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7.1 History/Symptoms/Presentation ofOropharyngeal Diseases
281
Table 7.3
• Pharyngeal inammatory conditions—Tonsillitis, pharyngitis, chronic sinusitis with postnasal drip
• Gastro-oesophageal reux disease
• Psychological factors, such as stress or anxiety, depression
• Abnormal upper oesophageal sphincter function
• Rare tumours—Oropharyngeal metastasis of Merkel cell carcinoma
• Thyroid disease
• Previously lodged objects
• Temporomandibular joint (TMJ) disorders
• Inability to produce enough saliva
• Cervical osteophytes or bone spurs
• Eagle’s syndrome
• Laryngeal and pharyngeal tension
• Mode of onset
• Duration
Causes of foreign body sensation of throat
– Sudden—aspiration, exposure to irritant or
allergen, acute pharyngitis, foreign body in
oropharynx.
– Gradual/insidious—chronic pharyngitis,
chronic tonsillitis, chronic sinusitis.
– Acute—acute coughs begin suddenly and
usually last no more than 2–3weeks. URI,
acute pharyngitis, GERD, exposure to
irritant.
• Type of cough
– Dry cough—acute pharyngitis, LPRD,
acute laryngitis.
– Expectoration or wet cough—URI, acute
rhinosinusitis.
• Associated symptoms—fever, malaise, runny
nose, postnasal drip, heartburn, sore throat,
weight loss, hoarse voice, headache, dizziness, urinary incontinence, subconjunctival
haemorrhage, h/o choking, suffocation, H/o
recurrent pneumonia.
– Chronic—chronic tonsillitis, chronic phar-
yngitis, GERD.
Information to be gathered in history
• Was the onset of the cough sudden or insidious?
• What was its initiating event?
• Did it start as an isolated symptom or occur with or follow other symptoms?
• How long has the cough been present?
• Is it persistent or episodic?
• Is it seasonal or perennial?
To determine the severity of the cough, ask:
• How frequent is a coughing spell?
• How long does each coughing spell last?
• What is its effect on daily activity or rest?
Is the cough productive or dry? Lack of expectoration does not necessarily indicate that the cough is dry, as
many patients, particularly children and women, tend to swallow their sputum raised to the level of the
pharynx. The sound of the cough would help in determining its productive or dry nature. Patients with sputum
production should be asked about its frequency and description of the physical characteristics of the sputum
including the amount (with each coughing spell and daily total), colour, consistency, ease of its expectoration,
taste and smell.
Associated symptoms—Is the cough the only symptom, or is it associated with other respiratory or non-respiratory
symptoms? Inquiry should be specically made about conditions known to cause the cough, particularly when it is
chronic and persistent.
In addition to an accurate smoking history, ask: To what respiratory irritants is the patient exposed at home or at
work? Is exposure accidental or intentional?
(continued)
282
What are the precipitating or aggravating factors?
• What time of the day or night is the cough or sputum production worse?
• Does it happen in supine position, upon arising in the morning, with drinking or eating, with exercise, or with
breathing cold or dry air?
• Does the cough awaken the patient from sleep?
Is there a past history (recent or old) of foreign body aspiration?
• Has the pattern of the cough and the amount or other characteristics of the sputum changed recently?
• Can the patient locate the site of origin of the cough or the sputum, such as from the throat or deeper in the chest?
• Has the patient had a similar problem with coughing in the past?
• Does the cough have easily recognizable characteristics, as in croup or whooping cough?
Table 7.4 Causes of cough
Dry cough (non-productive) Productive cough
Acute cough—Common cold, acute sinusitis, pertussis,
infectious mononucleosis, GERD
Subacute—Postinfectious rhinitis Subacute—Sinusitis, asthma
Chronic—Allergic fungal sinusitis, allergic rhinitis,
bacterial sinusitis, occupational rhinitis, rhinitis
medicamentosa, upper airway cough syndrome, ACE
inhibitor use, psychogenic, postnasal drip, GERD,
laryngitis, allergic pharyngitis
Acute—Pneumonia, URI, acute bronchitis, postnasal
drip, cystic brosis, allergic rhinitis, allergic pharyngitis,
retropharyngeal abscess, peritonsillar abscess
Chronic—Chronic sinusitis, pyocoele, COPD, bronchial
asthma, bronchiectasis
7 History andExamination ofOropharynx
Causes of Cough (Table7.4).
