Dear XXXXXX,

Hello, I am Dr Ravinder Sharma ENT surgeon. Based on the information provided it seems you have a collection of secretions (in your sinuses) or swelling of the sinus lining leading to infection. As the result of this, the secretions are moving towards posterior choana and nasopharynx causing infection in the pharynx. It appears this is a chronic infection.

Possibly, you have undergone a diagnostic nasal endoscopy and you were told about some swelling in the nasal mucosa and middle meatus.

As far as the term granuloma is concerned - it refers to the disease process (pathology) in a variety chronic diseases - may be infective or autoimmune. They are rare in nose and sinuses. Symptoms include nasal discharge, nasal blockade, nasal bleeding and inability to smell.

I would further advise you to plan for a CT scan of sinuses and nose. This will help in making a diagnosis. Once I see the CT scan, I will be able to comment more on it.

Based on information provided, it would keep a conclusion of chronic sinusitis with postnasal drip or polyps in nose.

For treatment part, an antiallergic and steam inhalation will help you but this is just for the time being until you get your CT scan done.

I hope his answers your concern. Feel free to contact me if you have more concerns about it.

With warm regards

Ravinder Sharma

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Dear XXXXXX
Thanks for your feedback. Now you are more clear. The doctor had done a laryngoscopy (examination of voice box with a endoscope). This is done with a telescope(endoscope) passed through nose or oral cavity. He is talking about formation of nodules on vocal cords. when they XXXXXXX in midline than it produces voice. Excessive or misuse of voice (commonly seen in teachers, preachers, hawkers) lead to thickening or nodule formation on vocal cords at the junction of anterior one third and posterior two third of vocal cords. When they XXXXXXX in midline they rub on each other and may produce harsh voice. Voice rest gives improvement in symptoms. Reflux and post nasal drip (as i described earlier) can also exacerbate hoarseness of voice. So it is advisable to take treatment of both these problems.

The term used to describe this condition is VOCAL NODULE. This is not a GRANULOMA. They responds well to voice rest and speech therapy. Rarely it may require microlaryngeal surgery

In your case Voice rest, steam inhalation and antiallergic medication will be of help. If it is not improving after a week to ten days consider speech therapy. Most of the times it works.

Do let me know if you have any more concerns

with warm regards
Ravinder Sharma

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Dear XXXXXXX
Thanks for your query.
Vocal nodule causes hoarseness of voice. Mild discomfort in throat while talking can be seen in some cases.
However discomfort in swallowing in not because of vocal nodule. It is more commonly associated with pharyngitis -- may be allergic or infective. Post nasal drip because of nose or sinus pathology or reflux may also cause soreness in throat while swallowing.

I hope this answers your concern. Feel free to contact me if you need more information about it

Ravinder Sharma

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Dear XXXXXX,

Thanks for sending a follow up query

Excessive talking causing throat discomfort can be because of excessive use of vocal cords in relation to the vocal nodule (voice box) or allergy or infection in pharynx

As you say that it is from right side and lozenges helps in reducing pain it appears that you also have a swelling in throat (Pharyngitis) or tonsils (Tonsillitis). Other causes of off and on pain include styalgia - where the elongated styloid process present lateral to tonsil in neck can cause pain which increases on swallowing.

Examination of throat and larynx is the key to diagnosis. Discuss with your ENT surgeon whether or not you also have these associated conditions. If yes, we need to treat them independently.

I hope this answers your concern. Do let me know if you need further information on this.

With regards,
Dr. Ravinder Sharma

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