Search for tag: "throat"

Interviewer: You have a pretty bad sore throat. Dr. Tom Miller, is that worth a trip to the doctor?

Dr. Miller: It might be. Most sore throats are caused by viruses. But if you have tender, swollen lymph nodes in your neck, if you have a fever of greater than 100 or 100.5, and if you look in the back of your throat with a penlight and you see sort of plaques on your tonsils, there's a good chance that you have strep throat, especially if you live with young kids who also get strep throat more commonly than adults. It might be worth a trip to the doctor.

He'll evaluate those same things. If you have all three of them, he's likely to give you an antibiotic. If you have one or two of them, he'll do what's called a rapid strep test. That will tell him if you have strep throat, and if you do, you'll have an antibiotic. That will reduce the symptom duration by one or two days and you'll feel better and get back to work.

Interviewer: So strep throat pretty much the only sore throat that you're going to get an antibiotic for.

Dr. Miller: There are others but more rarely.

updated: November 11, 2021
originally published: July 13, 2017

Interviewer: You have this feeling like you have to constantly clear your throat. Dr. Katherine Kendall's a laryngologist. What's going on?

Dr. Kendall: That sensation usually starts from an irritation in the larynx from a cold or a cough, or another exposure. The feeling goes on after the original problem has resolved, and it's like scratching a mosquito bite. The more you scratch it, the more it itches. So I generally recommend that patients try to stop throat clearing.

Interviewer: So, generally, it's not caused by anything other than just a habit. So what do you do?

Dr. Kendall: I recommend substituting the response with a throat clear with something other than a throat clear, such as a hard swallow, a sip of water, chewing gum, or even snapping a rubber band on the wrist.

Interviewer: And how long until I see some results?

Dr. Kendall: Three months should do it. If not, an individual should seek care from a laryngologist.

updated: June 4, 2021
originally published: February 6, 2019

Interviewer: What are the symptoms of food allergies? We'll examine that next on The Scope.

Announcer: This is "From the Frontlines" with emergency room physician Dr. Troy Madsen on The Scope. On The Scope.

Interviewer: If you're listening to this right now, you probably suspect you might have a food allergy and you're curious to know for sure if that could be the case. Probably have a lot of questions and so do I so we're going to talk to Dr. Troy Madsen. He's an emergency room physician at University of Utah Health Care. So symptoms of food allergies, how do I know if I have a food allergy? What are some of the common symptoms? And there's a difference between food allergies and food sensitivities?

Dr. Madsen: Exactly, yeah and that's often a point of confusion, but allergies are like any other kind of allergy. If you have a food allergy, it can range from mild, so maybe some itching, little bit of a rash; to more severe, where you have some throat tightness, some lip tingling, to really severe cases where you just can't breathe. So those are what we think of with allergies.

Interviewer: With food allergies. And is it possible for me to just be minding my business, I'm eating something I've eaten my whole life and now, all of a sudden, my throat's swollen, like I've reacted that quickly and that severely?

Dr. Madsen: It is possible and, surprisingly, it's not uncommon. People I've known who have had eaten shellfish for years and then sometime in adulthood, eat some lobster or some shrimp, and just suddenly develop itching and facial swelling and trouble breathing. So it's entirely possible. You could've eaten this food for years and then, later in life, develop a food allergy.

Interviewer: All right. And if you start having these symptoms, what should you do?

Dr. Madsen: If they're mild symptoms, like a rash, maybe just a little bit of itching, you're probably okay just to take some Benadryl. But if it's more severe, anything that involves the airway, any lip swelling, tongue swelling, throat tightness, trouble breathing, that's where I would even call 911. I mean, you've got to get to the ER because those things can develop really quickly and be life-threatening, just very, very severe reactions.

Interviewer: So those symptoms again, lip swelling, tongue swelling, tingling?

Dr. Madsen: Tingling, I would get to the ER and, again, if you're . . . any concerns about your airway, call 911.

