Acute dyshagia and odynophagia

1
ACUTE DYSPHAGIA

ODYNOPHAGIA By rushika
gaonkar(intern 10-11.)
2

• The following conditions present acute dysphagia
  as a symptom.
• Adhijivha
• Prabandhane adho jivhaya shopho jivhaagra
  sannibha
• Saankurah kaphapittaasrayhi laaloshaast ambhavan
  kharah
• Adhijivha sarukkandurvaakyahaar vidyat krut.
• Va.U.21/34,35

3

• On the dorsal surface of the tongue, a swelling
  of the shape of tongue develops due to kapha,
  pitta and rakta dushti. It contains ankur,
  excessive salivation, burning sensation, pain and
  kandu(itching) are also present. According to
  Acharya Kashyapa, aruchi, glani (fatigue),
  stambha and kapola shotha are also present. It is
  rough to touch. There is difficulty in
  deglutition and speech.
• Sadhyasadhyata It is asadhya in pakwa awstha.

4

• Chikitsa
• Unnamya jivhamaakrushtam badishena
  adhijivhikam.-Va.U.22/45
• Chedayen mandalagrena tikshnoshnergharshanadi
  cha.
• Tikshnashcha nasyadayah A.Sa.U.26/190
• Patient is asked to elevate the tongue or the
  vaidya elevates it with the help of badish
  yantra.Then with the help of mandalagra
  shastra,chedan of adhijivha is done. After chedan
  the vrana is rubbed with tikshna and ushna churna
  and tikshna nasya is given.

5

• Ranula
• It is a retention cyst in the floor of the mouth
  arising from the minor salivary glands. It may
  penetrate the mylohyoid muscle and present in the
  neck (Plunging ranula)
• Clinical features
• It presents as a bluish, translucent cyst in the
  floor of the mouth, resembling the frog belly.
• Treatment
• Ranula confined to the mouth should be excised.
• Plunging ranula should be marsupialised and the
  sublingual gland excised.

6

• 2. Tundikeri- (Acute Tonsillitis)
• Shophah sthulastodadahaprapaki praaguktabhyam
  tundikeri mata tu. Su.Ni.16/42
• Hanusandhyashritah kanthe kaarpaasiphala
  sannibha.
• Picchilo mandaruk shophah kathinastundikerika.
  Va.U.21/47
• The shotha occuring at talu region due to kapha
  and rakta is called tundikeri. Toda, daha, paka
  are the symptoms. It is as big as the seed of
  cotton. Acharya Vagbhata has called it kantha
  roga and stated its site to be the inner side of
  jaw. The shotha is hard, slimy to touch with
  slight pain and fever.

7

• 3. Adhrusha
• Shophah stabdho lohitastaludeshe raktaajneyah so
  adhrusho rugjwaraadhyah. Su.Ni.16/42 Chikitsa
  shastrakarma
• The reddish shotha occuring at taalu pradesh due
  to rakta is Adhrusha.It is stabdha, slow
  spreading and associated with pain and fever
• Acute Tonsillitis
• It is an infection of the tonsils occurring
  frequently up to 15yrs of age, but without any
  age bar. Both sexes are equally affected.

8

• Predisposing factors
• Endogenous
• Pre-existing upper respiratory tract infection
• Pre-existing chronic tonsillitis.
• Post nasal discharge due to sinusitis.
• Residual tonsillar tissue after tonsillectomy.
• General lowering of the resistance.
• Exanthemata
• Blood dyscrasias Very low resistance due to
  diseases like agranulocytosis, leukaemias, or
  hodgkins disease may cause gangrenous
  tonsillitis.

9

• Exogenous
• Ingestion of cold drinks or cold foods causes
  direct infection or lowers the resistance by
  vasoconstriction.
• Contagion The infection may be contacted from
  other individuals having infection .
• Pollution and crowded ill-ventillated
  environment.
• Imbedded foreign body.
• Causative organisms Respiratory gram positive
  cocci like streptococcus, pneumococcus and
  diphtheroid organisms. Haemolytic streptococcus
  has a special prediliction. It may be a viral
  infection

10

• Pathological types
• Acute Parenchymatous Tonsillitis The tonsils
  are enlarged congested.
• Acute Follicular Tonsillitis The crypts are
  studded with pus stand out as multiple yellow
  spots on the red congested tonsils.

