 

Other children and teenagers

If your child with a sore throat is not Māori or Pacific, they have a low risk of developing rheumatic fever. Sore throats are usually viral. Most children with a sore throat do not need any tests. 

All children

You should see a doctor urgently if your child has:

• drooling (dribbling)
• difficulty breathing
• a new skin rash or bruising
• extreme tiredness or drowsiness
• possibly choked on a foreign object or swallowed a toxic substance

You should see your family doctor if your child:

• has symptoms that are not improving after 48 hours
• has not been drinking well for more than 24 hours, or you are worried about dehydration
• has great difficulty swallowing
• has increased snoring when asleep, or periods of stopping breathing when asleep
• has tender lumps in the neck that are getting bigger

What is the treatment for a sore throat?

Infections caused by viruses can not be treated with antibiotics. The body will clear out the virus on its own without treatment.

If your child needs take antibiotics for a strep throat, make sure they take all the doses for 10 days even if their symptoms have improved. Your child can return to school or daycare 24 hours after they start antibiotics.

Pain relief can help any sore throat. It will help your child eat and drink. You can relieve pain in the following ways:

• paracetamol (you must follow the dosage instructions on the bottle; it is dangerous to give more than the recommended dose)
• gargling with warm salt water (1 teaspoon of salt per glass of water)
• throat sprays can help but stop using them if your child doesn’t like them
• sucking on lozenges can help by increasing saliva production but don’t give them to young children because of the risk of choking
• drinking warm liquids – honey or lemon is a common way of providing relief
• cool liquids and ice blocks 

If your child has glandular fever (Epstein Barr virus), they should not take antibiotics because antibiotics don’t work against viral infections. In fact, some types of antibiotics, especially amoxycillin, can cause a rash in children with glandular fever.

Is a Sore Throat a Symptom of Coronavirus? How to Tell the Difference Between Hay Fever and COVID-19

For millions of people, spring ushers in the irritating and sometimes debilitating symptoms of hay fever, from a stuffy nose to a scratchy throat. And this year, many sufferers will be trying to manage their condition while monitoring themselves for COVID-19 symptoms.

So, how can a person tell if their cough or sore throat is just a spot of hay fever or symptoms of the coronavirus?

Professor Martin Marshall, chair of the family doctors’ body the Royal College of GPs, told Newsweek that its members would normally expect to see patients at this time of year suffering with symptoms of pollen allergy known as allergic rhinitis, or hay fever. According to the American College of Allergy, Asthma, and Immunology, up to 60 million Americans are thought to get hay fever.

Symptoms of hay fever include itchy nose, eyes, ears, palate and throat, sneezing, a runny or blocked nasal passage, watery eyes—as well as those which overlap with COVID-19, such as a cough and a sore throat.

However, Stephen Durham, professor of allergy and respiratory medicine at Imperial College London, told Newsweek such symptoms “are quite distinct from COVID-19 symptoms” and “in stark contrast to the dry cough, fever, fatigue, breathlessness and loss of smell and taste” which are “the hallmarks of COVID19.” And despite the name, “there is no fever,” stressed Durham.

He said these symptoms “should therefore not be confused, but they may co-exist.”

It is also useful to remember that allergy symptoms tend to be milder and fluctuate depending on the time of day, as pollen levels are often higher in the afternoon and evening, Marshall said.

“Similarly, wet weather may lead to patients experiencing milder symptoms,” he added.

“Patients who regularly suffer from hay fever will be familiar with the symptoms they usually get and the severity of them,” said Marshall.

If a person experiences “a significant deviation from this” or has COVID-19 symptoms such as a new, persistent cough, and a high temperature, Marshall urged them to self-isolate, adding they should seek medical advice from their family doctor if their symptoms worsen.

Durham said: “I suggest don’t self isolate for hay fever symptoms alone, nor for sore throat alone, in absence of fever, cough, loss of smell, fatigue or breathlessness.”

The U.S Centers for Disease Control And Prevention states those who believe they have COVID-19 should contact their health care provider and recover at home if possible. Those who have emergency warning signs—such as trouble breathing, persistent pain or pressure in the chest, feeling newly confused or having an “inability to arouse,” and bluish lips or face—should seek immediate medical attention by calling 911.

As those with hay fever and COVID-19, whether knowingly or not, could spread the coroanvirus to others if sneezing is one of their symptoms, “it is essential that hayfever sufferers are even more meticulous about taking their intranasal steroids, antihistamines and anti-allergic eye drops to suppress their symptoms,’ Durham said.

Not keeping symptoms like sneezing in check would “guarantee widespread dissemination of the virus as an aerosol” if a person also has COVID-19, he warned.

Durham went on to stress there is no evidence that hay fever puts people at greater risk of COVID-19, or that treatments like intranasal steroids or antihistamines suppress the immune system to the extent that they risk developing severe COVID-19 disease.

According to Johns Hopkins University, almost 2.5 million people have been diagnosed with COVID-19 since the outbreak started late last year in the Chinese city of Wuhan. A total of 171 people have died, and almost 659,000 have recovered. As shown in the Statista chart below, the U.S. has the highest number of known cases.

Countries with the most COVID-19 cases.
Statista

Centers for Disease Control and Prevention Advice on Using Face Coverings to Slow Spread of COVID-19

• CDC recommends wearing a cloth face covering in public where social distancing measures are difficult to maintain.
• A simple cloth face covering can help slow the spread of the virus by those infected and by those who do not exhibit symptoms.
• Cloth face coverings can be fashioned from household items. Guides are offered by the CDC. (https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/diy-cloth-face-coverings.html)
• Cloth face coverings should be washed regularly. A washing machine will suffice.
• Practice safe removal of face coverings by not touching eyes, nose, and mouth, and wash hands immediately after removing the covering.

World Health Organization advice for avoiding spread of coronavirus disease (COVID-19)

Hygiene advice

• Clean hands frequently with soap and water, or alcohol-based hand rub.
• Wash hands after coughing or sneezing; when caring for the sick; before, during and after food preparation; before eating; after using the toilet; when hands are visibly dirty; and after handling animals or waste.
• Maintain at least 1 meter (3 feet) distance from anyone who is coughing or sneezing.
• Avoid touching your hands, nose and mouth. Do not spit in public.
• Cover your mouth and nose with a tissue or bent elbow when coughing or sneezing. Discard the tissue immediately and clean your hands.

Medical advice

• Avoid close contact with others if you have any symptoms.
• Stay at home if you feel unwell, even with mild symptoms such as headache and runny nose, to avoid potential spread of the disease to medical facilities and other people.
• If you develop serious symptoms (fever, cough, difficulty breathing) seek medical care early and contact local health authorities in advance.
• Note any recent contact with others and travel details to provide to authorities who can trace and prevent spread of the disease.
• Stay up to date on COVID-19 developments issued by health authorities and follow their guidance.

Mask and glove usage

• Healthy individuals only need to wear a mask if taking care of a sick person.
• Wear a mask if you are coughing or sneezing.
• Masks are effective when used in combination with frequent hand cleaning.
• Do not touch the mask while wearing it. Clean hands if you touch the mask.
• Learn how to properly put on, remove and dispose of masks. Clean hands after disposing of the mask.
• Do not reuse single-use masks.
• Regularly washing bare hands is more effective against catching COVID-19 than wearing rubber gloves.
• The COVID-19 virus can still be picked up on rubber gloves and transmitted by touching your face.

These are some of the new top 5 Covid symptoms

PeopleImages | E+ | Getty Images

LONDON — When the coronavirus pandemic first emerged in early 2020, governments quickly put out information on what symptoms to look out for, little knowing then that much of the transmission was asymptomatic.

The public was told to look out for a high temperature and a new continuous cough, with a loss of taste or smell, fatigue and a sore throat also named as possible symptoms (some added at different points of the pandemic).

Fast forward to the present day and more symptoms are being reported and recognized. The variation in symptoms has happened over time as several variants of the virus — such as the alpha strain and now the highly transmissible delta variant — have gone on to replace the “original” strain of Covid-19 first discovered in China in late 2019.

Read more: Covid delta variant: Symptoms, spread and what to look out for

Now, an ongoing U.K.-based study which enables the public to enter their Covid symptoms on an app — which enables scientists to then analyze the data — says there are new coronavirus symptoms being widely reported.

