Effective diagnosis and treatment of head & neck disorders is a complex process that requires a diverse team of specialists. From patients suffering from Sleep Apnea, to those with Thyroid & Parathyroid issues, our trained specialists can offer insight and evaluate the patient on their health conditions.
Working with other surgeons, endocrinologists, pathologists, and radiologists, our physicians evaluate, diagnose, and treat your head and neck condition with efficiency, effectiveness, and comprehensive care.
Contact Penn Medicine Becker ENT & Allergy Center today to learn about the many services for symptoms pertaining to the head & neck.
Head & Neck Cancer
Head & Neck Cancer is defined as malignant tumor growth in the mouth, throat, larynx, nose, sinuses, salivary glands, or lymph nodes. Most of these tumors originate in the squamous cells lining the moist tissues of the head and neck.
Head and Neck Cancers
Head & neck cancer is identified based on the part of the body where they begin. There are five major types. Oral cavity cancer affects the lips, tongue, gums, cheeks, and palate. Larynx cancer involves the vocal cords and epiglottis. Pharynx cancer includes the esophagus and trachea. Nasal cavity and paranasal sinus cancer invades the hollow spaces around the nose. Salivary gland cancer affects the major glands in the mouth and jaw.
Other types of cancer involving the brain, eyes, esophagus, and thyroid are classified differently, and are not considered head and neck cancers.
Causes & Symptoms
Tobacco and alcohol use are the two leading risk factors for head and neck cancers. Studies show 85% of head and neck cancers are caused by tobacco use alone; that number rises for people who use both tobacco and alcohol.
Other risk factors include human papillomavirus (HPV) infections, radiation to the head and neck, sun exposure, industrial toxins, wood dust, asbestos, Espstein-Barr virus, poor oral hygiene, and consumption of certain preserved or salted foods during childhood. Those of Asian ancestry (particularly Chinese) are also at greater risk for some types of head and neck cancers.
Common symptoms include a lump or sore that doesn’t heal, a sore throat that does not respond to treatment, difficulty swallowing, and a change in the voice (such as hoarseness). Other signs might include unusual swelling of the jaw and chin, blocked sinuses, chronic sinus infections, facial pain and numbness, ear pain, headaches, difficulty breathing or speaking.
Treatment for head and neck cancers depends on the location and stage of the cancer, and may include surgery, radiation, chemotherapy, or a combination of the three. Side effects vary based on the treatment type. Follow-up care is crucial, as people who have had head and neck cancers have an increased risk of the cancer returning, or a second cancer developing. Regular medical checkups and dental exams are highly recommended. Patients who smoke or use chewing tobacco will be urged to quit.
Swallowing disorders, or dysphagia, are characterized by difficulty swallowing, and may be accompanied by pain, coughing or gagging, choking, drooling, regurgitation, heartburn, and weight loss. A number of conditions can cause swallowing difficulties, including nervous system and immune system disorders, esophageal spasm, scleroderma, gastroesophageal reflux disease, and other blockages of the throat or esophagus.
In addition to a physical exam, your doctor will order tests to determine what is causing your swallowing trouble. These may include barium X-rays, endoscopy, manometry, or a dynamic swallowing study.
Making a change to your dietary habits – eating smaller, more frequent meals; eating more slowly; trying foods with different textures; and avoiding alcohol and caffeine – are lifestyle remedies that may work. Other treatments include swallowing exercises, esophageal dilation, medications, and surgery. Severe cases may require liquid diets or intravenous feeding tubes.
Thyroid & Parathyroid Glands
The thyroid & parathyroid are glands in the neck that produce hormones responsible for regulating many body functions. Diseases of both glands are common, and usually revolve around too much or too little hormone production.
The thyroid is a butterfly-shaped endocrine gland that uses iodine to produce hormones that regulate metabolism. The most common thyroid condition is hyperthyroidism, an overabundance of thyroid hormones. Several disorders can cause hyperthyroidism, including Grave’s disease, toxic adenomas (nodules in the thyroid gland), goiter, subacute thyroiditis (inflammation of the thyroid), pituitary gland malfunctions, and cancer. Symptoms include weight loss, irregular rapid heartbeat, anxiety, irritability, sweating, tremors, and increased sensitivity to heat.