11

• Symptoms
• Raw sensation in the throat.
• Pain in the throat, aggravated by swallowing, may
  be referred to ears.
• Refusal to eat children refuse to eat because of
  odynophagia.
• Voice is thick muffeled due to thick secretions
  impeded movements of the palate.
• Jugulodigastric nodes are enlarged painful.
• Malaise, fever, headache tachycardia may be
  present.
• Duration is usually 4 to 6 days.

12

• Signs
• Tonsils become congested swollen.
• Secretions increase become tenacious.
• Movements of palate become impeded due to pain.
• Halitosis may be present.
• Jugulodigastric nodes get enlarged tender.

13

• Treatment
• Bed rest soft diet are advised.
• Antibiotics Acute tonsillitis responds promptly
  to most antibiotics as well as sulphonamides.
  Mild infection may resolve without antibiotics.
• Analgesics are advised to reduce pain pyrexia.
• Warm saline gargles are soothing.
• Lozenges with local anaesthetic action may be
  comforting

14

• 4. Rohini
• Vataja Rohini-(Diphtheric Pharyngitis)
• Hanushrotrarukkari. Va.U.21/42
• Vatatmakopdravagaadhyukteti vatatmaka upadravah.
• Kampavinaamstambhaadayasteyratishayamanugata
  Madhukosha Ma.Ni.Pa 261
• On all 5 sides of tongue, painful mamskur
  develop. They cause obstruction of the throat
  dysphagia. There is talu shosha, there is pain in
  ear jaw. Kampa, vinam, stambha like upadrava of
  vata are present.

15

• Kaphaja Rohini
• Kaphen Picchila Panduh v.a.u.21/44
• Kaphaja rohini is guru, sthira does not form
  paka soon, picchila panduvarni. This causes
  srotorodha, thus leading to shwas kanthaavrodha
  change in voice.

16

• Vataja Rohini Chikitsa-
• Vatakim tu hrute rakte lavanayhi pratisaaryet.
• Sukhoshnan sneha gandushaan dhaaryechyaapya
  bhikshnashah. Su.Chi.22/60/61
• Atham antarbaahyatah swinnam vatarohinikam
  likhet.
• Angulishastrena aashupatuyuktanakhena va.
• Panchamulambu kavalah tailam gandushanavanam.
  Va.U.22/58,59
• Elapunarnavasinhikapittha kalka payovipakwam
  tailam gandusho navanam cha. A.sa.U.6.Pa.191

17

• Raktamokshan is done by siravedha.
• Swedan is done to antarbahya rohini then lekhan
  is done with angulishastra or with nails filled
  with lavan.
• Gandush is done with sukhoshna sneha.
• For that ela, punarnava, adulsa, kapittaha their
  kalka milk siddha taila is used. It can be used
  for nasya.
• Kadha of brihat panchamoola is used for kavala
  dharan.

18

• Kaphaja Rohini Chikitsa
• Agaardhumkatukayhi shleishmiki pratisaaryet
  shweta vidanga dantishu tailam siddham
  sasaindhavam.
• Nasyakarmani yoktavyam tatha kavaladharne.
  Su.Chi.22/62,63
• Katukayhi katuvargoktayhi Arunadatta
• Swedayitwa vilikhya pratisaaryet.-A.Sa.U.26.Pa
  192
• Swedan lekhan is done. Pratisaran is done with
  gruhadhuma churna of katuvarga medicines.
  Vacha, vidanga, danti siddha taila with saindhav
  is used for nasya kavala.

19

• Diphtheric Pharyngitis
• Aetiology
• Children between the age of 2 to 5 yrs. are
  usually affected.
• Corynebacterium diphtheriae is the cause.

20

• Clinical Features
• Symptoms
• Raw sensation in the throat.
• Pain in the throat occur which is often
  aggravated by swallowing. It may be referred to
  the ears.
• Refuse to eat Children refuse to eat because of
  odynophagia.
• Voice may be thick muffled due to thick
  secretions impeded movements of the palate.
• Jugulodigastric nodes may be enlarged painful.
• Constitutional symptoms like malaise, fever,
  headache tachycardia may be present.
• Duration of acute tonsillitis is usually 4 to 6
  days.

21

• Signs
• The tonsils become congested swollen.
• Secretions increase become tenacious.
• Movements of the palate become impeded due to
  pain.
• Halitosis may be present
• Jugulo digastric nodes get enlarged tender.

22

• Treatments
• Bed rest soft diet
• Isolation of patient
• Antitoxin is given immediately if diptheria is
  clinically suspected 20,000 units per patch are
  given parentarally
• Penicillin erythromycin control the infection.
• Immunisation of contacts should be performed.
• Tracheostomy is necessary in those cases who also
  have diphtheric laryngitis with respiratory
  obstruction.