The Zoe Covid Symptom study has identified the current top five symptoms that have emerged in recent weeks which seemingly differ depending on whether you’ve been vaccinated, and how many doses you’ve had.

The symptoms highlighted below were first published in late June but still represent the top five symptoms being reported, the Zoe Covid Symptom study told CNBC Wednesday.

The symptoms rankings are based on members of the public’s reports in the app alone and do not take into account which variant caused the virus or demographic information.  

These are the top five symptoms being reported by people who are fully-vaccinated, have had one dose of a vaccine or are unvaccinated.

Symptoms if fully-vaccinated?

The Zoe Covid Symptom study says that, generally, it has seen similar symptoms of Covid-19 being reported overall in the app by people who had and hadn’t been vaccinated.

However, fewer symptoms were reported over a shorter period of time by those who had already had the shot, suggesting that they were falling less seriously ill and getting better more quickly.

Here is the current ranking of Covid symptoms after two vaccinations:

1. Headache
2. Runny nose
3. Sneezing
4. Sore throat
5. Loss of smell

The study noted that “traditional” Covid symptoms such as anosmia (loss of smell), fever and shortness of breath ranked way down the list, at five, 12 and 29 respectively. “A persistent cough now ranks at number 8 if you’ve had two vaccine doses, so is no longer the top indicator of having Covid.”

Symptoms after one vaccine dose?

The ranking changes again after one dose of the vaccination as observed below:

1. Headache
2. Runny nose
3. Sore throat
4. Sneezing
5. Persistent cough

With the protection from only one vaccine dose, one of the original indicators of a persistent cough has made the top five symptoms, Zoe noted.

Symptoms if you’re unvaccinated?

If you’ve not yet been vaccinated then the symptoms are more recognizable to the traditional ranking, Zoe said, “however we can still observe some changes from when Covid-19 first appeared over a year ago.”

1. Headache
2. Sore throat
3. Runny nose
4. Fever
5. Persistent cough

“Loss of smell comes in at number 9 and shortness of breath comes far down the list at number 30, indicating the symptoms as recorded previously are changing with the evolving variants of the virus,” the study found.

Covid cases attributed to the much more contagious delta variant are surging in parts of Europe, the U.K. and the U.S., particularly among young people and the partially vaccinated and unvaccinated.

Read more: The delta variant is spreading in Europe and can’t be stopped

While two doses of the Oxford-AstraZeneca or Pfizer-BioNTech vaccine provide protection against the delta variant, both were significantly less effective after only one shot.

The latest research from Israel on Monday found a decrease in the effectiveness of the Pfizer-BioNTech vaccine in preventing infections and symptomatic illness, coinciding with the spread of delta, but said it remained highly effective in preventing serious illness.

Getting Through Mononucleosis – Student Health and Wellness Services

What is mononucleosis?

Mononucleosis (mono) is an infection caused by the Epstein-Barr virus. Signs of mono include fever, sore throat, headaches, white patches on the back of your throat, swollen glands in your neck, feeling tired and not feeling hungry.

How is mononucleosis passes?

The virus is found in saliva and mucus. It can be passed from one person to another through coughing, sneezing and kissing. Signs of mono usually develop four to seven weeks after you’re exposed to the virus. Generally, people only get mono once. It is most common in people 15 to 35 years old.

Does mononucleosis have any complications?

Sometimes. The main serious concern with mono is that the spleen will enlarge and even rupture. Although a ruptured spleen is rare in people with mono, it’s wise to be aware of the signs and call the Health Center right away if you notice any of them:

• pain in the upper left part of your abdomen
• feeling lightheaded
• feeling like your heart is beating hard and fast
• bleeding more easily than usual
• having trouble breathing

Can mononucleosis be cured?

No, but mono will go away on its own. Symptoms usually last about four weeks.

How is mononucleosis treated?

The main point of treatment is to relieve your symptoms. The following list includes tips on treatment:

• Rest
• Drink plenty of fluids (alcohol NOT included)
• If you have a sore throat, gargle with salt water or suck on lozenges, hard candy or frozen desserts (popsicles are good)
• You may want to take acetaminophen or ibuprofen to relieve pain and fever. Aspirin should be avoided because it is associated with Reye’s syndrome in children and young adults. Reye’s is a serious illness that can lead to death.

Do I need an antibiotic?

Antibiotics like penicillin are of no help in mono, because mono is a virus and antibiotics are used to treat infections caused by bacteria. Your clinician may give you an antibiotic if you have a bacterial infection in addition to having mono.

What about sports and exercise?

Avoid sports activities or exercise of any kind until the clinician tells you it’s safe.

Anything else?

NO ALCOHOL!!! Because enlargement of the spleen and liver may occur with this disease, alcohol should be avoided.

This information was made available by the American Academy of Family Physicians.

COVID-19 testing includes strep throat

Featured Topic

Thursday, February 4, 2021

The COVID-19 testing process at Mayo Clinic locations across the Midwest will now include group A streptococcus — strep throat — assessment and testing when indicated for all patients 3 to 75. Based on the number of strep throat cases seen, combining assessment and testing with COVID-19 is expected to improve the patient experience and expedite care.

Get screened

If you are a Mayo patient, but not a Mayo Clinic staff member, you should call the COVID-19 Help Line at 507-293-9525 or answer questions about your symptoms using the Check Symptoms assessment tool through Patient Online Services on the web or through the Mayo Clinic app. This tool, which offers the same screening questions as the COVID-19 Help Line, is available 24/7 to all Mayo Clinic patients with home addresses in Iowa, Minnesota or Wisconsin.

Get tested

Once screened, you will receive further instructions for scheduling your tests at the appropriate local testing site. For patients in Rochester and Southeast Minnesota using the Check Symptoms assessment tool, scheduling options will include being able to conveniently schedule an appointment using Patient Online Services if testing criteria are met.

At the testing site, Mayo Clinic staff will collect specimens using appropriate precautions. If you require more than one test, staff may need to collect more than one specimen.

Get results

Specimens will be sent to a Mayo Clinic lab for analysis, with results expected in 24 to 72 hours. If you are positive for any of the illnesses, you will be contacted and advised of next steps.

Your results will all be available in Patient Online Services or by calling the Test Result Phone Line at 877-838-2050. Have your Mayo Clinic number available when you call.

Influenza and respiratory syncytial testing

Influenza and respiratory syncytial virus was previously included in the combined testing process. However, due to the incredibly low rates of influenza across the nation and Mayo Clinic Health System, testing was removed in late January. These tests are still available through your primary care provider when symptoms indicate it is necessary.

Get more trusted information about COVID-19, safe care, visitor guidelines and vaccine updates.

For the safety of our patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a non-patient care area where social distancing and other safety protocols were followed.

90,000 Laryngeal cancer, throat swelling: treatment, symptoms, diagnosis

Laryngeal cancer may require surgery to remove the larynx. This throat cancer treatment is very traumatic. As a result of the intervention, the person loses the ability to speak independently. Today scientists have created an artificial larynx – the so-called “voice prosthesis” capable of restoring up to 80% of speech.The device is a small box that is implanted into the space formed after the operation between the trachea and the esophagus.

Cancer of the larynx is a malignant tumor originating from the tissue of the larynx.

According to the localization, the forms of laryngeal cancer are determined.

Epiglottis cancer. This species develops slowly. Often it grows behind the hyoid bone, into the pre-epiglottis space, at the root of the tongue.Regional metastases occur quite early.

Cancer of the vocal cord or cancer of the vocal apparatus is one of the serious pathologies. The swelling usually spreads up and forward or backward, or under the crease. Regional metastases practically does not give, it is within the fold for a long time.

Isolate cancer of the larynx of the lower (2%), middle (28%) and upper (70%) sections. Cancer that occurs in the lower larynx is characterized by infiltrative intensive growth.In the middle section, the tumor, as a rule, is located on one of the vocal cords, which leads to a change in voice formation. In the upper section, the tumor can be localized on the ventricles of the larynx, epiglottis. If the formation is located on the ventricles of the larynx, it blocks the lumen of the throat and leads to a disorder of respiratory function.