Another common condition is hypothyroidism, which occurs when too little thyroid hormone is produced. This results in low energy levels and sluggishness. Hypothyroidism can be the result of an autoimmune disorder known as Hashimoto’s disease, thyroid gland removal, excessive iodine consumption, and lithium. Symptoms include fatigue, weight gain, increased sensitivity to cold, constipation, dry skin, muscle and joint aches, and weakness.
As dangerous as both conditions can be, they are easily treated and managed.
There are a total of four parathyroid glands in the body; they are about the size of a grain of rice, and are responsible for regulating calcium levels in the body. Like the thyroid, the parathyroid glands can also produce too much or too little hormone. An overactive gland is usually the result of a parathyroid adenoma, a type of benign tumor, and causes hyperparathyroidism. Symptoms include osteoporosis (fragile bones), kidney stones, excessive urination, abdominal pain, bone and joint pain, tiredness, and weakness.
Conversely, hypoparathyroidism is the result of a lack of calcium, and can be caused by injuries to the parathyroid glands, endocrine disorders, or genetic conditions. Symptoms may include tingling in the extremities, muscle aches and spasms, fatigue, weakness, anxiety, depression, and headaches.
As with thyroid disorders, parathyroid conditions are also easy to treat.
Many factors can cause a person to have voice problems or difficulty swallowing. Fortunately, most of these conditions aren’t serious and can be treated easily. Regardless, if you are experiencing a swallowing or voice disorders, it’s best to have a laryngologist or other ENT specialist give you a full evaluation.
Common Voice Disorders
A voice disorder is any condition that affects the larynx, or voice box, and is marked by a change in pitch, volume, or quality of sound. Symptoms may include hoarseness; a raspy, scratchy, or weak voice; shortness of breath; and, in some cases, a total loss of voice. Causes vary, and range from infections and allergies to acid reflux, vocal cord nodules and polyps, and cancer. Finding the underlying cause is important.
To test for a voice disorder, your doctor will give you a physical examination, and check your vocal cords for irregularities. Diagnostic tests, such as acoustic analysis and laryngeal electromyography, may be ordered.
Treatment depends on the diagnosis. Home remedies – resting your vocal cords and drinking plenty of liquids, giving up smoking, etc. – are often enough to help ease your symptoms. Medications to treat inflammation or acid reflux are available, and surgical removal of vocal cord lesions may be required.
Head & Neck FAQ’s in NJ
Had and neck cancers are defined as those that begin in the throat, larynx, nose, mouth, sinuses, salivary glands, or lymph nodes of the neck.
The predominant risk factors for developing head and neck cancer are age and lifestyle factors, such as tobacco and alcohol use. Other risks vary depending on the type of cancer, but include sun exposure, human papillomavirus (HPV) infections, radiation to the head and neck, exposure to industrial toxins, wood dust, asbestos, poor oral hygiene, and consumption of certain preserved or salted foods during childhood. People of Asian ancestry (especially Chinese) have an increased risk for some types of head and neck cancers.
Symptoms vary depending on the location of the tumor, but often include a lump or sore that doesn’t heal, persistent sore throat, trouble swallowing, or a change in the voice. Additional symptoms might include white or red patches on the gums or tongue, bleeding in the mouth, chronic sinus infections that don’t respond to treatment, nosebleeds, headaches, swollen eyes, dental pain, numbness or paralysis in the face, ear pain, ringing in the ears, difficulty breathing, and trouble hearing. Since cancer symptoms can mimic those associated with so many other conditions, a full evaluation by a medical specialist is necessary for a proper diagnosis.
A variety of diagnostic tests will be used to check for head and neck cancer. In addition to a thorough physical exam, your doctor may perform an endoscopy, laboratory tests, biopsy, X-rays, CT scan, MRI, or PET scan.
Treatment depends upon the location and stage of the tumor, as well as the patient’s age and health. Surgery, radiation therapy, chemotherapy, targeted therapy, or a combination of treatments may be employed.
Surgery for head and neck cancers may cause swelling of the face and neck, and affect a patient’s ability to chew, swallow, or speak. Numbness and weakness may also occur. Radiation can cause redness, irritation, and mouth sores, and cause difficulty swallowing, changes in taste, and nausea. Chemotherapy causes a variety of symptoms, depending on the drug used; nausea, vomiting, hair loss, fatigue, lowered resistance to infection, loss of appetite, and cognitive dysfunction are all commonly experienced.