23

• 5. Kantha shaaluka (Adenoids)
• Kolasthimatrah kaphasambhawo yo granthirgale
  kantakabhutah kharah sthirah shastranipaata
  sadhyastam kanthashaalukamiti bruvanti
  .-Su.Ni.16/51
• Antargale ghurghurikanvitam cha
  shaalukamucchwasanirodhakaari.. Ca.Chi.12/75
• Granthi developes in gala region of the size of
  borum seed. There is pricking pain in the
  throat. Its shape is like kamalkanda it grows
  slowly. Sparsha is khara. It is shastrasadhya.
  According to acharya Vagbhata there is kapha
  dosha adhikya that leads to margavrodh. The
  patient has difficulty in breathing, keeps the
  mouth open in sleep snores shwas, kasa are
  present.

24

• Adenoids
• When hypertrophied nasopharyngeal tonsil starts
  producing symptoms.
• Aetiology
• Adenoids occur usually between the age of 3 yrs.
  10 yrs. May be present earlier.
• The hypertophy of nasopharyngeal tonsil is often
  physiological, but is considered to be unhealthy
  if it produces symptoms.
• In many cases, infection supervenes
• Tuberculosis may be present.
• Predisposing Factors
• Similar to those for acute chronic tonsilitis

25

• Clinical Features
• Associated with obstruction
• 1) Nasal obstruction leads to mouth breathing
  snoring, drooling of saliva from the mouth
  difficulty in eating, particularly in infants.
• Adenoid facies may develop gradually nose becomes
  pinched narrow because of the lack of
  respiratory air flow there is a chronic nasal
  discharge.
• Mouth remains open, particularly at night. The
  teeth start protruding become irregular
  crowded, lower jaw becomes under-shot. High
  arched palate develops. There is drooling of
  saliva. The face becomes expressionless. All
  these features combine to give Adenoid Facies.
• Chest becomes flattened
• Voice becomes flat toneless (Rhinolatia clausa)

26

• 2) Eustachian Tube Obstruction It may occur
  which leads to middle ear diseases like
  Eustachian catarrh, serous otitismedia acute
  otitis media chronic otitis media. This results
  in deafness or otorrhoea.
• B) Associated with infection
• Nose Purulent discharge from nose due to
  rhinitis sinusitis may occur.
• Throat Recurrent upper respiratory tract
  infection is frequent. The patient may have post
  nasal discharge, pharyngitis tonsillitis cough.
• Ear Recurrent Eustachian catarrh, acute otitis
  media, chronic otitis media or serous otitis
  media may occur.
• Lymphadenitis upper deep cervical nodes the
  nodes in the upper part of the neck get infected.
• Bronchial Asthma bronchitis, if present may get
  aggravated.

27

• C) General
• Nocturnal enuresis night terrors may be present
  due to suffocation.
• Mental Backwardness is not real but the child may
  become backward in studies because of deafness.
• Diagnosis
• Clinical features clinch the diagnosis in most of
  the cases.
• Posterior Rhinoscopy may reveal adenoids in a
  co-operative child.
• Digital palpation of the nasopharynx may detect
  adenoids, but is an unpleasnt procedure hence
  avoided.
• Radiological examination of the lateral view of
  the nasopharynx for soft tissue shadow may reveal
  adenoids.
• Examination under general anaesthesia at the time
  of tonsillectomy can be easily carried out
  adenoidectomy may be performed, if necessary.

28

• Treatment
• Conservative
• In mild cases, conservative treatment may take
  care of adenoids. This is complemented by natural
  involution.
• Antibiotics are useful for acute inflammation.
• Decongestants may be useful in re-establishing
  breathing.
• General improvement in health hygiene may help.
• Exercises Breathing exercises should be
  advised.
• Surgical
• Adenoidectomy is advised to patients having
  persistent or recurrent problems.
• Antral lavage may be required for concurrent
  sinusitis.
• Grommet may have to be inserted in the ear drum
  of a patient having secretory otitis media.