Diagnostics

The larynx and laryngopharynx are located deep, therefore the diagnosis presents certain difficulties.Using a special instrument, which is a flexible thin tube with an illuminator, the nasal cavity, larynx and hypopharynx are carefully examined. If a suspicious lesion or tumor is detected, a biopsy is performed (taking a piece of tissue for examination).

Computed tomography (CT) makes it possible to determine the size of the tumor and its spread in the lymph nodes and surrounding tissues.

On the recommendation of a clinical oncologist, a study PET-CT can be prescribed to determine the stage of the disease (if it is necessary to clarify the tactics of treatment), as well as to assess the response to treatment (usually 9-12 weeks after its completion).

Contrast examination of the esophagus with barium provides additional information about the tumor.

Biopsy is the only method that allows you to confidently judge the presence of cancer. A biopsy may involve taking a piece of tissue or puncturing the tumor with a needle.

The diagnosis of laryngeal cancer is confirmed by examining a piece of biopsy. In LISOD, histological verification is carried out in a reference foreign laboratory.

Treatment

Consultants of the LISOD Information Service will provide you with full information on the diagnosis and treatment of this type of cancer:

• 0-800-500-110 (toll-free for calls to
  from landline phones in Ukraine)
• or +38 044 520 94 00 – daily
  from 08:00 to 20:00.

Tactics of treatment of patients with laryngeal cancer is developed by a clinical oncologist.This takes into account the type of tumor, the degree of spread of the disease, the current condition of the patient, his age, concomitant pathologies, etc.

If necessary, all methods of treatment of patients with cancer of the larynx and laryngopharynx can be used: surgery, radiation (radiotherapy for laryngeal cancer) and chemotherapy for laryngeal cancer. Chemotherapy is not used as an independent treatment for laryngeal cancer. Its combination with radiation or surgical methods significantly improves the results.A combined treatment method is often used – radiotherapy for laryngeal cancer, chemotherapy and surgery. Traditionally, for LISOD, irradiation is carried out on linear accelerators manufactured by the American company Varian . The use of linear accelerators in combination with three-dimensional planning makes it possible to deliver the required radiation doses to the tumor while minimizing the effect on healthy tissues.

Symptoms

The main reason for the detection of an early disease is hoarseness.Only timely treatment of laryngeal cancer can help the patient.

We recommend contacting a specialist if you find any of the following symptoms in yourself:

• unreasonable weight loss;
• hoarseness and long-lasting cough;

90,051 shortness of breath;

• discomfort when swallowing – difficulty, pain;
• persistent sore throat or ear;
• swelling or swelling in the neck.

In all of the above cases, a high-quality diagnosis of throat cancer is required.

Risk factors

• The most common cancer of the larynx (oropharyngeal cancer, swelling of the throat) occurs in people who smoke. The longer the smoking history, the higher the risk of a smoker getting laryngeal cancer.
• Increases the risk of alcohol abuse.
• Lack of vitamins B and A may also contribute to laryngeal cancer.
• At risk are people with a weak immune system – with congenital diseases, HIV-infected.
• Increases the risk of contact with harmful chemicals such as wood dust, paints, varnishes, etc.
• HPV-induced papillomas can subsequently degenerate into malignant tumors of the larynx.
• Cancer of the larynx (oropharyngeal cancer) is more commonly diagnosed in African Americans.

Prevention

The main prevention of cancer of the larynx and hypopharynx is aimed at quitting smoking and alcohol abuse.

Questions and Answers

The section publishes questions from patients and the answers of our specialists. Each person’s question concerns a specific problem related to their illness. The patients are answered by Israeli clinical oncologists and the chief physician of LISOD, MD. Sci., Professor Alla Vinnitskaya.

Experts’ answers are based on knowledge of the principles of evidence-based medicine and professional experience.The answers correspond exclusively to the information provided, are for informational purposes only and do not constitute a medical recommendation.

The main purpose of section is to provide information to the patient and his family so that, together with the treating physician, they can decide on the type of treatment. The proposed treatment tactics may differ from the principles stated in the answers of our specialists. Do not hesitate to ask your doctor about the reasons for the differences. You need to make sure you are getting the right treatment.

Good afternoon! My father has cancer of the larynx of vestibular localization T3N0M0 stage 3, group 2 with metastases to the lymph nodes.He underwent three courses of chemotherapy and two courses of radiation therapy, performed a tracheostomy, but his wound festers. Now he is in the hospital. They suggested an operation to remove the larynx, tell me what to do? Thank you!

If the process is operable and there is no distant metastasis, surgery is the only option to cure your father.Repeated radiation therapy to the larynx is not performed. Chemotherapy can stop the progression of the disease, but not cure it.

Good afternoon.My tats are 59 years old. Diagnosis: squamous laryngeal cancer of the larynx T3N1M0. Completed the 2nd course of chemotherapy. Pukhlina changed 2 times. After a long time, another chemistry was given, and a course of exchange therapy was prescribed. We will continue to plan for more than 3 courses of chemistry. Say, what are the chances, can you continue your life?

According to the standards, at this stage of the disease, it is possible to carry out chemotherapy at the first stage (the so-called neoadjuvant), which has been done.Given the good response to treatment, the next step is radical radiation therapy concurrently with chemotherapy during irradiation. If after treatment the disease completely disappears after treatment, then after 9-12 weeks a PET-CT scan should be performed and, in the presence of residual disease (primary or in the lymph nodes), surgery should be performed. If everything is “clean” – observation. Prophylactic chemotherapy after radiation exposure does not improve results. If there is a residual disease clinically, they operate.

Good afternoon.Patient 55 years old, diagnosed with stage III laryngeal cancer. From December 2010 to June 2012 he underwent 4 operations, 42 beams and 6 courses of chemotherapy. In June 2012, he was denied treatment because doctors “do not see the point in this.” He now has three tumors: one behind the ear and two on the throat.
CT signs of recurrence of the underlying disease.

The next line of chemotherapy should be weighed, taking into account the previously received drugs and the general condition of the patient.

Dear Doctor, Zvi! I am writing at the request of a friend of my mother, who is now in the hospital. In March 2010 she was diagnosed with grade 2 laryngopharyngeal cancer T2N2No, 2 CL.GR. A course of chemotherapy with I / O PCT was carried out according to the PBMF scheme (methotrexate, cisplatin, fluorouracil, bleocin).
After this course, a tumor regression of 70% was observed visually.
Then 3 more courses of chemotherapy were carried out according to the same scheme.
In September 2010, a course of DHT.
After the irradiation, 4 more courses of chemotherapy were carried out according to the same scheme.
Tumor regression noted 80%
02/06/2012 diagnosed with cancer of the laryngopharynx grade 2 T2N2Mo, 2 CL.GR (area of ​​expression up to 0.5 cm). Tumor regression 100%
Now they are offering a course of chemotherapy for OCP (doctorubicin, cyclophosphamide, vincristine, sturgeon).Please write your opinion about the proposed treatment. Maybe there is something more effective. Please advise.
Thanks

Squamous cell carcinoma was found histologically at the time of initial diagnosis? As I understand it. that this ulceration is the only finding, and no affected lymph nodes or distant metastases have been identified.Please tell me if a biopsy was taken from this suspicious ulceration? If not, then you should take it. It may not be a tumor at all, and then no oncological treatment is indicated. If it is a relapse or a residual tumor, it is necessary to weigh the surgical removal, if the process is operable, and if not, repeated irradiation with a sufficient dose (up to 66 Gray) + combined chemotherapy with cisplatin (or irradiation with Erbitux). Before that, you should do an MRI of the head and neck + CT of the chest (if not performed) to clarify the tactics of treatment.

Good afternoon. My father was diagnosed with carcinoma of the larynx of the actual vocal apparatus T2N1M0 St3, underwent a course of chemotherapy and 20 radiation sessions, the doctor recommends 10 more radiation sessions. Do I need to re-irradiate and what is the prognosis for this diagnosis? Thanks.