7.1.6 Expectoration
• Colour of expectoration
– White—allergic pharyngitis.
– Yellow—it is purulent expectoration sug-
gestive of bacterial infection.
– Green—bacterial infection.
• Amount
– Small—allergic pharyngitis.
– Large—COPD, asthma, bronchiectasis,
sinusitis.
• Consistency
– Thick—peritonsillar abscess, retropharyn-
geal abscess, COPD, bronchiectasis.
– Thin—allergic pharyngitis, allergic
rhinitis.
• Mode of onset
– Sudden—URI, acute rhinosinusitis.
– Gradual—chronic sinusitis, COPD,
asthma, bronchiectasis.
• Duration
– Acute—URI, acute sinusitis.
– Chronic—chronic sinusitis, COPD,
asthma, bronchiectasis.
• Smell
– Foul smelling—pharyngeal pouch, tonsil-
lar debris, anaerobic infection.
– Non-foul smelling—peritonsillar abscess,
aerobic infection.
• Associated symptoms—nasal discharge, nasal
obstruction, headache, throat pain, cough,
diurnal variations, odynophagia, dysphagia.
7.1.7 Halitosis
Described in oral.
7.1.8 Burning Sensation inThroat
• Duration
– Acute—common cold, u, infectious
mononucleosis, peritonsillar abscess, Strep
throat.
– Chronic—idiopathic, carcinoma.
• Mode of onset
– Sudden—Strep throat, peritonsillar
abscess.
– Gradual—idiopathic, burning mouth syn-
drome, carcinoma.
7.1 History/Symptoms/Presentation ofOropharyngeal Diseases
Table 7.5 Causes of burning sensation in throat
Causes Presentation
Postnasal drip Coughing, tickle in throat, mucous in throat, runny nose, congestion, hoarse voice
Strep throat Lymphadenopathy, fever, rashes, nausea, vomiting, aches & pain, red swollen tonsils with
white streak
Common cold Runny nose, stuffy nose, sneezing, coughing, headache, low fever
Flu Fever with chill, cough, runny nose
Mononucleosis Extreme tiredness, fever, bodyache, rash
Table 7.6 Difference between obstructive and central sleep apnoea
Obstructive Central
Obstructive sleep apnoea occurs as repetitive episodes
of complete or partial upper airway blockage during
sleep presented as snoring, frequent night awakening,
excessive daytime sleepiness
The airway is not blocked, but the brain fails to signal
the muscles to breathe due to instability in the
respiratory control Centre presented as recurrent
awakenings or insomnia, although they may also
experience a choking or gasping sensation upon
awakening
283
• Associated symptoms—electric-like sensation, pain, foreign body sensation, GERD,
odynophagia, bitter taste in mouth.
• Causes (Table7.5).
7.1.9 Swelling/Bulging/Growth
• Site
– Posterior pharyngeal wall—retropharyn-
geal abscess, carcinoma of oropharynx.
– Lateral oropharyngeal wall—parapharyn-
geal abscess, parapharyngeal tumour.
– Bulging of tonsil—peritonsillar abscess.
– Base of tongue—lymphoid hyperplasia,
cyst, carcinoma base of tongue.
– Tonsils—chronic tonsillitis, NHL, carci-
noma tonsil, tonsillar cyst, tonsillar debris,
tonsillar stone.
• Duration
– Acute—acute tonsillitis, peritonsillar
abscess.
– Chronic—chronic tonsillitis, parapharyn-
geal tumour.
• Side
– Unilateral—tonsillar cyst, tonsillar tumour,
tonsillar debris, parapharyngeal abscess,
parapharyngeal tumour, peritonsillar
abscess.
– Bilateral—chronic tonsillitis, diphtheria.