Interviewer: All right. Don't mess around with that.

Dr. Madsen: Exactly.

Interviewer: I feel like we only talked for a few seconds here about this topic. Have we covered it all? Is that pretty much it?

Dr. Madsen: Well, like you mentioned, there's also the issue with food sensitivity versus allergies. So again there, we're talking about very different things, some people may have concerns about gluten or other things in foods. There, they may have some more abdominal cramping, maybe some nausea, diarrhea. That's not a true allergy. Again, the allergies are the things we think of with any sort of allergy: itching, rashes, airway issues, much more concerning in terms of getting to the ER.

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Interview: Strep throat. What is it? What are the symptoms and what do you do about it? That's next on The Scope.

Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen, on The Scope.

Interview: All right. Today on the Scope, we're talking about strep throat: the symptoms and what you can do about it. Troy Madsen is an emergency room physician at University of Utah Health. Tell me, strep throat, and I think we should also talk about what people might confuse it with, but what is strep throat?

Dr. Madsen: So strep throat is a bacterial infection of the tonsils. It's by strep, streptococcus, it's the full name of the bacteria. It's something you can get just by being exposed to someone with strep, usually from droplets like if they're coughing or they touched something that's been in their mouth and then you'd touch that and put it in your mouth. That's primarily how you're going to catch strep.

Interview: And what are the symptoms, normally?

Dr. Madsen: It's interesting with strep, it's one of these things where it's probably been so over-treated and confused over the years that there have really been some good studies done to try and figure out exactly what symptoms would suggest strep throat. There are four things that suggest strep throat. Those things are:

1. first of all, not having a cough, so if your throat hurts and you don't have a cough, you're more likely to have strep;
2. if you push on the front part of your neck and you feel your glands or your lymph nodes, sometimes we'll call them glands, you feel that area and it's swollen and it hurts, that also means you're more likely to have strep;
3. if you have a fever, you're more likely to have strep; and
4. the fourth thing, if you can somehow look in a mirror or if someone can look in your mouth with a flashlight, kind of pushing your tongue down a little bit, and you can see your tonsils and there's white stuff on the tonsils, that also suggests strep.

So those four things. There have actually been several studies done that looked at those and each one of those increases the likelihood of strep from about if you have one of those four maybe it's 10-15 percent chance, all four it's closer to 60-70 percent. So those are the classic symptoms of strep: sore throat without a cough, with tender, swollen lymph nodes in your neck, with a fever, and with white stuff on your tonsils.

Interview: And if I don't have tonsils, then I can't get strep throat?

Dr. Madsen: Technically, you could still get an infection back there. That's a great question. It's going to significantly decrease the likelihood that you would have strep throat. I think you can still get a bacterial infection back there. If someone came in and told me they have their tonsils removed and they're having pain there, I'm still going to do a throat culture on them to make sure there's nothing there.

Interview: All right. So that's the next step, right?

Dr. Madsen: Yes.

Interview: So if you have all those symptoms, then you should go to see your doctor and they're going to do a throat culture.

Dr. Madsen: Usually. But it's funny if you look at throat cultures, so we have what's called the rapid strep. It's that test that comes back, you do the swab, it comes back within an hour, sometimes faster, yes or no on strep, that's only going to pick up strep 70-80 percent of the time. And, like I mentioned, if you meet four of those four criteria for those symptoms, odds are 60-70 percent.

So it's really not wrong for a physician even to just examine you and say, "Hey, you meet all four of these criteria. You've got strep. Let's skip the rapid strep. We know what the answer is." It's not wrong to just do that and then treat with antibiotics. But your doctor very well may opt to just do a throat culture to confirm what they already think.

Interview: All right. And antibiotics, is that the only form of treatment?

Dr. Madsen: It is. Yeah. I mean typically, yup, you're going to be on antibiotics for that and usually about a week of antibiotics.