The success of laryngeal carcinoma treatment depends on many factors.One of the most important is the radiation dose. So, the dose should be about 70 Gy for all foci of the disease, including the affected lymph nodes (N1). It is impossible to bring such a dose in 20 sessions with standard fractionation. So, we must continue the treatment. The relative 5-year survival rate for stage III laryngeal carcinoma is about 52% (The AJCC Cancer Staging Manual. 7- Edition, 2010)

Good day! My uncle has cancer of the throat, the last stage, having metastases already in the legacy, and there is no need for the development of biochemistry and operability.Say whether weasel is possible to continue living your life.

Given the prevalence of the disease, chemotherapy should be weighed. It all depends on the general condition of the patient. With a good response to treatment, palliative neck radiation therapy is also possible.

Hello! My nephew was born in 1995.It all started with an inflamed lymph node. Since 2006, there has been a lump on the left side of the submandibular zone. Throughout the entire period, the inflamed lymph node was treated (lotions, rinsing). In December 2010, he was diagnosed with a thickening of the salivary gland – surgery is required. In June 2011, an operation was performed. From the protocol of the operation: … there is an intimate fusion of the superficial fascia, platysma, capsule of the gland with the tissue of the gland and adjacent enlarged lymph nodes surrounding the muscles, and is soldered to the body of the lower jaw from the inside.the gland is reduced in size, dense, removed, sent to the PGI. Removed two enlarged lymph nodes with a diameter of 2.0 and 1.0 cm in the upper-lateral part of the neck on the left, elastic, gray-pink color, completely sent to PGI. According to the results of the conclusion, the diagnosis: adenocarcinoma of the submandibular salivary gland on the left. T2N1M0, Cl. group II
Sent for a consultation at the Cancer Institute. Based on the results of the repeated analysis of the PGZ, the diagnosis was made: acinous cell carcinoma of the salivary gland with infiltration of the adjacent muscle tissue.Tumor metastasis in one of the examined lymph nodes.
CT scan of the skull, chest, abdomen and pelvis with contrast was prescribed.
Can you please tell me the possible methods of treatment, the need for additional tests ??? Which area doctors should be consulted (endocrinologist …) ??? How safe is the simultaneous CT scan of all the listed areas?
Can you suggest the nature of this disease?
Thank in advance!

Ekaterina, an acinous cell tumor (acinous cell adenocarcinoma) occupies an intermediate position between adenomas and cancer, which means there is no consensus regarding the biological nature of the neoplasm and the prognosis of the disease.The main feature of acinous cell tumors is considered to be the similarity of tumor cells to the cells of the terminal sections of the salivary glands. With any histological structure of these tumors, relapses, regional and distant metastases are possible. Moreover, in the presence of metastases in the lymph nodes. the likelihood of distant metastases increases significantly. That is why your doctors perform CT scans to exclude them. The lungs are most commonly affected and may be limited to CT of the lungs and MRI of the head and neck.
With regard to the treatment of these types of tumors, the radicalism of the surgical removal of all foci of the disease is very important.If only a biopsy of these “two enlarged lymph nodes” is performed, then this is not enough. Dissection of the neck lymph nodes on the affected side is required. It is important to know whether the primary tumor is completely excised (histologically, the resection margins and all lymph nodes should be carefully examined). In any case, even with properly performed surgical intervention, if the tumor spreads to the surrounding tissues (muscle, as in this case) and the presence of metastatic lymph nodes, postoperative radiation therapy is indicated to reduce the risk of recurrence.Naturally, in the absence of distant metastases. Let’s hope they won’t.

Dear Dr. Bernstein! My father (born 12.04.1940) in April 2010 in a cancer hospital in Ivano-Frankovsk was diagnosed with laryngeal cancer, stage III. My neck metastasized into lymph node. The doctors said that only surgical treatment was needed, but we turned out to be, since the acquaintance died immediately after such an operation.Myi began to be treated with folk medicine – my dad drank amanita tincture, befungin. But now it becomes difficult for him to eat, he coughs. I don’t know what to do, how to help a loved one ??? When I found out about your hospital, there was some kind of hope. I beg you, help me first with a consultation: what to do, how to do the right thing to save dad? What can he do? Zaranen is very grateful. Svetlana

Dear Svetlana, firstly, it is necessary to assess the spread of the disease today: MRI of the head and neck, CT of the chest organs, laryngoscopy.If the tumor blocks the airways (which can be manifested by difficulty breathing), the question of the need for tracheostomy (installation of a breathing tube into the trachea below the tumor) or directly about radical surgery is decided if it is impossible to save the larynx due to extensive damage to the cartilage and if it is still possible. In the absence of the threat of airway closure and the absence of distant metastases (usually in the lungs), the question of the method of treatment is being resolved: it is possible that it is impossible to save the larynx, as I said, and an operation is required, in other cases, several courses of chemotherapy followed by radiation therapy with ongoing chemotherapy may be an appropriate option.Everything is very individual, and now it is impossible to say which method of treatment is most suitable. One thing is clear: your dad needs to be treated and the sooner the better.

In the summer of 2008 my father’s diagnosis was kidney cancer with metastasis in lower spine and liver. He was treated with radiation on spine and then interferon. Everybody thought he would be dead by spring 2009, because he was in very sick condition.His weight was 45 kg with heights of 173 cm. We stopped interferon and after that in April he started to walk, and gained 10 kg back and has very good appetite. He had one more tomography and it did not show metastasis in liver, but still tumor in kidney and ruined spine. But he doesn’t have pain. Could he be in remission? Interferon helped? Or wrong diagnosis? Thank you

Your father can be in remission but not in liver.Liver mts diagnoses was probably wrong.

90,000 Pharyngitis.Symptoms Drugs for treatment.

…

Pharyngitis is an inflammation of the pharyngeal mucosa, which
accompanied by pain, soreness, or discomfort in the throat. Sharp
pharyngitis can be divided into viral, bacterial, fungal,
allergic, traumatic (due to the ingress of a foreign body or
surgical intervention) ¹ .
Pharyngitis can also develop as a result of severe hypothermia,
addiction to smoking and alcohol, increasing the load on the voice
ligaments.
The disease often proceeds in an acute form, but there is also a danger that
the disease will become chronic. The acute form of pharyngitis can
signal the development of other diseases such as measles, rubella
or scarlet fever ² .

Symptoms and diagnosis of pharyngitis

It is not difficult to recognize a disease even with the “naked eye”. For
acute pharyngitis symptoms are as follows:
● pain while swallowing;
● perspiration;
● dryness;
● cervical lymph nodes become enlarged;
● body temperature may rise.
During the period of chronic course, the patient feels:
● prolonged dry cough;
● “lump” in the throat;
● irritability and sleep disturbance are manifested ¹ ;
● mucus in large quantities, which occurs often
cough up;
● temperature rise may not be observed ¹ .

Diseases of the gastrointestinal tract can also provoke
the appearance of symptoms of pharyngitis, therefore, the treatment of the disease, selected not
according to the reason, does not give a positive result.To
avoid unnecessary expenses for treatment, it is better to start with a visit to a specialist
otolaryngologist, and undergo special diagnostics. Most often a doctor
conducts a visual examination and takes a swab to make sure
bacterial or viral nature of the disease. Based on the pathogen, a specialist
will develop the correct treatment plan.
He can also offer hardware diagnostics – pharyngoscopy. She
helps to exclude sore throat and shows the level of changes affecting
the surface of the posterior wall of the pharynx and palatine arches.

Pharyngitis Treatment

The main treatment for pharyngitis is aimed at eliminating the cause that caused
his. The otolaryngologist will definitely prescribe antibacterial agents if
bacteria became pathogens, and antiviral drugs, if the main
the causative agent is a virus.
Without fail, the doctor will advise:
● exclude the use of spicy food for a certain period;
● warm compresses to warm the throat;
● exclude hypothermia of the body;
● drink warm drinks;
● carry out inhalations and rinse the throat with chamomile infusions,
mint, calendula, yarrow, eucalyptus ³ .

If the cause of the disease is work in an enterprise with hazardous
emissions and excessively polluted air, a sine qua non
treatment will become strict adherence to the rules of protection. Another must
a condition in the therapy of the disease – the patient must completely stop
smoking.
Particularly careful when treating pharyngitis should be pregnant and
nursing mothers. Their therapy takes into account the effects of drugs on the fetus and baby. A gentle diet, throat relief (less talk) will provide
its restorative effect.It is worth remembering that pregnant women
Not all medicines are suitable.

