EN4.{37-39,45} | Throat Pharynx and Oesophagus — Glossary

Ambulatory recording of oesophageal pH via a catheter probe over 24 hours; gold standard for confirming GORD; pathological if oesophageal pH <4 for >4% of the monitoring period.

A primary oesophageal motility disorder characterised by failure of relaxation of the lower oesophageal sphincter and absent oesophageal peristalsis, due to degeneration of Auerbach's myenteric plexus; causes dysphagia to both solids and liquids.

An autoimmune inflammatory complication of GABHS tonsillitis/pharyngitis, resulting from cross-reactivity of streptococcal M protein antibodies with cardiac valve epitopes; may cause permanent valvular heart disease (rheumatic heart disease); prevented by completing the full 10-day penicillin course.

Malignant tumour arising in Barrett's metaplastic epithelium of the lower third/gastro-oesophageal junction; associated with GORD, Barrett's oesophagus, and obesity.

Malignant tumour arising in the lower third of the oesophagus, almost invariably on a background of Barrett's oesophagus from chronic GORD; rising in incidence in Western countries.

Surgical removal of the nasopharyngeal tonsil (adenoid) under general anaesthesia, typically by curettage with a St Clair Thompson's curette or under endoscopic guidance; indicated for adenoid hypertrophy causing obstruction or recurrent otitis media.

A widespread maculopapular skin rash occurring in ~80–100% of patients with EBV infectious mononucleosis who are prescribed amoxicillin or ampicillin; an immune-mediated reaction, not a true penicillin allergy; a classic examination pitfall.

Fluoroscopic study with ingested barium contrast outlining the oesophageal lumen; first-line imaging for structural and motility oesophageal disease; shows characteristic appearances for carcinoma, achalasia, and pharyngeal pouch.

Metaplastic replacement of the normal squamous epithelium of the lower oesophagus by specialised intestinal columnar epithelium, as a consequence of chronic gastro-oesophageal reflux; a premalignant condition predisposing to oesophageal adenocarcinoma.

Electrosurgical haemostasis in which current passes only between the two tips of the forceps, limiting thermal spread to surrounding tissue; preferred over monopolar diathermy for haemostasis in the tonsillar bed to reduce thermal injury.

The classic radiological appearance of achalasia on barium swallow — smooth, tapered narrowing at the gastro-oesophageal junction resembling a bird's beak, with a dilated oesophagus above.

A soft, gurgling, compressible swelling in the left posterior triangle of the neck that reduces on pressure, found in pharyngeal pouch — represents the fluid-filled diverticulum just below the cricopharyngeus.

A self-retaining retractor used in tonsillectomy and adenoidectomy to hold the mouth open; has a tongue depressor blade and is suspended from a Draffin stand to free both the surgeon's hands; blade size matched to patient's anatomy.

Disc-shaped lithium battery commonly found in remote controls, hearing aids, and toys; if impacted in the oesophagus, generates electrical current causing liquefactive necrosis and full-thickness perforation within 2–4 hours; a surgical emergency.

Four clinical criteria to estimate the probability of GABHS tonsillitis: (1) tonsillar exudate, (2) tender anterior cervical lymphadenopathy, (3) fever >38°C, (4) absence of cough. Score 3–4 = high probability, empirical antibiotics and throat swab appropriate.

A technique using radiofrequency energy at low temperature (~60°C) to ablate tonsillar tissue with reduced thermal damage compared to conventional diathermy; associated with less post-operative pain in some studies but similar secondary haemorrhage rate.

The horizontal muscle band that forms the main component of the upper oesophageal sphincter; its failure to relax co-ordinately with swallowing contributes to pharyngeal pouch formation.

Uncoordinated, simultaneous (non-peristaltic) contractions of the oesophageal body causing intermittent chest pain and dysphagia to both solids and liquids; barium swallow shows a corkscrew pattern.