• Associated symptoms—pain, dysphagia, ody-
nophagia, trismus, H/o tobacco chewing,
smoking, alcohol intake.
7.1.10 Snoring
This is dened as making snorting or grunting
noise during sleep.
• Types of OSA (Table7.6)
• Presentation/presenting symptoms/chief complaints of sleep apnoea
Symptoms in adult
– Snoring
– Day somnolence/daytime sleepiness—
Because of a lack of restorative sleep at
night, people with obstructive sleep apnoea
often have severe daytime drowsiness,
fatigue and irritability. They might have
difculty concentrating and nd themselves falling asleep at work, while watching TV or even when driving.
– Frequent night awakening—episodes of
apnoea.
– Sudden awakening with sense of
gasping—severity.
– Dry mouth or sore throat on awakening.
– Cognitive impairment, such as trouble con-
centrating, forgetfulness or irritability.
– Mood disturbances (depression or
anxiety).
284
7 History andExamination ofOropharynx
– Night sweats.
– Frequent night-time urination.
– Sexual dysfunction.
– Headache.
– Excessive daytime sleepiness.
– Loud snoring.
– Observed episodes of stopped breathing
during sleep—apnoea.
– Abrupt awakenings accompanied by gasp-
ing or choking.
– Awakening with a dry mouth or sore throat.
– Morning headache.
– Difculty in concentration during the day.
– Mood changes, such as depression or
irritability.
– High blood pressure.
– Decreased libido.
Symptoms in children—The symptoms in chil-
dren may not be as obvious as adult. Children
and young people with obstructive sleep
apnoea might do poorly in school and commonly have attention or behavioural
problems.
– Poor school performance.
– Sluggishness or sleepiness, often misinter-
preted as laziness in the classroom.
– Daytime mouth breathing and swallowing
difculty.
– Inward movement of the ribcage when
inhaling.
– Unusual sleeping positions, such as sleep-
ing on the hands and knees, or with the
neck hyperextended.
– Excessive sweating at night.
– Learning and behavioural disorders (hyper-
activity, attention decits).
– Bedwetting.
• Associated symptoms or history of weight gain,
enlarged tonsil, H/O amyotrophic lateral sclerosis, hypertension, diabetes mellitus, chronic
nasal congestion/obstruction, smoking, asthma,
adenoid, drinking alcohol, daytime fatigue.
• Ruled out cardiovascular problems—H/o
hypertension, coronary artery disease, heart
attack and stroke indicate the severe sleep
apnoea. If there is history of underlying heart
disease, the abnormal heart rhythms (arrhythmias) may cause sudden death.
• Family history of sleep apnoea.
Red ag signs of snoring
• Snoring loud enough to disturb your sleep or that
of others.
• Waking up gasping or choking.
• Pausing in your breathing during sleep.
• Having excessive daytime drowsiness, which may
cause you to fall asleep while working, watching
television or even driving a vehicle.
7.2 Examination ofOropharynx
Clinical Anatomy
The oropharynx is located behind the oropharyngeal isthmus, below the nasopharynx and above the laryngopharynx.
Oropharynx contains tonsils, base of
tongue, posterior pharyngeal wall.
Method of Examination
Examine the oropharynx by placing a mirror or tongue depressor on the dorsal surface of the tongue applying gentle pressure
without having the patient protrude their
tongue out. The oropharynx is examined
with either headlight or head mirror with
bull’s lamp and with indirect laryngoscopy
mirror. A thorough examination of oropharynx should assess for change in colour
and/or texture of the mucous membrane,
inammatory areas, erythema, hyperpigmentation, macules, papules, vesiculobullous lesions, white lesions, greyish white
lesions, red lesions, induration, ulceration,
swellings and growths.
7.2.1 Inspection ofOropharynx
1. Examination with Headlight or Head Mirror
with bull’s Lamp
(a) Oropharyngeal isthmus opening—It is
opening through oral cavity opens in oropharynx. It is bounced superiorly by sift
7.2 Examination ofOropharynx
285
palate, laterally by anterior pillar and
inferiorly by junction of anterior 2/3 and
posterior 1/3 junction of tongue.