29

• 6. Valayah-(Malignant Tumours)
• Balaas evaayatamunnatam cha shopham
  karotyannagatim nirvaaya.
• Tam sarvathaivaaprativaar viryam vivarjaniyam
  valayam vadanti. Su.Ni.16/53
• Annagati nivaaryeti annasya gatiryena srotasaa
  so annagatihi annavahasrotaha. Nya cha

30

• Annavaha srotas gets obstructed due to kapha. It
  is due to the Shotha at that region. The Shotha
  is unnat ayat. Initially there is feeling of
  obstruction while deglutition later solid food
  cannot be taken. Only liquid diet is taken. If
  there is further srotorodha then no aahar can be
  taken. As aahar is slowly reduced, dhatuposhan is
  affected patient becomes thin weak.
• Sadhyasadhyata Asadhya

31

• 7. Vrunda
• Samunnatam vruntammandadaham tivrajwaram
  vrundamudaaharanti.
• Tam chaapi pittakshataja prakopadavidyaat
  satodam pawanaasrajam tu. Su.Ni.16/56
• Galaparsghavagah Va.U. 21/46
• Vrunda chikitsa Treatment is similar to
  kaphaja rohini
• On the right left side of gala an elevated
  round swelling occurs that is called vrunda.
  There is tivra daha tivra jwara. It is caused
  due to pitta rakta dushti. When vayu rakta
  are responsible, shoola is present

32

• Malignant Tumours of the oral cavity .Malignant
  tumours can arise from
• Lips
• Cheeks
• Oral Tongue
• Floor of the mouth
• Hard palate
• Retromolar trigone
• Gingiva
• Mandible
• Squamous cell carcinoma is the commenest
  malignancy of the oral cavity. Adenocarcinoma may
  arise from salivary glands on the palate fauces.

33

• Prediposing Factors
• Alcohol abuse
• Smoking
• Tobacco paan chewing
• Poor oral hygiene
• Sharp teeth ill fitting dental appliances

34

• Clinical Features
• Ulcerated mass with raised margins surrounding
  induration is the most common presentation.
• Pain can be severe referred to the ear.
• Trismus may occur with lesions in trigones
  region.
• Dysphagia may be present in posterior lesions.
• Metastases lymph nodes draining the affected area
  may be involved. Distant metastases can occur in
  late stage.

35

• TNM Classification
• Tumour
• T1 upto 2 cm diameter
• T2 2 to 4 cm diameter
• T3 More than 4 cm diameter
• T4 Spread to surrounding structure
• Nodes
• No No nodes

36

• N1 Single ipsilateral lymph node upto 3 diameter
• N2 Single ipsilateral lymph node from 3 to 6
  cm diameter
• N2a Multiple ipsilateral lymph nodes upto 6 cm
  size
• N2b Bilateral or contralateral nodes upto 6 cm
  diameter
• N3 Nodes larger than 6cm diameter
• Metastases
• Mo Nil
• Ms Present
• Mx Cannot be asessed
• Staging is similar to that of carcinoma of a
  larynx

37

• Treatment The choice of treatment is
  determined by the location the stage of the
  primary tumour.
• Surgery For stage 1 stage 2 oral cancer,
  surgical treatment consists of excision of the
  tumour with adequate margin repair of the
  defect by primary closure or by flap. Clinically
  positive nodes are treated by radical neck
  dissection.
• Radiation Can be by brachy therapy, external
  beam therapy or both. Early cases yield similar
  results with either surgery or radiation.
  Extensive oral cancer requires a combined
  approach with surgery followed by radiotherapy.
  Chemotherapy may be required in combination with
  surgical treatment radio therapy.

38

• Acute Retropharyngeal Abscess
• It is a very painful condition resulting from
  infection of the retropharyngeal lymph nodes. It
  usually occur only in children, because the nodes
  gradually atrophy, as one grows up.
• Aetiology
• It occurs in children usually under the age of 1
  yr.
• It is more common in boys.
• Nasopharyngeal or oropharyngeal infection may
  cause infection of the nodes
• Debility or exanthemata may predispose to
  inflammation of retropharyngeal nodes.
• Trauma to pharyngeal wall by a sharp foreign body
  may cause it.
• Mastoid abscess may rarely track along the
  Eustachian tube to the retropharyngeal space.
• Causative organisms are usually streptococcus
  staphylococcus.

39

• Clinical Features
• Dyspnoea may be caused by pressure on the larynx.
• Dysphagia child finds it difficult to swallow.
• Croupy cough is often present.
• Voice cry of the child becomes like quacking of
  a duck.
• Blocking of the Nose due to the spread of
  oedema to nasopharynx may occur.
• Child develops fever becomes restless.
• Oral cavity There is unilateral swelling in the
  posterior pharyngeal wall which shows signs of
  acute inflammation once the abscess forms, it
  present as a soft, fluctuating swelling , which
  extends upwards towards the nasophynx downwards
  into the cricopharynx, but does not cross the
  midline to the median raphe.