The thyroid gland is an endocrine organ. Endocrine organs produce hormones that help multiple processes in our body. The thyroid gland produces the hormone thyroxine that essentially controls the metabolic rate of our body and is essential in nearly all bodily functions. It produces this hormone in mass quantities and stores it for future use in a substance called colloid. The release of this hormone is promoted by hormones released by the pituitary gland in the brain, the “headquarters” of the endocrine system.
The thyroid gland is located in the neck. It has a butterfly shape with two lobes lying on either side of our trachea, or windpipe.
When thyroxine levels are too low in the body this is called hypothyroidism. Hypothyroidism is quite common, affecting up to 5% of the general population. The early symptoms of hypothyroidism are varied; common symptoms include cold intolerance, constipation, weight gain, menstrual irregularities, fatigue, itchy skin, brittle fingernails, depression, poor muscle tone, and joint pain. Hypothyroidsim and its possible causes can be identified on blood tests and is treated with thyroid replacement medications. Response to treatment is monitored by symptom control and serial blood tests.
Iodine deficiency is the most common cause of hypothyroidism worldwide, however supplementation of our table salt has limited this cause. In the US, the most common cause is an auto-immune condition called Hashimoto’s thyroiditis. There is no treatment for this condition, however the hormone abnormalities associated are treated as they develop. Some medications such as lithium, amiodarone, and thalidomide have been known to cause hypothyroidism. Exposure to radiation is another important source of hypothyroidisim.
When thyroxine levels are too high in the body this is called hyperthyroidism. Major clinical signs include weight loss (often accompanied by an increased appetite), anxiety, intolerance to heat, hair loss, muscle aches, weakness, fatigue, hyperactivity, irritability, and low blood sugar. Panic attacks, inability to concentrate, and memory problems may also occur. Some patients may experience cardiac arrhythmias; symptoms that are more present in elderly patients.
Ninety percent of hyperthyroidism in the US is caused by an auto-immune condition caused Graves’ disease.
The parathyroid glands are four small glands that lie adjacent to the thyroid gland. They secrete a hormone (parathormone) that controls calcium levels in our body. They occasionally harbor benign growths that cause elevated calcium. These can be surgically excised in a similar approach to thyroid surgery. During thyroid surgery, extra care is taken not to injure these four delicate structures.
The word nodule is not specific. It simply means a growth or mass within the gland. They can be a variety of sizes and can present as a single nodule or multiple nodules within the gland. In order to determine if the nodule is benign or malignant further investigations are necessary. It is important to know that a thyroid gland can have nodules and still have normal function.
The term “goiter” simply refers to the abnormal enlargement of the thyroid gland. It is important to know that the presence of a goiter does not necessarily mean that the thyroid gland is malfunctioning. A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). A goiter can be overall enlargement of the gland or a collection of multiple nodules. A large goiter can be clearly visible and cause compressive symptoms of shortness of breath and difficulty swallowing.
An ultrasound exam of the neck is the optimal method for evaluating the structure of the thyroid gland. The ultrasound can determine the location, number, and size of nodules. It also helps in determining the character of the nodules and looks at internal architecture and blood flow. This assessment helps characterize nodules as likely benign, suspicious, or concerning for underlying malignancy. The lymph nodes in the neck can also be examined for any enlargement indicating possible spread of cancer.
Although an ultrasound can provide information regarding the likelihood of malignancy, tissue is required for definitive diagnosis. For nodules greater than 1 cm and ultrasound guided fine needle aspiration (FNA) biopsy acquires cells from within the target nodule for pathological analysis. This FNA biopsy is an office based procedure that requires only local anesthesia. In the vast majority of cases, the FNA is sufficient for diagnosis of cancer. Occasionally, cellular features do not allow for definitive diagnosis. If FNA biopsy results are insufficient, show definitive cancer, or the patient has a visible neck mass causing symptoms of compression surgery is indicated.
Women are six times more likely to develop thyroid nodules and three times more likely to develop thyroid cancer. Although all the reasons are unclear, nodular growth has been shown to be estrogen sensitive. As a result, nodules developing after menopause or in men are more likely to harbor malignancy. Interestingly, a thyroid nodule in a child has a 50% likelihood of malignancy and surgery is often recommended.