Mallampati grading of oropharyn-
geal opening (Fig. 7.1)
(b) Uvula and soft palate—This area is exam-
ined using direct vision and is normally
not palpated unless necessary.
• Appearance—The uvula and soft palate usually appear reddish pink in
colour.
• Movement—Ask the patient to say ah
to observe the movement of uvula and
soft palate. The tissue should appear
loose, mobile and symmetrical during
function.
– Normal—The symmetrical move-
ment is normal, and asymmetrical
movement indicates paralysis of
soft palate.
– Abnormal—The uvula and soft
may deviated to one side (U/L
paralysis of soft palate) or no
movement (B/L palatal paralysis)
and restricted movement (OSMF).
• Size
– Normal.
– Small—brosis, iatrogenic.
– Large—swollen uvula—u, mono-
nucleosis, croup, uvulitis, trauma
(intubation, endoscopy, posttonsillectomy), allergy, medications (ipratropium bromide, ACE
inhibitors), snoring, hereditary
angio-oedema.
• Deformities—bid uvula, cleft soft
palate, notched uvula.
(c) Tonsil—The tonsils are examined using
direct visualization and palpation.
Atypical presentations include excessively large or asymmetrical tonsils,
cratered surfaces without evidence of
erythema or exudates. Individuals with
large crypts in the tonsils collect food
debris, bacteria and hardened
material.
• General appearance of tonsil—Tonsils
appear as rough, lobular and coral to
light pink tissue of varying amounts
between the anterior and posterior
pharyngeal pillars.
• Hypertrophy of tonsil
– Grading of tonsillar hypertrophy
(Table7.7 and Fig.7.2)
ClassDescription
Class I Visualization of soft palate, Hard palate, Uvula, and tonsillar Pillars
Class II Visualization of hard palate, soft palate and part of tonsillar pillar
Class III Visualization of hard palate, soft palate and base of uvula
Class IV Visualization of hard palate only
Class I Class II Class III Class IV
Fig. 7.1 Mallampati classication (Grade 1 to Grade 4) of oropharyngeal opening
286
Table 7.7 Brodsky grading scale of tonsillar hypertrophy
Grade Denition
Grade 0 Tonsils within the tonsillar fossa
Grade 1
Grade 2 Tonsils occupy 26%–50% of the oropharyngeal width (Fig.7.3y)
Grade 3 Tonsils occupy 51%–75% of the oropharyngeal width (Fig.7.3x)
Grade 4 Tonsils occupy more than 75% of oropharyngeal width or when tonsils touches each other
Tonsils just outside of the tonsillar fossa and occupy ≤25% of the oropharyngeal width
7 History andExamination ofOropharynx
Fig. 7.2 Grading of tonsillar hypertrophy
– The Brodsky grading scale com-
prised the 5 grades (Table7.7)
– Side of tonsillar hypertrophy
Unilateral—lymphoma, tonsillar cyst, peritonsillar abscess
(Fig. 7.3f), tonsillar carcinoma,
tonsillar stone (Fig7.3t), tonsillar debris (Fig.7.3k, u).
Bilateral—chronic tonsillitis
(Fig. 7.3e), acute tonsillitis
(Fig. 7.3a), acute parenchymatous tonsillitis (Fig.7.3c).
• Ulcer over tonsils
– Unilateral—carcinoma, aphthous
ulcer, traumatic, FB.
– Bilateral—diphtheria (Fig. 7.3b),
parenchymatous tonsillitis.
• Membrane over tonsils
– Side
Unilateral—trauma, carcinoma,
aphthous ulcer.
Bilateral—diphtheria (Fig. 7.3b),
parenchymatous tonsillitis, follicular tonsillitis, fungal infection.
– Colour—white or grey white
(diphtheria); white or yellow
(Streptococcus, fungal infection).
– Adherent or not—Diphtheritic
membrane is adherent to tonsil.
– Bleed on removal or not—
Diphtheritic membrane bleed on
removal.
