The outreach will be based in Centre Hospitalier D’Aneho (The Aneho Hospital) and the Slyvanus Olympio teaching hospital in Lome. The team from the UK have liaised with a local organising committee in Lome to perform surgical procedures on patients free of charge during the week. The team will also provide relevant surgical/nursing training.

Being able to feel a lump in the throat is a common symptom that patients discuss with ear, nose and throat specialists. In this article, Mr Wale Olarinde discusses the problem of lumps that cannot be physically felt with the fingers rather than the neck lump, which can be felt with the fingers.

Symptoms of feeling a lump in the throat

People usually complain of a wide variety of symptoms such as:

• a hair or tickly feeling or lump in the throat
• sensation of something stuck in the throat
• phlegm or mucus in the throat
• repeated throat clearing
• feeling of wanting to pull something out of the throat
• feeling of tightness or constriction in the throat.

The feeling of a lump in the throat can itself be due to many things. The common causes of this symptom will include laryngopharyngeal reflux (LPR) of acid in to the throat, Globus pharyngeus, or rarely throat cancer.

Reflux and the sensation of a lump in the throat

Often people do not have the typical symptoms of acid reflux, such as heartburn, and so it comes as a surprise when they are told they have a type of reflux known as silent reflux, where acid is literally sprayed in to the throat from the stomach. This can be caused by a variety of factors including: smoking, excess alcohol, obesity, late meals, spicy or fatty foods and fizzy drinks.

Globus Pharyngeus and feeling a lump in the throat

Another common cause of feeling something stuck in the throat is a globus feeling, sometimes referred to medically as globus pharyngeus. This is a sensation of something in the throat when nothing can be found to explain the feeling. It is common in middle life and several suggestions have been proposed, although none are completely plausible. There is no known proven cause for it and it is known to sometimes disappear on its own. Usually it is not a constant sensation. It is a diagnosis of exclusion. This means that your specialist will be reasonably convinced there is nothing else causing your symptoms before deciding it is a globus feeling.

Cancer of the throat and the sensation of a lump in the throat

Cancer of the throat is also a possible cause for feeling something in the throat. In this case, the sensation is more likely to be persistent and may be associated with other symptoms such as a constant sore throat, unexplained earache, difficulty swallowing, voice change or a neck lump that can be felt with the fingers. Throat cancers are commoner in smokers and people who drink a lot of alcohol, although there is now a well recognised association between throat cancers and the human papilloma virus. Throat cancers are, fortunately, less common than cancer of the breast, bowel, lung, prostate or even lymphomas.

Diagnosing the feeling of a lump in the throat

Your specialist will want to ask a few more questions about your swallowing, voice and any other symptoms that could be from a problem in your throat. You may also be given a questionnaire to fill out to provide more clarification about your symptoms.

An examination of the neck, mouth and throat will then be carried out. The examination will almost certainly include a camera examination of your throat and voice box. Sometimes the upper part of the gullet can be visualised by this means. The camera examination involves a flexible telescope (usually about the width of a mobile phone charger cable) going through your nose. The examination usually lasts about two minutes. You may be offered a local anaesthetic spray for your nose before the procedure but most of the sprays on the market have a bad taste that many people do not like.

Your specialist may decide you need further investigations although this is usually decided on a case by case basis in people with a feeling of a lump in the throat.

There are a number of reasons why a tonsillectomy is performed. In this article, Mr Wale Olarinde outlines the different conditions that may require a patient’s tonsils being removed.

What is a tonsillectomy?

A tonsillectomy is an operation where the tonsils (usually both) are removed. The tonsils are lymph glands that can be seen by looking at the sides of the throat right at the back. There are several other groups of lymph glands in the mouth, on the tongue and in the throat, so removing the tonsils does not affect your immunity in any way.

The reasons tonsils are removed

Tonsils are usually removed for many reasons although the most common reasons to remove them include recurrent tonsillitis, very large tonsils causing obstructive sleep apnoea (OSA) , and cancer (or suspicion of cancer) of the tonsil.

Recurrent tonsillitis

Recurrent tonsillitis is by far the most common reason to have a tonsillectomy. Recurrent tonsillitis is having five separate attacks of tonsillitis per year for two years in a row. Less stringent criteria may sometimes be used to define recurrent tonsillitis in adults.

Tonsillitis is usually a viral infection lasting for about five to seven days where the affected person finds it very painful to swallow, may feel feverish and quite ill, has a sore throat and may not be able to carry out their usual activity e.g. school, work or whatever their usual activity is. Recurrent tonsillitis ‘burns out’ in many people but can be very disruptive for the sufferer. Children are more commonly affected by recurrent tonsillitis because they get frequent infections of the upper respiratory tract. The tonsils are part of the respiratory tract.

Obstructive sleep apnoea and tonsillectomy

Obstructive sleep apnoea can be caused by enlarged tonsils (and sometimes adenoids too), blocking the airway when the affected person is asleep. This condition can usually be diagnosed by an ENT surgeon although investigations may be required to confirm it. A tonsillectomy (usually with removal of the adenoids in this case) usually resolves obstructive sleep apnoea, particularly in children.

Cancer of the tonsils

Cancer of the tonsil is not common although its incidence has over the past ten years been increasing. Removing the tonsil is usually done to diagnose or confirm a suspicion of cancer. Further investigations (scans) and treatment are usually required.

Tonsillectomy treatment

Most patients having a tonsillectomy will be discharged on the same day the operation. The operation is done through the mouth and usually takes about 30 minutes. There is usually pain after the operation and this gets worse between days four and five after the operation. Patients are prescribed two or three different types of pain killers to get through this painful period. It takes about two weeks to return to usual activity after surgery.

Risks associated with tonsillectomy

The main risk of a tonsillectomy is bleeding, which could happen anytime in the first ten days after the operation. The risk of a bleed is about three to five per cent. Most bleeds will cease with bed rest and mouth gargles, although most people with a bleed need to be admitted back to hospital for a 24 hour observation period. Less than a quarter of patients who bleed need to have another operation to stop the bleeding.