The mouth, pharynx and larynx are the structures through which air, food and voice pass. Persistent hoarseness, recurrent sore throat, snoring, difficulty swallowing or mouth lesions that do not heal warrant ENT assessment with endoscopy.
The consultation
The examination includes inspection of the mouth and oropharynx and flexible laryngoscopy: a thin flexible scope passed through the nose allows the pharynx, larynx and moving vocal cords to be examined in a few minutes.
Hoarseness and voice disorders
Hoarseness is often associated with infections or vocal strain and resolves on its own. Guidelines recommend laryngoscopy if it does not resolve within four weeks, or earlier if a serious cause is suspected. Relevant factors include smoking and alcohol, recent neck or chest surgery, recent intubation, breathing or swallowing difficulties, coughing up blood or a neck lump.
Common causes include vocal cord nodules, polyps and cysts, Reinke’s oedema in smokers, reflux and voice dysfunction. Less commonly, precancerous lesions or tumours are involved, making early diagnosis important. Laryngeal lesions can be removed by endoscopic microsurgery through the mouth, without external incisions, including to obtain a histological diagnosis.
Tonsils and recurrent sore throat
Most sore throats are viral and do not require antibiotics. Tonsillectomy is considered for well-documented recurrent tonsillitis, recurrent peritonsillar abscess or obstructive sleep apnoea.
Snoring and obstructive sleep apnoea
Snoring may be a sign of obstructive sleep apnoea, in which the upper airway repeatedly closes during sleep. Typical symptoms include breathing pauses noticed by a partner, waking with a choking sensation, daytime sleepiness and difficulty concentrating. Diagnosis relies on a sleep study: polysomnography or cardiorespiratory monitoring.
STOP-Bang screening and BMI calculation are available for initial orientation. They do not replace a sleep study or consultation.
Continuous positive airway pressure (CPAP) is the reference treatment for moderate to severe disease. Guidelines recommend considering surgery for patients who cannot tolerate or do not accept CPAP, or where an anatomical obstruction limits its effectiveness. ENT assessment examines obstruction in the nose, palate, tonsils and tongue base. In selected patients with severe sleep apnoea, palatoplasty may be indicated, possibly together with nasal surgery.
Difficulty swallowing (dysphagia)
Coughing or choking while eating or drinking, food feeling stuck in the throat, recurrent pneumonia or weight loss may indicate a swallowing disorder. The specialist endoscopic examination is FEES: fibreoptic endoscopic evaluation of swallowing.
Mouth lesions
Aphthous ulcers, small wounds and mouth inflammation usually heal within one or two weeks. A lesion of the mouth, tongue or throat that does not heal within two to three weeks, a persistent white or red patch, a lump or neck swelling should be assessed by a specialist, especially in people who smoke or drink alcohol.
Related topics include oral lesions, oral lichen planus, tongue lesions and oral cancer.
Questionnaires and assessment
Voice, reflux, sleepiness and swallowing can be assessed using validated questionnaires such as VHI, RSI, Epworth, STOP-Bang and EAT-10.
The information on this page is for educational purposes and does not replace a medical consultation.