An INFECTION in the mastoid BONE behind the EAR. Mastoiditis typically develops as a consequence of untreated or chronic OTITIS media (middle ear infection) when BACTERIA migrate from the middle ear to the adjacent mastoid bone. The rather porous structure of the mastoid bone, which is more a collection of small cavities than a solid structure, provides an ideal habitat for bacteria. Untreated mastoiditis can spread to the nasal SINUSES as well as the MENINGES (membranes surrounding the BRAIN and SPINAL CORD), causing bacterial MENINGITIS, and to the brain itself, causing ENCEPHALITIS. These infections are potentially fatal and require immediate medical treatment. Though mastoiditis was once a common cause of childhood death, it has become rare since the advent of ANTIBIOTIC MEDICATIONS.

PAIN behind the ear, FEVER, and a recent episode of otitis media are the leading indications of acute mastoiditis. The person may also have swelling and tenderness in the mastoid area, and the auricle (external ear) may appear to stick out from the side of the head. Chronic mastoiditis may be subclinical; that is, the infection causes few overt symptoms until it spreads beyond the mastoid or destroys mastoid bone tissue. Diagnosis includes blood tests and cultures of any fluid in the ear to look for signs of infection, and occasionally COMPUTED TOMOGRAPHY (CT) SCAN. In most cases of acute mastoiditis, antibiotic medications and occasionally MYRINGOTOMY (insertion of a small tube through the TYMPANIC MEMBRANE to allow fluid to drain from the middle ear) successfully eradicate the infection. Chronic mastoiditis sometimes requires surgery to open, drain, and occasionally remove portions of the mastoid structure. Severe mastoiditis may require mastoidectomy, in which the surgeon removes the entire mastoid bone. Most people recover fully following treatment, though should have an AUDIOLOGIC ASSESSMENT to determine whether there is residual HEARING LOSS.

Precancerous patches, or lesions, inside the MOUTH. The patches are light-colored and most commonly form on the tongue and insides of the cheeks. Irritation to these tissues over time, such as from all forms of tobacco use and poorly fitting dentures or dental bridges, causes leukoplakia to develop. In a type of leukoplakia specific to people with HIV or AIDS, hairy leukoplakia, the patches look like white fuzz. Hairy leukoplakia often is one of the earliest signs of HIV INFECTION. Leukoplakia may also affect the VULVA in women. Biopsy to examine the cells of the patches confirms the diagnosis. In some people, removing the source of the irritation causes the leukoplakia to go away. Often doctors prefer to remove the lesions surgically, which generally is an office procedure with local ANESTHESIA. When the irritation continues, or in the presence of HIV/AIDS, leukoplakia may return.

An air-filled bulge (herniation) that develops within the tissues of the larynx (voice box), often among the folds of the VOCAL CORDS. Laryngocele may be present at birth as a CONGENITAL ANOMALY or develop later in life, often as a consequence of persistent pressure against the structures of the THROAT. A congenital laryngocele may not cause symptoms until environmental stressors that create increased laryngeal pressure cause it to enlarge. Musicians who play wind instruments are particularly vulnerable to laryngoceles, as are people with OBSTRUCTIVE SLEEP APNEA. Occasionally a laryngeal tumor causes a laryngocele.

Hoarseness, a feeling that there is something caught in the throat, dry COUGH, and a soft lump visible on the external throat are among the most common symptoms. A large laryngocele can cause stridor (a high-pitched noise with inhalation) and difficulty swallowing. The diagnostic path typically includes COMPUTED TOMOGRAPHY (CT) SCAN or MAGNETIC RESONANCE IMAGING (MRI) of the throat and laryngoscopy (examining the inside of the throat through a lighted, flexible scope). Because a laryngocele presents a prime opportunity to trap BACTERIA that cause INFECTION as well as the potential to interfere with BREATHING and swallowing, the treatment of choice is an OPERATION through an incision in the neck to close or remove the laryngocele.