40

• 8. Neck is held stiff. There may be torticollis.
• Acute lymphadenitis. The jugulodigastric lymph
  nodes or the lymph nodes in the upper part of the
  posterior triangle may be inflammed.
• Radiology
• Lateral view of the neck may show the soft
  tissue swelling in the retropharyngeal space.
  There may be fluid level in the swelling.

41

• Treatment
• Antibiotics are administered to control the
  infection.
• Analgesics anti-inflammatory drugs are give.
• Steroids may be advised if laryngeal oedema is
  impending.
• Nutrition Proper fluid intake should be
  maintained.
• Incision drainage of the abscess should be
  performed transorally.
• Tracheostomy may be required if laryngeal oedema
  develops.

42

• Kantha shaaluka Chikitsa
• Visraavya kantha shaalukam saadhayettundikerivat.
  
• Ekkalam yavannam cha bhunjit snigdham alpashaha.
  Su.Chi.22/64,66
• Raktamokshan is done. Shastrakarma is done. One
  time yavanna is eaten.
• Vrunda Chikitsa
• Treatment is similar to kaphaja rohini
• Foreign Bodies
• Sharp small foreign bodies like fish bones may
  pierce the tonsils. Larger shaap irregular
  foreign bodies may get stuck in the valleculae or
  pyriform fossae. They cause pain pricking
  sensation smooth foreign bodies may be held up
  above the cricopharynx produce dysphagia.

43

• Treatment
• Tonsillar foreign body is removed by a nasal
  dressing forceps. For a foreign body embedded in
  the tonsil, tonsillectomy may be required.
• Laryngopharyngeal foreign bodies are removed by
  direct laryngoscopy or by mackenzie forceps.
  Laryngoscopic control often the foreign body
  passes down to the stomach. If the sensation
  persists for more than 48 hrs. endoscopy is
  indicated.
• Carcinoma of the vocal cords (Glottic)

44

• Aetiology
• It is usually seen after the age of 45 yrs.
  Sarcoma may occur at an early age.
• It is very common in males
• Premalignant conditions
• Single papilloma may become malignant.
• Leucoplakia is a premalignant condition.
• Precipatating factors
• Smokers have a higher incidence of laryngeal
  malignancy
• Chronic irritation
• Atmospheric pollution

45

• Symptoms
• Hoarseness
• Cough of dry nature
• Raw sensation in the throat
• Blood stained sputum may be coughed up
• Stridor is present in advanced cases
• Lymph node metastasis is a late symptom
• Widening of the larynx may occur
• Dysphagia is a late symptom.

46

• Signs
• Site Usually the growth arises from the
  anterior half of the vocal cord from its edge or
  upper surface.
• Morphology It is usually a cauliflower like
  growth, but it may be ulcerative leucoplakia may
  undergo malignant change.
• Movements As the growth progresses, movements
  of the vocal cords may be affected due to
  fixation of the cords.

47

• Spread
• Continuity
• Forwards to the anterior commissure to the
  anterior portion of the opposite vocal cord.
• Backwards to the arytenoid cartilage inter
  arytenoid region.
• Upwards towards the ventricle
• Downwards to the subglottic region
• Laterally to the cartilage, making the vocal cord
  fixed.
• Lymphatic The vocal cords have a poor lymphatic
  drainage hence the spread to lymph node is a
  late phenomenon.
• Blood stream Spread by blood stream may occur
  rarely as a late feature.

48

• Investigation
• Biopsy performed by direct laryngoscopy micro
  laryngoscopy. Endoscopy helps to estimate extent
  of growth.
• Routine Investigations like blood, urine, blood
  sugar electrocardiogram required for
  determining general fitness for surgery
• VDRL test
• Radiograph of the Chest
• Soft tissue radiographs
• CT scan

49

• Treatment
• The treatment depends upon
• Stage of the growth
• Histopathology
• General fitness of patient
• Facilities available
• Occupation
• Stage of growth
• Stage I Stage II Irradiation or surgery by
  laryngo fissure technique. Radiotherapy is
  preferred as the function of larynx is
  unaffected. Partial laryngectomy to preserve
  laryngeal function.

