Patient: “I have a terribly sore throat. Doctor and I feel awful. My husband says it is tonsillitis, but since it is only a child’s complaint, how is it possible?”
Poor Mrs. Brown could hardly speak. She held her head stiffly, opened her mouth with difficulty, and stuck out her tongue. It was coated and her tonsils were red and enlarged, with whitish-yellow spots. Her temperature was well above 38 degrees, and there were swollen glands in her neck. “There is no doubt that you have, tonsillitis”, I said, “but let me give you a thorough examination.”
Doctor: Let me listen to your heart. Stop breathing. Now breathe through your mouth. Yes, I hear some slight murmur but it is nothing serious. Let me examine your chest. That’s good. No wheezing. Now take a deep breath for I am going to palpate your abdomen. Well, your liver and spleen are not palpable. Bend your knees. Any tender spot?
Patient: No, Doctor.
Doctor: Are your bowels all right?
Patient: Yes, Doctor. They have been all right since I remember.
What’s wrong with me, Doctor?
Doctor: Well, tonsillitis is not serious although complications such as local spread of infection to sinuses and ears can be troublesome.
Patient: What is the best treatment for tonsillitis, Doctor?
Doctor: Many cases respond quickly to penicillin and I will start with a course of it unless you are allergic to it. Some of the cases of tonsillitis are due fo a virus infection, and the rest are caused by bacteria. If the infection does not respond rapidly to penicillin, the likelihood of a virus infection is greater. Further antibiotics are useless against viruses. Therefore, general measures must be taken. Regular doses of soluble aspirin will help to relieve pain and reduce temperature. You may gargle. Use three glasses of water, each a little hotter than the preceding one. Half a teaspoon of common salt in the first two glasses and the same amount of bicarbonate of soda in the third glass helps to clear mucus from the throat. You should stay away from other people in order to avoid spreading the infection.
Patient: Should I have my tonsils out, Doctor?
Doctor: Now you need a day or two of warmth and rest in bed. We will wait to see how well you recover. After getting well I would like to have an electrocardiogram (E. C. G.), several X-rays and a laboratory test (blood count, urinalysis and smear sputum test, i. e. full scale check-up to prevent any complications. Don’t worry about tonsillectomy since it isn’t necessary at present. Well, I will drop in tomorrow afternoon to see how you are getting on. Patient: Thank you, Doctor. See you tomorrow.
It is estimated that about 2 per cent of all malignant tumors occurs in the larynx. Tobacco is said to be a predisposing cause, as well as certain types of chronic laryngitis. Men are affected a great deal more frequently than women in whom the disease is uncommon. In both sexes it occurs chiefly in middle and late life, except for sarcoma which arises in children or young adults.
Epithelioma. Squamous-cell carcinoma consistently tends to arise in certain areas. The tumours may thus be classified as supraglottis glottic and subglottic; and their natural history varies in each site.
Metastasis to other areas of the body is rare.
Clinical picture. Up to quite a late stage hoarseness is the only symptom, but except in glottic growths, it may appear only at this stage. Once developed it is not merely persistent but progressive. The voice is harsh as well as hoarse, and loses tone and resonance until reduced to a whisper. Pain, cough and especially dyspnoea all occur, but again are late symptoms. Pain may be localized to the larynx and also referred to the ear.