Interview: Got you. Is there anything other than the discomfort that could come up strep throat that if I didn't take care of quickly enough?

Dr. Madsen: There are things. I mean they're rare, but the concern with strep is if it's untreated it can lead to things. You may have heard of scarlet fever. That can be something that happens after strep. It can cause kidney issues, heart issues, and those are rare things, but they do happen in people who do not have strep treated.

Interview: And what would be the difference between recovery time not treated and antibiotics?

Dr. Madsen: That's a great question and it's probably subject to a little bit of controversy. There's more out there suggesting that antibiotics may shorten the duration of strep by maybe a day.

Interview: That's it?

Dr. Madsen: I know. It's so surprising. And a lot of times, the antibiotics, it's even more maybe in kids to prevent some of these complications I talked about, but more stuff that's come out is suggesting maybe even in adults, it may shorten the symptoms by a bit, maybe get you back to work in four days instead of five, but it may not be that magic pill we've talked about. There are even some people who have argued maybe in adults, you don't treat it with antibiotics.

Again, there's a little bit of a controversial area, something that's been subject to more research that I've seen more kind of come out on and more people trying to sort out what exactly do we do with this. But I think in kids, it's probably a bigger deal because of those complications I mentioned. In adults, I'm not suggesting necessarily you tough it out, but also don't expect that you're going to take antibiotics and within 12 hours you're going to feel great. You're going to continue to feel sore and continue to have a sore throat for probably at least a few days after starting antibiotics.

Interview: Alright. So you can choose to treat it or not, it sounds like. If somebody's asking you for advice, "Should I take the antibiotics?" what would you say? I mean this is where it gets into that thing about your kind of own experience versus what does the data say? What does the research say?

Dr. Madsen: Yeah, if someone comes to the ER and I diagnosed them with strep, I recommend they take antibiotics. And I'm doing that in part because they've come in seeking help, it's going to shorten the duration of their symptoms at least a little bit. It probably helps, also, to decrease the transmission of the bacteria. I think it's going to assist with that. My recommendation is to be treated, to take the antibiotics, and, at this point, I can't say that I would feel comfortable just absolutely saying, "Don't treat it; don't worry about antibiotics; tough it out; you'll be fine."

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updated: July 6, 2018
originally published: December 5, 2016

Announcer: Is it bad enough to go to the emergency room or isn't it? You're listening to "ER or Not" on The Scope.

Interviewer: Time for another edition of "ER or Not" today. Your kid got a raisin stuck up their nose. Is that a reason to go to the ER to help get out of there? Doctor Troy Mattson is an emergency room physician with the University of Utah Health Care. Raisin up the nose, ER or not?

Dr. Madsen: Okay. I'm going to tell you something really gross here.

Interviewer: Okay.

Dr. Madsen: It's something you can try to home to avoid the ER and avoid the urgent care if you are brave. If you're the mother of this child that stuck a raisin up their nose, one trick you can do, and again avoid the ER, avoid urgent care entirely, it's actually to take your child, put your mouth on their mouth, almost like you're giving mouth to mouth, blow into their mouth, and with a little bit of force, it will then . . . the child will react by kind of closing off their airway, that air will go up into their nasal passages and blow the raisin out, probably onto your face.

Interviewer: Really?

Dr. Madsen: Along with some mucus, but that's a little trick. So this is one of those things you can go to the ER if you want. What it would mean in the ER as we would take a look up there. Try to find this raisin. Look up there with the light, sometimes have to use something to open up the nostril little bit, reach up there with some forceps and pull the raisin out. But if you're brave, that's a trick you can try at home. Actually blowing in your child's mouth and then being brave and knowing that you're going to get some mucus and a raisin on your face.

Interviewer: This sounds a little sketchy. Is this actually supported by research? This is an okay way to do it?

Dr. Madsen: This is supported in medical textbooks and in the medical literature.

Interviewer: Is it really?

