What are the treatment options for throat and neck problems?

Treatment Options for Throat and Neck Problems

The treatment approach for throat and neck problems depends critically on the underlying diagnosis, which ranges from infectious conditions requiring antibiotics, to functional disorders requiring speech therapy, to malignancies requiring multimodal oncologic treatment. The specific pathology—not the anatomic location of symptoms—must guide management decisions.

Infectious Throat Conditions

Acute Bacterial Rhinosinusitis

Reserve antibiotics for patients meeting specific clinical criteria: symptoms persisting >10 days without improvement, severe symptoms (fever >39°C with purulent discharge or facial pain for ≥3 consecutive days), or worsening after initial improvement ("double sickening"). 1

• First-line antibiotic: Amoxicillin-clavulanate is the preferred agent per IDSA guidelines, though some societies recommend amoxicillin alone 1
• Alternative agents: Doxycycline or respiratory fluoroquinolones for penicillin-allergic patients 1
• Adjunctive therapy: Intranasal saline irrigation and intranasal corticosteroids alleviate symptoms and may decrease antibiotic use 1
• Supportive care alone is appropriate for most patients, as the number needed to treat is 18 for rapid cure versus number needed to harm of 8 from antibiotic adverse effects 1

Upper Respiratory Tract Infections

Amoxicillin is indicated for infections due to susceptible (β-lactamase-negative only) Streptococcus species, S. pneumoniae, Staphylococcus spp., or H. influenzae affecting the ear, nose, and throat. 2

• Penicillin V potassium treats mild-to-moderate streptococcal infections of the upper respiratory tract, including scarlet fever 3
• Critical caveat: Severe pneumonia, empyema, bacteremia, pericarditis, meningitis should NOT be treated with penicillin V during acute stage 3

Allergic Rhinitis with Nasal/Throat Symptoms

Intranasal corticosteroids are first-line therapy for moderate-to-severe allergic rhinitis, particularly when nasal congestion is prominent. 4

• Dosing strategy: Twice-daily dosing optimizes effects over once-daily 4
• Continuous therapy is more effective than intermittent use 4
• Adjunctive measures: Empiric allergen avoidance, staying indoors with air conditioning during severe seasons, saline nasal irrigations 4
• Avoid oral antihistamines as first-line—they are less effective than intranasal corticosteroids for congestion 4
• Avoid topical decongestants beyond 3 days due to rebound congestion risk (rhinitis medicamentosa) 4
• Reassess after one week if no improvement; consider infection or alternative diagnosis 4

For patients with inadequate response to environmental controls and optimal medical management, allergen immunotherapy should be considered 1

Functional Voice and Swallowing Disorders

Functional Dysphonia/Aphonia

Symptomatic therapy techniques that facilitate return of normal voice through natural, reflexive behaviors are the cornerstone of treatment. 1

Specific therapeutic maneuvers include:

• Natural reflexive sounds: coughing, throat clearing, yawning with sighs, comfort moaning, gargling 1
• Phonation techniques: slow easy onset with prolonged sounds (/mmyyy-mmumm/), phonation on inhalation, siren sounds using nasal consonants 1
• Physical maneuvers: circumlaryngeal massage with concurrent vocalization, postural manipulations (phonating while bending over or looking at ceiling) 1
• Redirection techniques: bubble blowing with vocalization, large body movements with "shivering noises," walking while communicating 1

Psychological components:

• Communication counseling addressing predisposing, precipitating, and perpetuating factors 1
• Identify and address avoidance patterns or excessive dependence on communication aids 1
• For long-standing anxiety, comorbid depression, or medicolegal issues, collaborative work with mental health professionals or referral for structured CBT may be necessary 1

Prepare strategies for relapse management: Patients should receive clear criteria for when to seek future therapy and be equipped with self-management techniques 1

Dysphagia (Swallowing Disorders)

Videofluorographic swallowing study is the most useful diagnostic tool for identifying pathophysiology and empirically testing therapeutic techniques. 5

Management approach by phase affected:

• Oral/pharyngeal dysphagia: Usually amenable to rehabilitative measures including dietary modification and training in specific swallowing techniques 5
• Esophageal dysphagia: Most commonly caused by GERD and functional disorders; esophagogastroduodenoscopy is recommended for initial evaluation 6
• Severe disorders: May require bypassing oral cavity/pharynx entirely with enteral or parenteral nutrition 5

Critical consideration for frail elderly: Many older adults with progressive neurologic disease have significant unrecognized dysphagia, increasing aspiration pneumonia and malnourishment risk; diagnosis should prompt goals-of-care discussion before potentially harmful interventions 6

Speech-language pathologists provide structured assessments and recommendations for safe swallowing, palliative care, or rehabilitation. 6

Head and Neck Malignancies

Initial evaluation requires multidisciplinary team consultation including head and neck surgeons, radiation oncologists, medical oncologists, speech-language pathologists, and nutritionists. 1

Early-Stage Glottic Laryngeal Cancer (Stage I-II)

Single-modality treatment with either surgery or radiation therapy is recommended, as both modalities result in similar survival. 1

• Choice depends on anticipated functional outcome, patient preference, reliability of follow-up, and general medical condition 1
• Treatment options: endoscopic removal (stripping, laser) or radiation therapy for carcinoma in situ 1
• Partial laryngectomy or RT for early-stage disease 1

Advanced-Stage Disease

Combined modality therapy is generally recommended for locally or regionally advanced disease. 1

• If total laryngectomy indicated but laryngeal preservation desired: concurrent systemic therapy/RT with high-dose cisplatin (100 mg/m² on days 1,22,43) is preferred (category 1) 1
• Induction chemotherapy with management based on response is an option for all but T1-2, N0 disease 1

Essential supportive measures:

• Smoking cessation and alcohol modification—these habits decrease treatment efficacy and adversely affect outcomes 1
• Nutritional support to prevent severe weight loss 1
• Dental evaluation and management before and after treatment 1
• Management of sequelae: pain, xerostomia, speech and swallowing problems, depression 1

Cervicogenic Dysphagia

Degenerative changes in cervical discs and facet joints, and chronic multisegmental dysfunction of cervical spine facet joints can cause swallowing difficulties but are often overlooked in differential diagnosis. 7

Conservative therapy aims to improve swallowing capacity:

• Soft tissue techniques, stretching of shortened muscles 7
• Passive and active mobilization of facet joints 7
• Physical therapy, manual therapy, kinesiotherapy 7
• Medicamentous therapy when indicated 7

Important recognition: These cervical disorders are common additional causes of dysphagia in elderly with central swallowing control disorders (stroke, Parkinson's, dementia) 7