Throat Flashcards
Dysphagia
Difficulty swallowing
Aphagia
Inability or refusal to swallow
2 types of dysphagia
- muscular dysfunction
- block of the esophagus
Causes of muscular dysfunction
- stroke, brain, spinal cord injury
- inflammation
- Weakness (polymyositis)
- esophageal spasm
- scleroderma
Causes of block of esophagus
- ulceration scars from GERD
- Inflammation
- diverticular disease
- tumors
- masses
Alternative classification of dysphasia
- oropharyngeal
- esophageal
- functional (unknown cause)
Diagnostic procedures for dysphasia
- barium swallow
- laryngoscopy (look at back of throat)
- manometry (internal test of esophageal pressure)
- pH monitoring (determines acid reflux)
- upper GI or esophagoscopy
Treatment for dysphasia
- exercise swallowing muscles
- endoscopically or surgically remove
- dietary adjustments
- pharmacotherapy (treat GERD, treat infections, avoid/treat dry mouth)
Pharmacist role in dysphagia
- drugs to adjust stomach acid/treat GERD
- encourage monitoring of weight (weekly)
- MTM to assess for dry mouth
- recommend therapies to treat dry mouth
- assist with thickened liquids
Thin liquids
Water, coffee, tea, soda etc
Nectar like liquid
Coats and drips off spoon
Honey like liquids
Coats spoon, flows off in a ribbon
Spoon thick liquids
Remains on spoon in soft mass (pudding like)
Level 3 food standard
- nearly regular diet
- bite- sized
- avoid crusty, dry bread, nuts, dried fruits, raw veggies
Level 2 food standardized
Foods moist, soft, cohesive
Meats ground or minced
Avoid corn bread, rice, soups, casseroles, stringy food
Level 1 food standardized
Pureed and cohesive
No mixed textures
Everything pudding like
Drugs with anticholinergic side effects
- antihistamines
- atropine
- antidepressants (tricyclics)
- anticholinergics (benztropine)
- antipsychotics
- urinary incontinence drugs
- diuretics
- muscle relaxants
Laryngitis
Inflammation of larynx, causing voice to change
Acute causes of laryngitis
- viral infection
- GERD
- irritation (allergens, smoke, pollution)
- inhaled meds
- overuse of voice
Chronic causes of laryngitis
- GERD
- nerve damage
- polyps and nodules
- cancers
Laryngitis treatment
- Avoid talking
- Hydrate
- Rest
- no drug proven to be of benefit (compared to risk)
- increase humidity
**professionals steroids will reduce inflammation and swelling
Things to avoid for laryngitis
- talking, shouting, singing
- smoking
- dry air
- clearing throat
Pharmacists role in laryngitis
- give good advice
- do not give false expectations
- make appropriate referrals (assess pain well)
When to refer for laryngitis
- significant pain
- fever
- BP <100
- respiratory rate >25
- voice change >4 days, with rest
- oral lesions or visible lesions in throat
- history of inhalation damage (fire)
T/F throat pain is a disease
False, symptom not disease
Etiology of sore throat
- common cold
- mouth breathing
- flu
- viral pharyngitis
- group A strep
- sinus drainage
- inhale noxious fumes (smoking)
Treating throat pain
- treat underlying bacterial infection (test for it)
- systemic analgesic (NSAIDS, APAP, NO aspirin)
Topical products for throat pain
- anesthetics: benzocaine, dyclonine (numbs everything, caution with hot food, teeth grinders)
- antiseptics: menthol, camphor (direct relief, decrease nasal congestion and post-nasal drip)
- dosage forms: lozenges, sprays, gargles, dissolving strips
Recommendations for sore throat
- drink plenty of fluids (warm, tea with honey)
- gargle with warm, salt-water rinses
- hard candies to increase saliva production
- increase humidity
- avoid irritants
- rest
When to refer for sore throat
- significant pain, inability to eat or drink
- fever
- BP <100
- respiratory rate >25
- same time onset of joint pain or rash
- difficulty breathing
- pain >7 days
- felling of lump or swelling in throat
Point of care testing for GAS
- refer tonsillar exudates
- test GAS
T/F sleep studies are essential when apnea is suspected
True
T/F you can use benzocaine in all ages
False, not recommended for <2 years old
Therapies for snoring
- sprays
- breathing strips
- jaw slings (mouth breathing)
- mouth guards (jaw positioning)
- postural and lifestyle changes (elevate head, don’t sleep on back)
improve snoring
- sufficient humidity in room
- achieve optimal body weight
- avoid dry mouth
- protect ears of snorer
- down’t sleep with people who snore
- get animals out of bed
- remove irritants
- avoid hypnotics, alcohol
When to refer for snoring
- excessive daytime sleepiness
- difficulty concentrating
- morning headaches
- sore throat from snoring
- restless sleep
- gasping/choking in sleep or waking
- hypertension
- chest pain at night
- so loud it disrupts partner
What is the recommended questionnaire for patients to fill out in regards to snoring?
STOP BAND
T/F laryngitis is painful and you can offer NSAIDS for treatment
False
Best therapy is to avoid talking, hydrate and rest as it only affects the voice with no pain