Infection by Corynebacterium diphtheriae causing a grey-white adherent pseudomembrane that extends beyond the tonsillar pillars onto the pharyngeal wall and soft palate, bleeds on attempted removal, and is associated with toxin-mediated myocarditis and cranial nerve palsies.

Difficulty in swallowing — the sensation that food or liquid is not passing normally from the mouth to the stomach; distinct from odynophagia (pain on swallowing) and globus pharyngeus (sensation of a lump without true swallowing difficulty).

Endoscopic technique for removing flat or sessile mucosal lesions, including dysplastic Barrett's oesophagus and early oesophageal cancer, without open surgery.

A persistent, non-painful sensation of a lump or foreign body in the throat not related to swallowing; usually functional/psychogenic; must be distinguished from true dysphagia.

Condition where inappropriate relaxation or incompetence of the lower oesophageal sphincter allows gastric contents to reflux into the oesophagus, causing mucosal injury.

Rare post-adenoidectomy complication of atlantoaxial subluxation due to ligamentous laxity secondary to adjacent inflammation; presents with painful torticollis; requires urgent imaging and orthopaedic/neurosurgical consultation.

Streptococcus pyogenes; the most important bacterial cause of acute tonsillitis; responsible for the non-suppurative complications of acute rheumatic fever and post-streptococcal glomerulonephritis via immunological cross-reactions.

Surgical (laparoscopic or open) division of the LES circular muscle fibres for treatment of achalasia; usually combined with a partial fundoplication to prevent post-operative reflux.

Surgical division of the circular muscle fibres of the lower oesophageal sphincter (LOS) to relieve the obstruction in achalasia; performed laparoscopically, usually combined with a partial fundoplication to prevent GORD.

A muffled, indistinct speech quality caused by displacement of the soft palate and altered oropharyngeal resonance; a clinical sign of peritonsillar abscess (quinsy) or a large peritonsillar mass.

Acute infection caused by Epstein-Barr virus (EBV); characterised by severe tonsillitis, bilateral tonsillar exudate, posterior cervical lymphadenopathy, splenomegaly (in ~50%), hepatitis, and atypical lymphocytes on blood film; monospot (heterophile antibody) test positive.

Pathological replacement of one differentiated cell type (squamous) by another (intestinal columnar with goblet cells), occurring in the oesophagus in the context of chronic acid reflux.

A triangular anatomical weak point in the posterior pharyngeal wall between the oblique thyropharyngeus and horizontal cricopharyngeus fibres; the site through which pharyngeal (Zenker's) diverticula herniate.

A physiological high-pressure zone at the gastro-oesophageal junction; its failure to relax is the defining defect in achalasia.

A rapid bedside heterophile antibody agglutination test used to diagnose infectious mononucleosis (EBV); becomes positive in the second week of illness; sensitivity ~85% in adolescents.

First-line office-based treatment for peritonsillar abscess — an 18-gauge needle is inserted into the anterosuperior quadrant of the peritonsillar bulge under local anaesthesia to aspirate pus; provides immediate symptom relief and material for culture.

Long curved haemostatic clamps used during tonsillectomy to clamp tonsillar blood vessels (particularly the lower pole tonsillar branch of the facial artery) before tying or diathermising.

Laparoscopic or open surgical procedure for refractory GORD: the gastric fundus is wrapped 360° around the lower oesophagus to restore LOS competence.

Repetitive episodes of upper airway obstruction during sleep due to tonsillar and/or adenoid hypertrophy; recognised by loud snoring with observed apnoeic pauses; treated by tonsillectomy ± adenoidectomy, which resolves OSA in the majority of paediatric cases.

Pain on swallowing, as distinct from difficulty swallowing; suggests mucosal inflammation or ulceration (e.g., acute tonsillitis, oesophagitis, ulcerating carcinoma).

Congenital discontinuity of the oesophageal lumen due to failure of tracheo-oesophageal septation; most commonly (85%) type C (Gross) = blind upper pouch with lower-segment tracheo-oesophageal fistula.