Preparations for the treatment of pharyngitis

Drug therapy has its own characteristics. Usually,
the doctor takes into account the severity of the symptoms of pharyngitis when treating. Preference
given to drugs that have broad antibacterial
action (if the cause of the sore throat is bacteria), do not contribute
manifestation of allergies, do not irritate the mucous surface of the pharynx.
A good effect in the treatment of pharyngitis was shown by Pharingosept ⁴ .
Pharingosept has a mild effect. Can be used in the treatment of pregnant women and children ⁵ . It contains ambazon – a broad-spectrum antiseptic. The drug does not cause intestinal dysbiosis ⁵ . Natural cocoa powder is among the ingredients of the preparation. It has a soothing effect, helps relieve dryness, and relieves tickling and itching. Ambazon has retained its effectiveness against common causative agents of upper respiratory tract infections to the present.

90,000 Symptoms of vegetative vascular dystonia (VVD) in children

Vegetovascular dystonia (VVD) is a complex of symptoms of diverse clinical manifestations that affects various organs and systems and develops as a result of deviations in the structure and function of the central and / or peripheral parts of the autonomic nervous system.

Reasons

Socio-economic:

• Accelerated rate of civilization development.
• Adaptation to new living conditions.
• Introduction of new products and household chemicals.
• Acceleration of labor rhythms.
• Overload of the psyche from an increase in information flows.
• Stress factors in school and family.

Genetic predisposition of the body to various diseases that can provoke a violation in the activity of the vascular and vegetative systems.

Symptoms

• Changes in the condition of the skin (the skin acquires a different shade of color and a different pattern of blood vessels).
• Incorrect work of the sweat and sebaceous glands.
• Rash, itching, swelling.
• Disruption of the endocrine glands, which leads to weight loss or weight gain in the child.
• Excessive acne breakouts.
• Deceleration or acceleration of puberty.
• The rise and fall of body temperature for no particular reason.
• Behavior change. The drowsy state is replaced by the manifestation of panic and causeless anxiety.
• Respiratory distress.
• The appearance of “shortness of breath”.
• Disorder of the gastrointestinal tract.
• Frequent nausea and vomiting, diarrhea, disruption of the bile ducts, pain in the abdomen, lump in the throat.

The presence of such symptoms is rather beacons for the pediatrician, according to which he can prescribe a set of diagnostic measures and appropriate treatment.

Do not self-diagnose and treat yourself.Entrust your child’s health to a professional. Only in a clinic can a cardiologist correctly diagnose and prescribe the optimal and correct treatment. The role of parents is to create favorable conditions for overcoming the disease, while strictly following the recommendations of the doctor.

Prevention

• Strict observance of the daily routine: eight hours of sleep, prolonged exposure to air, restriction of the curriculum, minimum time spent at the TV and computer.
• Physical education with permissible loads. Swimming, skating, skiing, tennis, outdoor games are recommended.
• Balanced diet: no excess salt, sugar, fatty meat, baked goods. A variety of grains, legumes, apricots, raisins, root vegetables, herbs and nuts should be present as a source of potassium and magnesium.
• Psychotherapy. Various methods of deep relaxation of the nervous system, eliminating emotional stress.
• Therapeutic massage of the collar zone, electrophoresis.
• Multivitamins.

More about pediatric cardiology at the YugMed clinic

90,000 Throat treatment during pregnancy – ENT diseases in pregnant women

Pregnancy and sore throat

A sore throat is a common problem, aggravated by the fact that it is completely unclear which medications can be used without harm to the unborn child, which measures will not bring negative consequences.

What can be treated if the throat does not go away on its own? What medicine to take from the pharmacy shelf, if each one says “contraindicated in pregnancy”?

Traditional medicine knows many recipes that women have been passing on to each other for centuries.Unlike tablets, which always pose a potential threat, folk remedies do not contain dangerous chemical elements, their use is preferable.

You can find articles containing alternative methods for treating throat during pregnancy, but do not rely on them completely – if you have the slightest doubt about the adequacy of a prescription, discuss it with your doctor.

An excellent way to relieve inflammation and reduce pain is gargling with solutions of soda and salt, lemon juice, sea water.You can use herbal decoctions.

These procedures must be carried out multiple times throughout the day.

Why doesn’t throat treatment during pregnancy have the expected effect?

How is it that sometimes just a day of rinsing with baking soda allows you to cope with a sore throat, and another time, no matter what you do, relief does not come and it only gets worse (a severe cough develops, the general condition worsens)?

It’s just that the diseases that caused these symptoms are different.Let’s try to figure it out.

Sore throat during pregnancy occurs when an infection enters the body and provokes inflammation of the tonsils. It is not difficult for a pregnant woman to catch the virus, because the immune defense of the female body is weakened. A husband or children can infect, a trip to the store or a planned visit to the clinic can turn into a disease.

The most common throat disorders are pharyngitis or tonsillitis (tonsillitis).

Pharyngitis is a disease of the pharyngeal cavity, often of a viral nature, with the following symptoms:

• tingling pain, soreness and dry throat
• weakness, general malaise
• runny nose
• light cough
• tingling pain, soreness and dry throat
• temperature rise

Angina (acute tonsillitis) – inflammation of the tonsils, poses a danger to the health of the mother and her unborn child.Without professional treatment, the disease can lead to poor pregnancy outcomes. It is imperative to treat tonsillitis under the supervision of a doctor: bed rest and anti-inflammatory therapy are shown.

Symptoms of sore throat are:

• severe sore throat
• enlargement and redness of the tonsils
• general weakness
• high temperature

And in fact, and in another case, you cannot do without the advice of a specialist! The doctor will determine the disease of the throat in the first stages and prescribe an appropriate treatment course.This will keep you healthy – yours and your baby’s.

Do’s and don’ts during pregnancy:

• Do not overheat. Do not use mustard plasters, steam baths. Do not get carried away with hot tea with raspberries – all this is not recommended during pregnancy
• Use herbs with caution in treatment. Find out beforehand how they affect the tone of the uterus, blood pressure and kidneys. Tansy, aloe, St. John’s wort, a string open the list of non-recommended herbs
• Medications are dangerous in any trimester of pregnancy: most of them have side effects.Even if you are used to considering the drug safe, it will not be superfluous to check with your doctor if it is acceptable to use it

Medicines, incl. herbal origin cannot be used without consulting a doctor.

Pain in the throat – causes and possibilities of therapy | # 08/15

In ancient times, pain was believed to be the wrath of the gods. Only Hippocrates first defined pain as one of the manifestations of the disease.It is pain that is the earliest sign of many pathological processes, and its localization and character help in the diagnostic search. As you know, a significant part of patients’ visits to doctors of all specialties is associated precisely with complaints of pain sensations of various localization, and pain in the pharynx is the most common reason for visiting medical institutions and turning the population to pharmacies to purchase medicines. On average, every adult experiences pharyngeal pain about 2-3 times a year, in childhood these complaints occur more often – up to 8-10 times during the same period [1-3].

Currently, the concept of “sore throat” implies a wide range of pathological conditions and is used to define any pain in the back of the oral cavity or oropharynx [3, 4]. Pain in the pharynx can be varied in nature: they distinguish between acute, cutting, stabbing, dull, pressing, mixed, localized, diffuse, migratory and other types of pharyngalgia. The feeling of pain can intensify when swallowing, be constant, paroxysmal, subsiding, increasing.The high frequency and significant severity of pain in this localization is due to the rich innervation of the mucous membrane of the oropharynx and laryngopharynx. Sensory, motor and autonomic innervation is carried out through the pharyngeal plexus formed by the branches of the glossopharyngeal and vagus nerves, as well as sympathetic fibers of the superior cervical ganglion, which has connections with the second branch of the trigeminal nerve in the area of ​​the auditory tube orifices.

Features of the innervation of the pharyngeal tube provide “masking” of a number of pathological processes of other localization by pain in the throat.Irradiation of pain in the pharynx is observed with foreign bodies of the esophagus and the initial sections of the respiratory tract; inflammatory diseases of the larynx, ear diseases, pharyngolaryngeal and gastroesophageal refluxes, thyroid diseases, cardiac pathology, glossopharyngeal neuralgia; stylohyoid syndrome (Eagle’s syndrome), various somatalgias and sympathetic states [5].