Dr. Madsen: Yeah, it's actually something that is recommended if a parent wants to try it when they bring a child, a young child to the ER.

Interviewer: Well, that's one of the first things you'll recommend they try?

Dr. Madsen: I'll put it out there if they want to. I can't honestly say I've ever done it. Again, I've read it in textbooks and it has been recommended, but it's a trick. If I had a young child, I would probably try that before going to the ER.

Interviewer: It'd be fascinating to talk to somebody who's actually tried that.

Dr. Madsen: Yeah.

Interviewer: So would that work with most things that have been stuck up the nose? At least as something to try first?

Dr. Madsen: It's not unreasonable to try. I wouldn't put a lot of effort into it. You don't want to be fighting with your child there and causing them a lot of discomfort with this, but . . .

Interviewer: It can't really hurt them.

Dr. Madsen: It really can't hurt them. Essentially, you're just blowing in their mouth.

Interviewer: Sure, yeah.

Dr. Madsen: With a little bit of force, blowing in there like you were giving mouth to mouth, and then their natural reaction will be to kind of shut off their airway as that air is coming in. It might expand their lungs a little bit, but then it does force that air up into their nose, and then the air going through there is going to . . . If that thing can come out with that, it's going to come out with that force.

Interviewer: Are we talking about like fast or like a good, sustained, hard pressure blow?

Dr. Madsen: We're talking about something fast.

Interviewer: Okay.

Dr. Madsen: So basically a fast blow.

Interviewer: So a lot of pressure, a lot of pressure, really quick.

Dr. Madsen: Yeah, a lot of pressure, really quick.

Interviewer: A lot of velocity.

Dr. Madsen: Yeah, exactly.

Interviewer: Yeah, right on out.

Dr. Madsen: Bing. Right on out.

Interviewer: All right.

Dr. Madsen: Your mouth is over their mouth like you're giving mouth to mouth. Their nose obviously is open. You're blowing right into their mouth, just that force can sometimes do the trick.

Interviewer: All right. So go ahead and try that first, and then if that doesn't work, urgent care?

Dr. Madsen: You could try an urgent care. They very well may send you to the ER. I just don't know if they're going to have the equipment there to really search for this thing. And sometimes if this is buried really deep in the nose, it may require a specialist, an ear, nose and throat doctor to go searching up there for this.

Interviewer: Could it work up further while you're doing all these types of things?

Dr. Madsen: Technically, if you're blowing in their mouth, it shouldn't. It's really . . .

Interviewer: Like Utah to the urgent care, you have taken 45 minutes and then they say, "I better go to the ER," could it work up and become a worse problem?

Dr. Madsen: It possibly could if the . . . especially if the kids in discomfort, and they're kind of sucking up in their nose, and that kind of thing. They're crying and sniffling and sucking, I don't know. Trying to think . . . I guess potentially, it could.

Interviewer: Okay.

Dr. Madsen: Again, it's one of those things you can always start with the urgent care, but I won't be surprised if they then send you to the ER just because they don't have the tools there or because it needs a specialist to take a look at this.

Interviewer: So the answer is that it depends how brave you are.

Dr. Madsen: It depends how brave you are. You're going to avoid a visit altogether. Don't do it if you feel at all uncomfortable doing that, but if you want to give it a try, again, it's supported in medical textbooks. It's recommended to give it a shot. No harm in really trying it.

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Scot: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.
It's hard to believe you would think that parents would be aware of choking hazards, but choking is still the leading cause of unintentional injury and death in children, especially those three years and under, why is that still the case?
We're talking to Dr. Jeremy Meier; he's an EMT Specialist with University of Utah Health Care. Why are so many kids killed by choking still? I would think we would all know the dangers.

Dr. Jeremy Meier: We do, and there's actually been quite a few laws created over the years to try to prevent many of these episodes, and many of the choking hazards. However, kids are still smart, and they're very curious, and they're quick, and fast, and they'll get at things if we leave anything out and in their way, and the oral cavity, and oral stimulation is often where they first learn and so they're curious and want to put things in their mouth.