Measurement of intraluminal oesophageal pressures during swallowing; the definitive investigation for motility disorders, particularly achalasia (absent peristalsis + incomplete LES relaxation with elevated resting LES pressure).

Surgical removal of the oesophagus for carcinoma; the Ivor Lewis operation (right thoracotomy + laparotomy with intrathoracic anastomosis) is standard for mid/lower-third tumours.

The paired secondary lymphoid organs in the lateral oropharynx between the anterior (palatoglossus) and posterior (palatopharyngeus) tonsillar pillars; the site of tonsillitis and tonsillar abscess.

Validated criteria for tonsillectomy based on frequency of documented tonsillitis episodes: ≥7 per year in the preceding year, ≥5 per year for 2 consecutive years, or ≥3 per year for 3 consecutive years — each episode documented with supporting clinical criteria.

A deep-space neck infection in the parapharyngeal space medial to the parotid gland and lateral to the pharynx; may arise from spread of peritonsillar abscess; presents with trismus, neck swelling, and systemic sepsis; diagnosed by contrast CT neck; requires IV antibiotics and surgical drainage.

An endoscopic technique for achalasia in which a submucosal tunnel is created and the LES circular muscle is divided endoscopically through the submucosal space, without external incision.

A collection of pus in the peritonsillar space between the tonsillar capsule and the superior pharyngeal constrictor; the most common local complication of acute tonsillitis; characterised by unilateral peritonsillar bulging, uvular deviation to the contralateral side, trismus, and 'hot-potato' voice.

A potential space between the fibrous capsule of the palatine tonsil and the superior pharyngeal constrictor muscle; the anatomical site where a peritonsillar abscess (quinsy) forms.

A pulsion diverticulum of the posterior pharyngeal mucosa through Killian's dehiscence; presents in elderly patients with dysphagia, regurgitation of undigested food, halitosis, and a soft compressible neck swelling (Boyce's sign).

The triad of postcricoid web, iron-deficiency anaemia, and dysphagia occurring predominantly in middle-aged women; the postcricoid web is considered premalignant, carrying an increased risk of postcricoid carcinoma.

First-line endoscopic treatment for achalasia — a large-diameter balloon (3–4 cm) is inflated across the lower oesophageal sphincter to disrupt its circular muscle fibres and relieve outflow obstruction.

Immune complex deposition in the glomerular basement membrane following infection by nephritogenic strains of GABHS; presents 1–3 weeks after throat infection with haematuria, proteinuria, oedema, and hypertension.

A thin fibrous shelf on the anterior wall of the postcricoid region; the structural lesion responsible for dysphagia in Plummer-Vinson syndrome; appears as a shelf-like filling defect on lateral barium swallow.

Bleeding within 24 hours of tonsillectomy; caused by inadequate intraoperative haemostasis; managed by return to theatre under general anaesthesia.

Class of drugs (omeprazole, lansoprazole, pantoprazole) that irreversibly block the gastric H+/K+-ATPase pump, maximally suppressing acid secretion; first-line pharmacotherapy for GORD and Barrett's oesophagus.

A condition mimicking achalasia on barium swallow and manometry, caused by a malignant tumour at the gastro-oesophageal junction infiltrating the myenteric plexus; excluded by upper GI endoscopy and biopsy before treating for achalasia.

Endoscopic ablation technique for Barrett's oesophagus using radiofrequency energy to destroy metaplastic epithelium; allows re-growth of normal squamous mucosa.

Barium swallow appearance of oesophageal carcinoma: irregular narrowing with abrupt shouldered margins and central lumen reduction resembling a rat's tail or an apple core; indicates mucosal destruction.

Bleeding within 24 hours of tonsillectomy, typically after blood pressure normalises; caused by reversal of surgical vasoconstriction; managed as for primary haemorrhage.

