ENT Clinic

Hello everyone,

 I am Dr. Palak Shroff Bhatti, ENT and head and neck surgeon consultant at Mumbai. I would like to speak on laryngopharyngeal reflux. Now laryngopharyngeal reflux is very closely associated to a popularly known condition that is gastro-oesophageal reflux disease, which is quite common nowadays. Simply put in reflux disease is where the lower esophageal sphincter is loose and so acid comes from the stomach to the oesophagus and to your throat. Now, the conditions causing these are spices, stress, unhealthy food habits, unhealthy lifestyle and many more and the patient normally presents with a mild sore throat. A recurrent sore throat which is irritating, grating sensation in throat, mild hoarseness, lump in throat, clearing of throat on and off, sticking of mucus inside throat due to which the person will keep on coughing and trying to remove his expectoration, thinking that it is expectoration and it is not mucus.

Chronic dry cough and difficulty in swallowing due to repeated attempts of coughing and trying to swallow very hard. Now in this condition, one must visit an ENT surgeon and have a thorough check-up. In which the surgeon will do your ear, nose and throat examination including your laryngeal examination with an indirect laryngoscope that is simply a mirror put in your throat just to see your voice box or he can use a 70°scope also see to your voice box. Now there are certain investigations that are seen on examination, we recommend that is barium studies, that barium swallow or an upper GI endoscopy which normally is referred to the gastroenterologist. Now the treatment for this is definitely lifestyle changes such as bland diet, small frequent meals, avoiding to sleep just after the meal preferably, eat two hours before bedtime, head elevation while sleeping if there are recurrent cough and regurgitation and having a healthy lifestyle.

Only in a few cases, surgical correction is offered and that too by the general surgeon, which involves plication of the diaphragmatic area where there is light hernias. The do's and don'ts, mainly the don'ts. Avoid excessive clearing of the throat, avoid taking over-the-counter medications. Just when you have simple symptoms you just go to the pharmacist, take medicine, that should be avoided and eating acidic foods, eating tobacco, alcohol, excessive use of beverages like caffeine, tea etc and Do’s, maintain a healthy weight, a healthy weight not a low weight, relaxation, regular exercises and taking food or your meals at proper intervals.

If not treated what can happen? mainly sore throat, chronic cough and there is swelling of the vocal cords which will give you a very raspy voice and worsening of any chest condition like asthma or chronic obstructive lung disease. In worst cases, it can cause cancer. So my suggestion is please recognize symptoms, live a healthy lifestyle and at the slightest suspicion, it's better to show the ENT surgeon and the gastroenterologist for a proper evaluation and treatment of your condition.

Thank you!

Good day to all!

I am Dr. Palak Shroff Bhatti, ENT head and neck surgeon practicing at Mumbai. Today I would like to tell about premalignant conditions of the oral cavity. The premalignant condition simply put is any condition that shows the change in the lining of the skin of the mucosa which can potentially turn into a malignant or a cancerous condition. In the oral cavity, there are mainly leukoplakia, erythroplakia, sub-mucosal fibrosis which can lead to a malignancy.

Now in leukoplakia, around 20% of these lesions which are in the buccal mucosa can undergo malignant change and on the tongue nearly 41%. Erythroplakia still has a higher chance that is 91% can undergo malignant change. In submucosa fibrosis that is mainly the mouth opening is restricted and there is a white rubbery tissue which is lining the pallet and the mucosa. So these conditions can give rise to malignancy in the long run. That's why they need to be biopsied. Now the biopsy is mainly on the clinical acumen of the surgeon as well as a high level of suspicion. So in the oral cavity, firstly the doctor will do a proper thorough examination, suggest a biopsy and then go ahead with the management.

Now if it is proven that it can be a dysplasia or a premalignant condition then a wide excision with the proper margin is recommended and a follow-up is required at least for the first three years every three months. After that every six months, because nearly one-third can recur and nearly up to 35%, can turn malignant in spite of being originally non-malignant. So at least a follow-up of three to five years is a must with your doctor.

Thank you.