Irritation or INFLAMMATION of the larynx (voice box) that results in hoarseness or loss of voice. Most laryngitis is viral, though may accompany or follow a bacterial INFECTION such as STREP THROAT. Laryngitis is also common in people who strain their voices through loud singing, yelling, and extended talking, and in people who smoke or who work or live in environments that are smoky. Resting the voice by speaking softly (though not whispering as it further stresses the tissues of the larynx) and sucking on hard candy or COUGH drops help soothe the irritated tissues. A cool-mist humidifier, especially when sleeping, helps reduce irritation. Most laryngitis goes away within 10 to 14 days and does not need medical treatment. Bacterial laryngitis requires treatment with an appropriate ANTIBIOTIC MEDICATIONS.

A doctor should evaluate laryngitis when:

• hoarseness/discomfort last longer than 14 days
• an accompanying cough produces yellow or green sputum
• FEVER is greater than 101ºF

Frequent or extended laryngitis might indicate the presence of VOCAL CORD NODULE, VOCAL CORD POLYP, or laryngeal CANCER.

Surgical removal of the larynx, which includes the VOCAL CORDS and other structures that produce sound for the function of speech. Surgeons perform the majority of laryngectomies to treat CANCER due to cigarette smoking. Laryngectomy results in the loss of the ability to speak.

In laryngectomy, the surgeon makes an incision in the neck and removes the structures of the larynx, typically including the vocal cords and upper portion of the TRACHEA as well as surrounding MUSCLE tissue to obtain a cancer-free margin. The ESOPHAGUS, which carries food from the MOUTH to the STOMACH, remains intact. In the OPERATION’s final stage the surgeon creates a permanent opening through the neck into the trachea, called a stoma, for BREATHING.

The operation takes five to eight hours for the surgeon to perform, and most people stay in the hospital for 10 to 14 days following the surgery. Rehabilitation begins immediately and includes instruction to care for the stoma as well as swallowing exercises. Many people also start to learn ESOPHAGEAL SPEECH, though speech therapy is most extensive during outpatient rehabilitation following discharge from the hospital. The surgical wound heals completely in about six to eight weeks.

Occasionally doctors diagnose the cancer early enough to permit a partial laryngectomy, in which the surgeon removes only the tumor and tissues in proximity to it. With partial laryngectomy the airway and often part of the vocal structures remain intact, so breathing and speech are normal after recovery, though the quality and volume of the voice may change.

An INFLAMMATION or INFECTION of the vestibular system, the body’s balance mechanism within the inner EAR. The sudden onset of VERTIGO (feeling of spinning) is the characteristic symptom. Many people also experience transitory or temporary hearing problems and TINNITUS (a ringing or roaring sound). When an infection is present, it can be viral or bacterial. Bacterial labyrinthitis typically develops as a consequence of chronic OTITIS media (middle ear infection). Doctors believe viral labyrinthitis develops when the bloodstream carries a VIRUS into the inner ear. Inflammatory labyrinthitis may be an autoimmune condition; doctors are not certain of its etiology (origin and development). It is sometimes difficult to diagnose and distinguish the kind of labyrinthitis because access to the inner ear is so limited. Often in bacterial labyrinthitis there are signs of infection around the TYMPANIC MEMBRANE (eardrum), or might be signs of infection elsewhere including the mastoid (MASTOIDITIS) and less commonly, MENINGITIS.

Bacterial labyrinthitis has potentially serious complications, including destruction of the labyrinth and COCHLEA, which results in permanent and profound HEARING LOSS. It requires treatment with ANTIBIOTIC MEDICATIONS. Untreated bacterial labyrinthitis also can extend into other infections such as mastoiditis and meningitis. Viral labyrinthitis and inflammatory labyrinthitis generally do not leave lasting damage. Because distinguishing the cause of labyrinthitis is sometimes difficult and the consequences of untreated bacterial labyrinthitis can be severe, doctors typically prescribe antibiotics when the diagnosis is unclear, even though antibiotics will not treat viral labyrinthitis. Sometimes medications to suppress vertigo and resulting NAUSEA are also necessary, at least until the inflammation or infection is under control.