Wide-bore, double-lumen sump suction catheter used to continuously aspirate secretions from the blind upper oesophageal pouch in oesophageal atresia, preventing aspiration until surgical repair.

A mucosal ring at the gastro-oesophageal junction causing episodic solid-food dysphagia (steakhouse syndrome) — intermittent, not progressive; treated by endoscopic dilatation.

Bleeding occurring 5–10 days after tonsillectomy, caused by sloughing of the eschar in the tonsillar fossa; the most clinically significant post-operative complication in the community period; requires immediate return to hospital.

Bleeding 5–10 days post-tonsillectomy from sloughing of the fibrinous eschar in the tonsillar fossa; incidence ~1–2%; the most important complication to counsel about at discharge; any blood from the mouth requires immediate hospital attendance.

A mesh tube deployed endoscopically across a malignant oesophageal stricture to maintain luminal patency and provide dysphagia palliation in inoperable carcinoma.

Malignant tumour arising from the stratified squamous epithelium of the upper and middle thirds of the oesophagus; associated with tobacco, alcohol, hot beverages, achalasia, and Plummer-Vinson syndrome.

Malignant tumour arising from the squamous epithelium of the upper and middle thirds of the oesophagus; associated with tobacco and alcohol use; presents with progressive solid-food dysphagia and weight loss.

A curved metal instrument with a serrated leading edge used to perform adenoidectomy by blind curettage of the posterior nasopharyngeal wall; the adenoid tissue is swept into the oral cavity with a firm forward and downward stroke.

A cleft of the muscular layer of the soft palate covered by intact mucosa; recognised by the triad of bifid uvula, zona pellucida (translucent midline zone in the soft palate), and notch in the posterior border of the hard palate; an absolute contraindication for adenoidectomy (risk of VPI).

A moist gauze pack placed in the oropharynx or hypopharynx during tonsillectomy/adenoidectomy to prevent blood and debris from entering the airway; must be counted out at the end of the procedure before extubation.

Deep invaginations of the stratified squamous epithelium on the free surface of the palatine tonsil; in chronic tonsillitis they become colonised by mixed bacteria and fill with caseous debris (tonsillar plugs), causing foetor oris.

Surgical removal of the palatine tonsils via extracapsular dissection in the peritonsillar space, under general anaesthesia; indicated for recurrent tonsillitis meeting Paradise criteria, peritonsillar abscess, OSA, or suspected malignancy.

Abnormal communication between the trachea and the oesophagus; most commonly the lower oesophagus fistulates to the carina in type C oesophageal atresia; type E ('H-type') TOF has a patent oesophagus and presents with recurrent aspiration pneumonia.

Dysphagia arising from failure of the oral and pharyngeal phases of swallowing (oropharyngeal dysphagia) — difficulty initiating the swallow, coughing, and aspiration predominate; caused by neuromuscular disease.

Inability to fully open the mouth due to spasm of the masticatory muscles (especially the medial pterygoid), resulting from peritonsillar, parapharyngeal, or pterygoid space infection.

Inadequate closure of the velopharyngeal sphincter resulting in hypernasal speech and nasal regurgitation of liquids; a complication of adenoidectomy in patients with a cleft palate or submucous cleft palate, whose adenoid was contributing to velopharyngeal closure.

Acute necrotising ulcerative tonsillitis caused by synergistic infection with Fusobacterium necrophorum and Treponema vincenti; presents with unilateral grey-green membranous ulceration of the tonsil with a putrid smell; treated with penicillin and metronidazole.

The ring of lymphoid tissue guarding the entrance to the aerodigestive tract, comprising the paired palatine tonsils, the nasopharyngeal tonsil (adenoids), the paired tubal tonsils, and the lingual tonsil at the base of the tongue.

The endoscopically visible, irregular junction where oesophageal stratified squamous epithelium transitions to columnar gastric epithelium at the gastro-oesophageal junction; its proximal displacement marks Barrett's oesophagus.