Nevertheless, most often, pain in the pharynx is caused by acute inflammatory diseases (tonsillopharyngitis of various etiologies and their regional complications) and chronic inflammatory processes in the structures of the lymphoid tissue and the posterior pharyngeal wall [3, 6].In the submucosal layer of the pharynx there is a fairly large volume of lymphoid tissue – the Valdeyer-Pirogov lymphoepithelial ring, which determines the predisposition to the development of infectious and inflammatory processes, and the functional and anatomical features of this organ – to various effects of adverse factors and injuries. A very important place in the structure of inflammatory diseases of the pharynx is occupied by the pathology of the lymphoepithelial pharyngeal ring, the central working link of which is represented by the palatine tonsils.Chronic tonsillitis is the most common disease of all possible pathological processes in the lymphoid tissue of the pharynx [3, 4, 7]. However, the problem of chronic tonsillitis remains especially relevant not only due to its significant prevalence among children and the most efficient part of the adult population of the world, but also due to the high risk of developing numerous complications. The main function of the tonsils, as you know, is participation in the formation of local and general immunity – the tonsils are constantly in contact with antigens penetrating the body and, due to their anatomical and morphological structure, provide the production of interferons, interleukins, immunoglobulins and other biologically active substances.Inflammation is an integral part of the functional state of the tonsil tissue. With the development of a chronic process, inflammatory reactions in the tonsils are more pronounced and develop in deeper sections of the amygdala, including the lymphatic and circulatory vascular network. It has been proven that the onset and subsequent development of tonsillitis depends not only on the state of immunity, but to a greater extent on infectious factors, both of individual types of microorganisms and their associations [3, 7].

Adequate diagnosis and rational effective treatment of diseases of the pharynx is an urgent problem of practical health care. One of the main tasks of treating patients with pharyngeal pathology is the normalization of the pharyngoscopic picture and the relief of local unpleasant sensations. Accordingly, therapeutic methods are aimed at eliminating the etiotropic factor, reducing inflammatory changes and eliminating the symptoms of the disease. The main infectious factor in the development of acute inflammatory changes in the pharynx are viral agents.Unfortunately, in Europe and the Russian Federation, already at the first appeal with complaints of pain in the pharynx in 70% of clinical cases, medical workers prescribe systemic antibacterial agents to patients. Against the background of the often unreasonable and irrational use of systemic antimicrobial drugs in recent years, there has been an increase in the number of antibiotic-resistant strains of the bacterial flora, which can serve as an etiotropic factor in the development of a number of infectious processes, primarily in the ENT organs and the lower parts of the respiratory tract.The prescription of systemic antibiotics should be clinically justified and limited by strict medical indications [8]. Systemic etiotropic treatment in all cases is indicated only for patients with acute streptococcal tonsillopharyngitis. For sore throat, it is also not recommended to routinely use systemic non-steroidal anti-inflammatory drugs due to the high risk of side effects – hypersensitivity reactions, ulcerogenic effects, nephropathies and a number of others. The use of safer modern selective non-steroidal anti-inflammatory drugs, inhibiting mainly cyclooxygenase-2, is inappropriate due to the delayed anti-inflammatory effect in comparison with the “classical” drugs.

Thus, the main treatment for diseases of the pharynx is the use of topical drugs. The main advantages of local therapy are the creation of the optimal concentration of the drug in the area of ​​the pathological focus and the absence of systemic action. Most of the drugs produced for the treatment of acute inflammatory diseases of the pharynx belong to the OTC group and are used by patients independently, without the consent of a doctor.But it is often difficult for specialists to navigate the huge number of drugs for relieving pain in the throat. Symptomatic therapy consists in the appointment of analgesic and local anesthetic drugs. Local dosage forms of anesthetics and pain relievers are designed to avoid the systemic action of non-steroidal anti-inflammatory drugs by providing direct contact of the drug with the mucous membrane of the mouth and pharynx [9]. Drugs for local treatment should not only stop the main symptoms of acute and exacerbation of chronic pharyngeal inflammatory processes, but also have a wide spectrum of antimicrobial action, low allergenicity, lack of toxicity and irritation to the mucous membrane.Local treatment involves the appointment of drugs with antiseptic, anti-inflammatory and analgesic effects [6]. The composition of local dosage forms usually includes one or more antiseptics (chlorhexidine, hexetidine, benzydamine, ambazon, thymol and its derivatives, alcohols, iodine preparations), non-steroidal anti-inflammatory drugs, essential oils, local anesthetics (lidocaine, tetracaine, menthol), less often – antibiotics (fusafungin, framycetin, gramicidin C) or sulfonamides.The preparations may also contain bacterial lysates, natural antiseptics (plant extracts, bee products), synthesized factors of nonspecific protection of mucous membranes, which also have antiviral effects (lysozyme, interferon, lactoferrin), vitamins (ascorbic acid) and some other components [2].

A new, clinically substantiated pathogenetic treatment of pharyngeal pain with a high safety profile is the use of Strepsils® Intensive, which has pronounced anti-inflammatory and analgesic properties.Strepsils® Intensive is available in the form of resorption tablets and contains low doses of the active ingredient – flurbiprofen. The mechanism of action of flurbiprofen is associated with inhibition of the enzyme cyclooxygenase and inhibition of the synthesis of prostaglandins – inflammatory mediators that cause the development of edema, pain, hyperemia and functional disorders. Per day, according to the instructions for use, you can use no more than 5 tablets. Strepsils® Intensive must be slowly absorbed, the interval between doses is 2-3 hours.Do not take this remedy for more than 3 days. Flurbiprofen as an anti-inflammatory and analgesic agent most mildly acts on the affected mucous membrane of the pharynx. The patient feels additional relief from the effect of the physical wrapping around the throat. In addition, the required dose of an active substance taken with local analgesics is lower than with systemic analgesics, and the effect occurs rather quickly [10]. Flurbiprofen belongs to the well-studied non-steroidal anti-inflammatory drugs, its effectiveness and sufficient safety have been proven not only in clinical studies, but also by the results of many years of use in practice for various pathological conditions [4, 10, 11].National and international data of Strepsils® Intensive safety monitoring allowed to transfer the drug to the group of non-prescription drugs [9]. This drug has a powerful anti-inflammatory and analgesic effect, against the background of good tolerance, demonstrates high clinical efficacy: the therapeutic effect occurs within 15 minutes after taking the first dose and lasts at least 2-3 hours. A pronounced persistent decrease in symptoms – pain and inflammatory changes in the pharynx – is achieved already on days 2–3 of treatment [12, 15].The drug reduces the swelling of the pharyngeal mucosa for up to 4–6 hours, which greatly facilitates difficulty in swallowing, and is able to quickly suppress the inflammatory process resulting from the action of both viruses and bacteria [12].

In order to assess the effectiveness and safety of using Strepsils® Intensive in patients after tonsillectomy, a simple comparative non-interventional observational study was carried out on the basis of the Department and Clinic of Ear, Throat and Nose Diseases of I.M.I.M.Sechenov. During the study, 60 patients aged 18 to 47 years with chronic tonsillitis were observed, who, according to indications, underwent a planned bilateral tonsillectomy. An analysis of subjective complaints was carried out – pain in the pharynx, a feeling of difficulty in swallowing, an unpleasant taste in the mouth, a feeling of edema, discomfort and sore throat, general malaise; assessment of the objective picture – perifocal hyperemia and edema of the pharyngeal mucosa, the severity and color of fibrinous plaque in the niches and taking into account the frequency of use of systemic anesthetic drugs (Ketonal).The results of the observational study demonstrated that the addition of Strepsils® Intensive to the treatment regimen for patients after tonsillectomy leads to a decrease in the severity of reactive inflammatory changes and pain, which improves the quality of life and accelerates the healing process.