The clinical term for bad breath. Halitosis can indicate numerous local or systemic health conditions. Local halitosis occurs when an abundance of BACTERIA that release sulfur as a waste byproduct colonize in the mouth. Systemic halitosis occurs as a response to metabolic and chemical changes that the disease process causes in the body.

LOCAL CAUSES OF HALITOSIS

• poor ORAL HYGIENE
• food stuck between TEETH
• inadequate saliva production
• TONSILLITIS, adenoiditis, SINUSITIS
• POSTNASAL DRIP

SYSTEMIC CAUSES OF HALITOSIS

• PEPTIC ULCER DISEASE
• GASTROESOPHAGEAL REFLUX DISORDER (GERD)
• certain cancers
• DIABETES
• LIVER disease
• kidney disease

Treatment for underlying conditions often reduces or eliminates halitosis. When the source is ineffective ORAL HYGIENE, improved brushing and flossing techniques can help clean food debris from the MOUTH, which reduces the presence of sulfur-producing bacteria. Medications can cause dry mouth and even leave unpleasant odors in the mouth. Some people are predisposed to mouth conditions that support the presence of bacteria. Typically, a dentist treats halitosis related to oral hygiene, PERIODONTAL DISEASE, DENTAL CARIES, and other dental conditions. A doctor may recommend approaches to minimize halitosis that exists secondary to other health conditions. Thyme, eucalyptus, peppermint, and caraway are among the herbal remedies for halitosis.

The common term for the circumstance of overgrown filiform papillae on the tongue, a condition known clinically as lingua villosa. Filiform papillae are long, resemble hairs, and do not contain taste buds. Their purpose is to help move food during chewing and swallowing. Normally the wear and tear of this function breaks them off, a process called desquamation. Various circumstances inhibit desquamation, allowing the filiform papillae to grow up to 10 times longer than normal. The overgrown filiform papillae then trap food debris and other substances that impart color (such as coffee and tea), giving the characteristic “colored hair” appearance of hairy tongue. The causes of hairy tongue are numerous and include eating habits centered around soft foods, which do not scrape the tongue, and inadequate ORAL HYGIENE.

From a medical perspective hairy tongue is harmless, though people in whom it develops tend to find it aesthetically displeasing and in some it tickles or irritates the soft palate during swallowing. Brushing the tongue as a routine aspect of oral hygiene, or using a tongue scraper, nearly always restores the desquamation process and reduces the length of the filiform papillae. Hairy tongue is also slang for a bad hangover, probably stemming from the correlation between chronic ALCOHOL abuse and poor oral hygiene habits.

An INFLAMMATION of the tongue that is typically the result of irritation, viral or bacterial INFECTION, vitamin B deficiency, or ANEMIA. Glossitis may also develop as an opportunistic condition in people who have IMMUNE SYSTEM disorders.

A rare though potentially life-threatening complication of glossitis is swelling that causes the tongue to block the airway. This requires emergency medical attention.

In glossitis, the tongue often hurts, has a characteristic “beefy” appearance, and has a surface that is deep red and smooth. Swallowing and speaking may be difficult. Most glossitis responds to corticosteroid mouthrinses to reduce the inflammation. Mouthrinses with diphenhydramine may also bring relief. A bacterial infection requires treatment with ANTIBIOTIC MEDICATIONS; a yeast infection requires treatment with ANTIFUNGAL MEDICATIONS. Dietary changes or nutritional supplements are necessary when vitamin B or iron deficiency is the cause. Appropriate treatment typically resolves the symptoms, and the tongue returns to normal.

INFLAMMATION of the gum tissue around the TEETH. Most gingivitis is an early form of PERIODONTAL DISEASE. Signs of gingivitis include painless bleeding (spontaneous or with brushing) and swollen gums that may be bright red or shiny. Some people develop painless sores or ulcerations on the gums that indicate INFECTION. Though people may seek medical care because of the bleeding, dentists and periodontists provide dental-based care for gingivitis. People who have DIABETES, people who smoke cigarettes, or use smokeless tobacco, and women who are pregnant have increased susceptibility for gingivitis.