50

• State III Stage IV (with fixation of cords
  or cartilage involvement) treated by total
  laryngectomy. If lymph nodes are involved, block
  dissection of neck.
• Laser Surgery
• Advanced Cases Palliative treatment is advised.
• Analgesics
• Antiobiotics
• Tracheostomy for stridor
• Ryle tube feeding or gastrostomy for dysphagia
• Chemotherapy
• Irradiation

51

• Chemotherapy In malignancy it may help as a
  palliative measure to a certain extent. It is
  also given to reduce the extent of growth.
• Radiotheraphy
• It is useful under the following circumstances
• For early growths with the advantage of
  presenting voice.
• In combination with surgery
• Palliative measure for advanced cases
• Anaplastic growths

52

• 8. Gilayu
• Granthirgale twamalakaasthimaatrah shiroalparuk
  syaata kapharakta murtihi sanlakshyate
  saktamivaashanam cha sa shastrasaadhyastu gilayu
  saujnayah.- su.Ni.16/58
• At jivha mula, in the gala region granthi of the
  size of amla seed develops. It is the vriddhi
  dushti of the mamsa granthi on either side of
  tongue. They grow slowly there is mild pain.
  When there is increase in their size, there is
  difficulty while breathing eating. There is a
  feeling of food getting obstructed in throat.

53

• Gilayu Chikitsa
• Gilayushchaaapi yo vyaadhistam cha shastren
  saadhayet .-Su.Chi.22/66
• Shastrakarma is the treatment. Gilayu chedan is
  done stoppage of raktasrava is confirmed. When
  raktasrava stops, pratisaran is done with honey.
  Gandush is done with kwath of kashaya rasa
  dravya. Complete removal of gilayu is confirmed.
  Shastrakarma is done only when condition is
  worsened medicines are ineffective
  Arogyavardhini chyavanprash can be given for 1
  month. In case of shotha, treatment is similar to
  galagraha in fever, suvarna malini vasant
  amrutarishta are effective.

54

• Supragloltic Laryngopharyngeal Malignancy
• Symptoms
• Symptoms appear late as compared to the
  carcinoma of the vocal cords.
• Dysphagia
• Pain in the throat. May radiate to ear
• Foreign body sensation in the throat or a lump in
  the throat may be felt.
• Change of voice As the vocal cords get involved,
  horseness develops.
• Blood stained sputum cough.
• Hard cervical lymph node swelling
• Stridor inspiratory dyspnoea in advanced cases.

55

• Signs
• Cauliflower like growth or an ulcer seen on
  indirect laryngoscopy
• Pooling of saliva is present due to irritation
  dysphagia.
• Hard metastatic lymph nodes.
• Diagnosis
• Diagnosis is made by clinical examination
  Histopathological examination is essential.
• Investigations
• Similar to those for glottic carcinoma

56

• Treatment
• Stage I II Radiotherapy or surgery.
  Conservative laryngectomy may be done for
  selected cases.
• Stage III IV laryngopharygectomy with neck
  dissection. Combination of irradiation,
  chemotherapy surgery improve the prognosis to
  some extent.
• Palliative treatment Similar to that for
  glottic carcinoma.

57

• 9. Galougha-(Acute Retropharyngeal Abscess)
• Shopho mahannajalawrodhe tivra jwaro vata gale
  nirhanta.
• Kaphena jate rudhiraan vitena gale galougha
  parikirtyate a sou. Su.Ni.12
• It is a shotha occurring in gala region due to
  kapha rakta prakop. There is tivra jwara. There
  is obstruction in food, liquid intake air
  intake.
• Sadhyasadhyata It is asadhya

58

• Neurological Disorders
• Clinical Features
• The disorders may be sensory or motor
• Sensory
• Anaesthesia may be unilateral or bilateral.
• Hyperaesthesia may be normal or abnormal.
• Paraesthesia is often functional
• Neuralgia Glossopharyngeal neuralgia may be due
  to an elongated styloid process.

59

• Motor
• Palatal There may be unilateral or bilateral
  paralysis with nasal twang nasal regurgitation
• Pharyngeal The gag reflex is absent there is
  dysphagia. On swallowing the food may enter into
  the tracheobranchial treee producing coughing,
  spasms, cyanosis inhalation pneumonia.
• Associated neurological lesions may be present.

60

• Treatment
• Cause should be treated.
• General
• Ryle tube feeding is required for pharyngeal
  palsy.
• Tracheostomy may be required for
  trancheobronchial toilet, if there is recurrent
  inhalation of liquids food into the
  trancheobronchial tree.
• Gastrostomy is rarely required.

61
ACUTE PHARYNGITIS
62
ACUTE TONSILLITIS 1
63
ACUTE TONSILLITIS 2