Scot: Yeah, and anything's fair game when you're a kid, right?

Dr. Jeremy Meier: That's right; especially those things that are shiny and they look enticing.

Scot: Yes, so what constitutes something as a choking hazard?

Dr. Jeremy Meier: Well, if it's small enough to fall into their airway. So usually that's a little over an inch in diameter, I often think of my pinky and if it's smaller than that, then it could easily fall into the airway.

Scot: All right, got you and I was surprised to see that 60% of choking was caused by food. So are there common culprits in the food world?

Dr. Jeremy Meier: Yes, nuts are a big risk factor so children under two should avoid all nuts, peanuts, popcorn kernels can be dangerous, beans, anything small like that that's solid that could easily just slip into the airway. Beans can also be somewhat serious as they, as we've seen where they'll swell inside the airway as they get...and so that can lead to further obstruction, and bigger problems.

Scot: Got you, any other food culprits? I was reading hot dogs, is that true?

Dr. Jeremy Meier: Yes, hot dogs is a big one, out at the picnics, and enjoying the summer afternoon, and those can be a problem as well.

Scot: What about household items? Are there any household items you see a lot?

Dr. Jeremy Meier: Yeah, well, we pull out a lot of coins.

Scot: They're again shiny, right?

Dr. Jeremy Meier: Yeah, and so that cost of a penny was left on the floor then becomes several thousand dollars to the parents.

Scot: Yeah, pretty quickly.

Dr. Jeremy Meier: Right, so coins. We see disk batteries, or button batteries, those can actually be life threatening. If they swallow those, they could stuck in the esophagus and will actually erode through the esophagus and then . . .

Scot: What?

Dr. Jeremy Meier: Yes, and that can happen over minutes to hours.

Scot: Wow so not just a choking hazard, but what else is going on? It's the acid?

Dr. Jeremy Meier: Well the acid, right the acid starts to leak out and it will erode through the esophagus, it's and then it can erode into the carotid arteries and cause major problems.

Scot: What are some other causes of choking that you see?

Dr. Jeremy Meier: Balloons can be a . . . we don't see it because unfortunately most of those kids don't make it to the hospital, if they're...if a young child is blowing on a balloon, or they're sucking on a latex balloon they can inhale that and it can cause sudden death. I've pulled out lots of toys, just random trinkets from kid's airways. I've even had a child that aspirated a safety pin, and it was lodged into the airway and that was a little tricky pulling out.

Scot: Did it open up?

Dr. Jeremy Meier: It was opened up, luckily the sharp point was pointing towards us, but the clasp was hooked into the airway.

Scot: Oh, my goodness.

Dr. Jeremy Meier: So it was a little tricky getting it out.

Scot: So other than keeping you knows things away from kids, are there other ways to prevent choking?

Dr. Jeremy Meier: No, I mean you can't watch your kid 24/7, but just do your best to prevent any loose items from being left around, realize where they are, what is in there sight of view, and just try to avoid any exposures. You know parents may know what is appropriate, but older brothers, or older sisters, may not and they may feel that their younger sibling can play with a toy that they're able to play with and they may leave something out that the younger sibling then goes and grabs.

Scot: Yeah so educate everybody it sounds like, in the house?

Dr. Jeremy Meier: Exactly.

Scot: What about toys? Are those age recommendations legit on toys?

Dr. Jeremy Meier: Yes, they are, and the United States has done a good job of creating guidelines and laws to reduce the risk as much as possible.

Scot: All right let's talk about what happens if you do find your kid choking on an item, what should you do?

Dr. Jeremy Meier: Yeah, I mean that's obviously one of the biggest fears of any parent. It's important to attend to the child first then try to get help as quickly as possible, whether there's someone else around that can call for help, or call 911.