Noteworthy is another drug in the line of local forms – Strepsils® – a combined antibacterial and fungicidal drug for use in dentistry and ENT practice.Due to the combination of two active substances in the preparation – amylmetacresol (600 μg) and 2,4-dichlorobenzyl alcohol (1.2 mg) – its high antimicrobial activity has been achieved. Amylmetacresol destroys the actual membrane of the microorganism, 2,4-dichlorobenzyl alcohol causes dehydration of the biological object. Strepsils® has antiseptic, antimicrobial and antimycotic effects, is active against a wide range of gram-positive and gram-negative microorganisms that cause diseases of the pharynx, including against most staphylococci, streptococci of groups A, C and D, Diplococcus aeroniae, Pseudomonaslebsella aerugenella Haemophilus influenzae, Proteus spp., Aerobacter aerogenes, Aerobacter cloacae and others, as well as yeast-like fungi Candida albicans [14]. Experimentally in vitro demonstrated the activity of amylmetacresol and 2,4-dichlorobenzyl alcohol in relation to strains of respiratory syncytial virus (RSV), influenza virus (type A), SARS virus (SARS-CoV) [5]. The presence of excipients in Strepsils® – essential oils, eucalyptus, honey, lemon, herbs, menthol and others – helps to eliminate irritation in the pharynx and oral cavity, reduces pain, foreign body sensation, perspiration, soreness and discomfort in the pharynx.The components of the drug have low adsorption, and therefore there is no systemic effect – the toxic dose for humans exceeds the therapeutic dose by 70 thousand times. A special dosage form is also produced – Strepsils® for children from 6 years old with lemon flavor [13].

To summarize the above, rational local therapy is the most effective and safest way to treat inflammatory diseases of the pharynx. Clinical success and good tolerance make it possible to recommend the widespread use of topical drugs, including Strepsils® Intensive and Strepsils® as drugs of choice in the treatment of pharyngeal pathologies of various origins.

Literature

1. Arefieva N.A. Tonsillar pathology. Current state of the problem // Bulletin of otorhinolaryngology. 2012. No. 6. P. 10–13.
2. Polunina T.A. Treatment of sore throat in children // Practice of the pediatrician. 2011. October. S. 59–61.
3. Palchun VT, Luchikhin LA, Kryukov AI Inflammatory diseases of the pharynx. A guide for doctors. M .: GEOTAR-Media. 2007.288 s.
4. Blagden M., Christian J., Miller K., Charlesworth A. Multidose flurbiprofen 8.75 mg lozenges in the treatment of sore throat: a randomized, double-blind, placebo-controlled study in UK general practice centers // Int J Clin Pract. 2002; 56 (2): 95-106.
5. Gwaltney J. M. In: Mandell G. L, Bennet J. E., Dolin R. eds. Principles and practice of infectious diseases. New York, 1995.
6. Polyakova T.S., Gurov A.V., Polivoda A.M.15, no. 2, p. 146-150.
7. Ponomarev LE, Shubich MG Topical issues of tonsillar immunology // News of otorhinolaryngology and logopathology. 1998. No. 2, p. 105-110.
8. Strachunsky L.S., Kamanin E.I. Antibacterial therapy of infections in otorhinolaryngology // BC. 1997. T. 6. No. 11. P. 684–693.
9. Sedinkin AA, Balandin AV, Dimova AD Results of an open, prospective, controlled, randomized comparative study of the efficacy and tolerability of flurbiprofen and paracetamol in patients with sore throat // Ter.archive. 2005. No. 77 (3). S. 74–76.
10. Gibb I. A. et al. Research Report TH9903 – A pharmacy-based post-marketing population risk trial of flurbiprofen 8.76 mg lozenges in subjects with sore throat. Boots Healthcare International. Veltri J., 2000.
11. Watson N., Mimmo W. S., Christian J. et al. Relief of sore throat with the anti-inflammatory throat lozenge flurbiprofen 8.75 mg: a randomized, double blind, placebo controlled study of efficacy and safety // Int J.Clin Pract. 2000; 54 (8): 490-496.
12. Christian J., Largey P. M., Shaw H. et al. Local and general tolerability of flurbiprofen lozenges in healthy volunteers / Poster presented at XXIX National Congress of the Italian Society of Pharmacology. Florence, Italy, 20-23 June 1999.).
13. www.strepsils.ru. Instructions for use of the drug Strepsils.
14. RSV, SARS-assoziiertes Coronavirus, Influenza-A-Virus. A throat lozenge containing amylmetacresol and dichlorobenzyl alcohol has a direct virucidal effect on respiratory syncytial virus, influenza A and SARS-CoV // Antivir.Chem. & Chemother. 2005; 16: 129-134.
15. Svistushkin V.M., Nikiforova G.N. et al. Optimization of the postoperative period in patients with chronic tonsillitis // RMJ, No. 6, 2015.

G.N. Nikiforova ¹ , Doctor of Medical Sciences, Professor
V.M. Svistushkin, Doctor of Medical Sciences, Professor
M.G. Dedova
D.M. Pshonkina

First Moscow State Medical UniversityI.M.Sechenov, Ministry of Health of the Russian Federation, Moscow

¹ Contact information: [email protected]

90,000 Benign neoplasms in the outpatient practice of an otorhinolaryngologist

/ Bondar Natalya Petrovna – otorhinolaryngologist of the highest qualification category, Shakhmatova Olga Nikolaevna – otorhinolaryngologist of the highest qualification category /

The problem of combating tumor diseases of the upper respiratory tract and ear has been and remains relevant in otorhinolaryngology.The prevalence of benign neoplasms of the ENT organs is quite high, according to the literature, they constitute from 0.5 to 2.5% of all patients with ENT pathology (Ena E.N., 2011)

More than half of the neoplasms are tumors of the larynx, the second place is taken by the tumors of the nose and paranasal sinuses, the third place is the tumors of the pharynx. Ear neoplasms are less common.

The benign nature of the tumor is often conditional, since some neoplasms have a tendency to malignancy, nearby organs can grow and thereby cause life-threatening complications (Ena E.N., 2011)

Benign tumors of the ENT organs can develop from all tissues that form these organs. According to the histological structure, epithelial tumors (papilloma, adenoma, etc.), soft tissue tumors (lipoma, hemangioma, neurofibroma, neurilemmoma, chemodectoma, etc.), bone and cartilage tumors (osteoma, chondroma, etc.), tumors of mixed genesis (teratoma, etc.), and tumor-like formations (keratosis without atypia, cysts, intubation granuloma, polyps, amyloid deposits, etc.).

There are several classifications of tumors: the international histological classification of tumors, the classification of V.F. Antoniv et al. (2001), which is based on the principle of dividing anatomical regions (ear, nose, pharynx, larynx) into sections and fragments.

Clinical manifestations of the disease are associated with the localization of the tumor, its size and cell structure.

Most common benign tumors of the upper respiratory tract and ear:

Papilloma – an epithelial tumor that occurs on the skin or mucous membranes, gray or gray-pink in color, on a narrow base, in shape and appearance, the surface of the papilloma resembles a mulberry or cauliflower.One of the most common tumors of the larynx, accounts for 35 to 45% of all benign tumors of this localization. (Soldatov I. B, 1994)

Hemangioma – vascular tumor of red, sometimes purple-red color, the surface is bumpy, the consistency is soft, often bleeds, can be diffuse and encapsulated

Adenoma – an epithelial tumor, consisting of glandular structures, has the shape of a node and is localized under the mucous membrane, which, as a rule, is not changed, is characterized by slow growth and can reach large sizes

Osteoma – a tumor that develops from bone tissue, grows over the years as an immobile, dense, painless formation.It is one of the most common benign neoplasms of the paranasal sinuses

Other benign neoplasms: rhabdomyoma, leiomyoma, chemodectoma, lipoma and other tumors included in the histological classification are rare.