Radiation exposure is a significant risk factor for thyroid cancer. Rates of thyroid cancer in children exposed to the Chernobyl nuclear disaster in the Ukraine and Eastern Europe are 10 times the general population. Surveillance for thyroid disease is already underway in Japan in the wake of the tsunami and resulting nuclear accident in 2011. Radiation related cancer is typically a more aggressive variant.
There are three common types of thyroid cancer. Papillary thyroid cancer represents 70% of all thyroid malignancies. It can present in multiple parts of the thyroid simultaneously, so complete surgical excision is recommended.
Follicular carcinoma represents another 25% of thyroid cancers and is treated in a similar fashion. It is more likely to have spread to the lymph nodes at the time of diagnosis, however still carries a good prognosis.
A much more aggressive variant, Medullary carcinoma is fortunately rare, comprising less than 5% of thyroid cancers. It is also treated surgically, however more extensive lymph node dissections are typically performed in addition to gland excision.
Anaplastic carcinoma, a very rare form, presents in the elderly and is uniformly fatal.
For the three most common types of thyroid cancer, total thyroidectomy is the primary treatment. If the cancer is entirely confined to the gland, this is often the only treatment necessary. For a tumor with concerning features, or extraglandular spread, the patient’s endocrinologist may treat with radioactive iodine to destroy any remaining or metastatic thyroid tissue. Overall, the cure rates for papillary and follicular carcinoma are well over 95% with only these methods.
If cancer has spread to local lymph nodes within the neck, it is essential that these are addressed surgically as well. Your surgeon may recommend a neck dissection in addition to thyroidectomy to address these malignant nodes. Interestingly, this local spread does not alter the prognosis of the disease very much and patients still do very well. In the rare cases where an FNA biopsy result is non-diagnostic, your surgeon may recommend a hemi-thyroidectomy. In this surgery, the lobe of the thyroid containing the concerning nodule is removed. While under anesthesia, pathology colleagues examine the nodule and will determine if a malignancy is present. If cancer is identified, your surgeon can then remove the opposite lobe. If the nodule is benign your surgeon may leave the other lobe intact. For most patients, only a half of the thyroid gland is necessary to maintain adequate thyroid function.
Thyroid surgery is performed under general anesthesia. Although minimally invasive options are being developed, an anterior neck incision is still commonly utilized. The surgery is typically 2 to 3 hours and due to the cosmetically sensitive area, closure is performed carefully. An attempt is made to “hide” the incision in existing neck folds and this area typically heals very well.
For a hemi-thyroidectomy, patient may go home the same day. For a total thyroidectomy, most surgeons will admit the patient overnight to monitor calcium levels.
As with most surgeries, there are common risks of bleeding, infection, and those associated with general anesthesia. Infection is very rare postoperatively in thyroid surgery.
Occasionally, the parathyroid glands are affected by the local manipulation of tissue. Following total thyroidectomy approximately 1/3 of patients will have a transient drop in calcium levels and will require supplementation. A dangerous or precipitous drop in calcium is rare, but can occur. As a result, calcium levels are often followed closely in the post-operative period with serial blood tests. Permanently low calcium levels are rare; less than 3%, but present a chronic and difficult problem to treat.
The thyroid gland overlies the recurrent laryngeal nerve, the nerve that controls our vocal folds. In the event this nerve is injured during surgery, vocal fold paralysis can occur. This can lead to a weak, hoarse voice, difficulty swallowing, and shortness of breath with exertion. About 10-20% of patients will have some transient weakness or change in their voice. Only 1% of patients have permanent dysfunction.
The recovery from thyroid surgery is typically quite quick. Normal daily activities can resume quickly with the exception of heavy lifting. Neck soreness and discomfort with swallowing are the most common complaints. Pain medicine, occasionally antibiotics, and supplemental calcium are often provided. If the entire gland has been removed, the patient begins thyroid replacement medication.
Lifelong thyroid replacement is necessary to maintain normal metabolic activity. This is typically done using a once a day dosed thyroid medication. Hormone replacement and the use of radioactive iodine for cancer are typically arranged by your endocrinologist. Typically, regular blood tests including a protein called thyroglobulin are ordered. This protein is made by thyroid tissue and a rising value may be an early sign of cancer recurrence. Imaging is then utilized to determine the site of recurrence.
For patients who underwent hemithyroidectomy, surveillance ultrasound for the alternate side is typically performed annually. Thyroglobulin is only followed in cases of total gland excision.