Scot: If a kid's choking, should you just call 911?

Dr. Jeremy Meier: Yeah, that's what I would do.

Scot: Yeah, if it was your child?

Dr. Jeremy Meier: Right.

Scot: What else would you do if it was your child? You've called 911, how do you attend to child? What does that mean?

Dr. Jeremy Meier: The first thing is always the airway and breathing so if the child can, is still able to breath and move air, then you've got some time. If they're not moving any air then you can try the Heimlich maneuver, you can try a finger sweep, but there's unfortunately not a lot. You can try positioning the child upside down, and doing anything to try and dislodge that.

Scot: Is it just a good idea just to try to do anything and everything if they're not breathing because what kind of time do you have at that point?

Dr. Jeremy Meier: Exactly, you don't . . . by the time the EMS would get there you probably would be out of time so just do whatever you can.

Scot: So Heimlich, a finger sweep, and turn them upside down and shake them.

Dr. Jeremy Meier: Exactly, and pound on their back.

Scot: Whatever.

Dr. Jeremy Meier: Right.

Scot: All right, what's the most important thing to keep in mind when it comes to choking in your opinion?

Dr. Jeremy Meier: I would say prevention is the number one priority, keeping things away from your child that are a hazardous choking risk is the best medicine.

Scot: We're your daily dose of science, conversation, medicine. This is The Scope, The University of Utah Health Sciences Radio.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: If your one of those people in the wintertime that gets a dry throat, maybe it's inching all the time, irritated throat. We're going to talk about that and maybe come up with some things you can do to feel better. Doctor Marty Trott, ear, nose and throat specialist at St. John's Medical Center in Jackson Hole Wyoming. Let's talk about that itchy, sore throat.

Dr. Trott: Boy, an awfully common problem. I'd say one of the most common reasons are upper respiratory tract infections or viral illnesses and they're always moving through the school system. So if you have school aged children you're going to be exposed to them. The other reason, are just being outside. Being dry, we're in a very, one of the advantages of living in this part of the country is that we're high and dry. But that's one of the disadvantages as well.

Interviewer: So how does that affect my throat? What's going on?

Dr. Trott: Well, your throat has mucus covering, just like your nose does and the job of the nose in general is to make sure that the air that gets to your lungs is warm and humidified. And if you're exercising with your mouth open, which you need to do if your exercising, then you're going to get a little bit drier.

Interviewer: Okay. Is it a good idea to try to breathe with your mouth closed as much as possible if you live in this environment?

Dr. Trott: I suppose it's possible. If it's possible. It's hard to exercise, it's hard to move enough air through your nose alone with your mouth closed. If you tried even getting on a treadmill if you close your mouth, you won't be able to do it for very long without breathing through your mouth.

Interviewer: Okay.

Dr. Trott: So it's just one of the necessary evils.

Interviewer: Gotcha. What are some things that I can do to maybe find some relief then?

Dr. Trott: Humidification is key, particularly in the home and it's a trade off, because the more we humidify our homes the potentially more we can get allergens in the home. But I would tell people that if they're very dry every morning that it's a good idea at least in the bedroom to get a humidifier in the bedroom and run the humidifier all the time with the bedroom door closed. That would keep the relative humidity at least in that area up.

Interviewer: Okay. Any other thoughts on throat health in high, dry climates?

Dr. Trott: Well in general the other big issue that's coming to the fore, is potential for re-flux. So, heartburn or re flux symptoms that manifest themselves only with a sore or irritated throat. So I tell patients that they have a sore or irritated throat, if it's new it's something that hasn't been there before, it's going on for more than two and three weeks, you should see your family doctor, your provider about that.

Interviewer: So is it essentially three different causes of the sore throat or are there more than that? Illness, re flux, dry air.

Dr. Trott: I think that's a good characterization, we can always figure out more aciduric things, but I think those are the common.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah health sciences radio.