From my own observations of rare benign neoplasms, I would like to cite the following:

Ceruminal adenoma (ceruminous adenoma, ceruminoma) is a rare benign tumor of the sulfur glands of the external auditory canal.Mainly men of middle and elderly age are affected. Usually, the tumor is localized in the cartilaginous part of the external auditory canal, i.e., the zone of concentration of the bulk of the ceruminous (sulfur) glands. Less commonly, it is found in the bony part of the external auditory canal, where the sulfur glands are few in number and are located only in its upper wall. Clinically, such an adenoma manifests itself as a painless nodule, sometimes accompanied by unilateral hearing loss. Macroscopically, the tumor looks like a delimited polypoid node on a broad base, less than 1 cm in diameter, covered with normal, less often eroded skin.After removal, the tumor can recur after a long time, after 7-10 years. Tumor growth is extremely slow, more often expansive, but in the absence of a capsule, the tumor, despite a fully mature, high histological differentiation, has a tendency to invasive growth. Thanks to this growth, it can grow into the middle ear. (MedicalPlanet)

Patient K., 63 years old, has complained of purulent discharge from the left ear for three months, a history of left-sided chronic mesootitis.On examination, there is purulent discharge in the left external auditory canal, the external auditory canal is obturated with a rounded formation, pinkish in color, with a flat surface, the eardrum is not visible. MSCT of the temporal bones show signs of a chronic inflammatory process of the left ear, complicated by caries of the middle ear, spontaneous RO (cholesteatoma is not excluded). Polyp? external auditory canal on the left. For treatment, he was sent to a hospital, where a general cavitary operation was performed on the left ear, removal of the neoplasm of the ear canal.The conclusion of the histopathological study is ceruminous adenoma. When the patient was observed for the next five years, tumor recurrence was not detected.

Dystopia of the salivary glands may consist in finding islets and inclusions of glandular tissue in unusual places, outside the gland, or in an abnormal location of the entire gland. They are most often found in the lymph nodes near the parotid gland, in the tonsils and in the sternocleidomastoid region. Dystopic salivary glands can also be a source of cysts or tumors.

Patient K., 56 years old, complained of difficulty in nasal breathing, decreased sense of smell. History of bilateral maxillary and ethmoidal sinusitis. On examination, nasal breathing is difficult on the left, the nasal mucosa is pink, there is no edema, in the middle nasal passage on the left there are polypous vegetations. The nasal septum on the right has a cauliflower-like mass that bleeds when touched, about 1 cm in diameter. For surgical treatment, he was sent to a hospital, where he performed: right-sided endoscopic microhymoroetmoidotomy, right-sided endoscopic infundibulotomy, left-sided endoscopic polypetmoidotomy, removal of neoplasm of the nasal septum on the right.Pathohistological examination of the neoplasm of the nasal septum – a fragment of cartilaginous tissue with uneven growth of normally formed tissue of the salivary gland with dilated excretory ducts. There is no growth of atypical cells.
When the patient was observed for the next four years, tumor recurrence was not detected

Cysts of the larynx
Most of the cysts of the laryngeal region are localized outside the laryngeal cavity – on the epiglottis or at the root of the tongue, but can also occur in the ventricles of the larynx and on the scooplary laryngeal folds.On the vocal folds, small cystic formations can occur as a result of the transformation of polyps in this area. Most of the laryngeal cysts are retentional, formed as a result of blockage of the excretory ducts, their expansion and hypertrophy of the walls of the acini. Laryngeal cysts contain serous fluid of varying viscosity, depending on the content of colloidal proteins in it. Very rarely there are cysts of embryonic origin in the form of dermoid cysts, which are located on the valecules or epiglottis.Cysts located on the vocal fold can be confused with nodules. Laryngeal cysts tend to grow extensively without invading surrounding tissue. For a long time they can be asymptomatic, but, having reached a certain size, they cause disorders of swallowing (cysts of the epiglottis, scapular folds) or phonation and respiration (cysts of the vocal folds, ventricles of the larynx). Cysts trapped in the respiratory gap can cause an acute attack of suffocation.

Patient K., 61 years old complained of difficulty in swallowing solid food and liquids, could swallow only in a certain position of the head, breathing was not difficult. History of chronic catarrhal laryngitis for more than 3 years. On examination, breathing is free, the mucous membrane of the pharynx and larynx is focal hyperemic, dryish. In the laryngopharynx on the right at the level of the upper edge of the epiglottis, between it and the lateral wall of the pharynx, there is a rounded formation covered with unchanged mucous membrane about 2 cm in diameter.MRT examination was performed: along the posterior and right lateral walls of the oropharynx and laryngopharynx, at the level of the upper sections of the epiglottis, a solid exophytic formation of an irregular shape, on a broad base, measuring 17 × 22 × 21 mm, with uneven clear contours, without signs of invasion.Surgical treatment was performed: microsurgical removal of the laryngeal neoplasm. Histological examination: retention cyst. When the patient was observed for 3 years, no recurrence of the cyst was detected.

Literature:

1. Antoniv V. F., Rishko N. M., Popadyuk V. I., Pronchenko S. V. Classification of benign tumors of the ENT organs. // Bulletin of otorhinolaryngology, 2001, No. 4, p. 18-24.
2. Daikhes NA, Yablonskiy SV, Davudov Kh. Sh., Kuyan SM Benign tumors of the nasal cavity, paranasal sinuses and nasopharynx in children // M., Medicine, 2005. – 264 p.
3. Ena EN Radio wave surgery of benign neoplasms in otorhinolaryngology // Abstract of the thesis. Candidate of dissertation, M., 2011, 23 p.
4. Soldatov I. B. Guide to otorhinolaryngology. M., Medicine, 1994.- 608s.
5. MedicalPlanet

When do you need to make an appointment with an otolaryngologist

If you suspect a disease of the ears, throat or nose, you should consult an otolaryngologist. The doctor will conduct a complete examination, prescribe an effective and targeted treatment.It is important to know when you need to make an appointment with an otolaryngologist.

Who needs advice

The doctor specializes in three important organs – throat, ears, nose. It is important to protect these parts of the body, and when alarming symptoms appear, they should be diagnosed in time and treated fully.

It is important to schedule a visit to the doctor in one of the following cases:

• persistent runny nose and cough;
• dryness in the nasal mucosa;
• snoring;
• frequent nosebleeds;
• Difficulty in nasal breathing;
• there was an unpleasant odor from the mouth;
• fast fatigability;
• poor sleep, feeling of weakness in the morning, dizziness.

Pay attention! There are general conditions in which it is important to immediately consult an otolaryngologist. The specialist pays special attention to cases of impairment of smell and hearing, an increase in lymph nodes under the jaw.

How is an appointment with an otolaryngologist

Treatment of ENT diseases requires strict supervision by a specialist. It is important to follow all the recommendations so that the disease goes away without consequences and complications. This will help to get rid of the disease and its consequences in the shortest possible time.

During the consultation, the doctor performs the following procedures:

• collects patient complaints, compiles an overall picture of the medical history;
• performs an examination of the ears, throat, nose using special tools and equipment;
• , upon detection of diseases, prescribes drug therapy according to an individual scheme;
• gives advice on diet during treatment, health procedures.

The otolaryngologist uses gentle and effective methods for treatment.These include sanitation, phonophoresis, laser therapy. The choice depends on the form of the disease. In some cases, rest and taking medications are enough, in others, courses of treatment are prescribed with regular visits to a specialist.

If a patient suffers from a chronic illness, it is important to monitor the condition and visit the doctor regularly when the first symptoms appear. For the treatment of exacerbations in the form of otitis media, adenoids or tonsillitis, course methods are provided. On average, their duration is 5-7 procedures, but it all depends on the complexity and course of the disease.

Pay attention! To alleviate the condition of a chronic disease and strengthen local immunity, one or two courses of visiting a doctor per year are enough. At the same time, an accurate and safe examination is carried out to make a diagnosis.

Reasons for visiting a doctor

Diseases of the ENT organs occur more often than other diseases. This also occurs in relatively healthy people with a slight decrease in immunity during the season of exposure to viruses.First of all, patients complain of a runny nose and sore throat. Despite the seeming ease of the disease, it is better to consult a specialist and spend the recovery period at home.

Patients often consult a doctor with severe lumbago in the ears, after an untreated cold. Also, a similar symptom appears with an infectious disease.

Make an appointment if you experience discomfort in the tonsils and throat. Prolonged activity in the presence of symptoms takes away strength, complicates communication, affects performance and general well-being.It is important to visit a doctor if there is a sore throat, a feeling of a lump in the throat, or a cough.

If the first symptoms of hearing impairment appear, it is important to immediately contact an otolaryngologist. If ear congestion is observed and there is partial hearing loss, a doctor should be visited urgently.