• Debris in tonsillar cleft or crept—a
large crypts in upper part of the tonsils
that collect food debris, bacteria and
7.2 Examination ofOropharynx
287
hardened material (Fig.7.3k, u).
• Tonsillar stone—a lump of calcied
material in the tonsils (Fig.7.3t).
Diphtheritic membrane—It is a grey thick
pseudomembrane of dead tissue that is
caused by bacterium Corynebacterium
diphtheriae. It presents over tonsil and can
obstruct airway.
(d) Anterior tonsillar pillar and posterior tonsil-
lar pillar
• Normal—The anterior pillars should
appear vascular, smooth and
symmetrical.
• Congestion—chronic tonsillitis.
• Bulging—peritonsillar abscess (anterior
tonsillar pillar medially bulged).
• Ulceration—OSMF, aphthous ulceration,
neoplastic lesions.
(e) Posterior oropharyngeal wall—The tissue in
this area should appear very vascular but otherwise homogeneous in colour tending
towards reddish pink.
• General appearance—The surface may be
smooth or appear to have small coral pink
to translucent, gelatine-like, homogeneous surface prominences which are
consistent with normal areas of scattered
lymph tissues (lymphoid aggregates).
• Postnasal drip—Homogeneous and nontender erythema associated with postnasal
drip and/or smoking.
• Erythema and purulent exudate indicate
pharyngitis.
• Hypertrophied lymphoid follicle.
• Ulcer—carcinoma, postradiation,
postchemotherapy, infection, herpangina.
• Swelling—lymphoid hypertrophy.
• Bulging—retropharyngeal abscess
(Fig.7.3g).
• Growth—SCC and other carcinoma.
• Congestion—infection (pharyngitis).
• White patches—candidiasis.
(f) Lateral oropharyngeal wall—This is the area
located behind the posterior tonsillar pillar.
• Bulging of lateral oropharyngeal wall—
parapharyngeal tumour, tumour of deep
lobe of parotid, parapharyngeal abscess
(Fig.7.3h).
(g) Base of tongue (posterior 1/3 of tongue)—
This area is examined either by asking the
patient to protrude the tongue or by indirect
laryngoscopy.
• Mass
Hypertrophied lymphoid follicle
(Fig.7.3r)—Hypertrophied lingual tonsil and
lateral lingual tonsil, lymphoma, tongue base
lymphoid hyperplasia, cystic isolated
lymphoma.
Lingual thyroid—This is abnormal position
of thyroid and may be only thyroid in body.
• Growth—carcinoma of base of tongue,
clear cell carcinoma.
• Swelling—vallecular cyst, schwannoma,
lipoma, haemangioma, dermoid cyst, epidermoid cyst, lymphangioma.
2. Examination of oropharynx with Indirect
laryngoscopy Mirror or Endoscope
(a) Base of tongue and vallecula to be exam-
ined for mass/swelling/growth.
7.2.2 Palpation ofOropharynx
• Tonsil
– Tenderness over tonsil—It is sign of acute
tonsillitis, peritonsillar abscess, acute parenchymatous tonsillitis, acute follicular
tonsillitis, acute membranous tonsillitis.
– Induration over tonsil—This is dened as
hardness of soft tissue. It is a sign of inammation and malignancy.
– Consistency
(a) Tonsillolith—Consistency may range
from rm to hard on palpation.
(b) Chronic tonsillitis—They are rm on
consistency.
(c) Malignancy—Firm to hard on
palpation.
(d) Lymphoma—Firm to rubbery hard on
consistency.
(e) Enlarged styloid process—Bony hard
on consistency.
288
7 History andExamination ofOropharynx
• Base of tongue
– Tenderness—It is due to inammation of
lingual tonsils.
– Induration—It is due to malignancy of base
of tongue.
– Consistency of swelling
(a) Lymphoid hyperplasia—Firm on
palpation.
(b) Malignancy—Hard on palpation.
(c) Lymphangioma/haemangioma/vallec-
ular cyst—Soft on palpation.
(d) Lingual thyroid—Firm on consistency.
• Gag reex—Normally, gag reex may range
from mild to very severe elicited by touching
posterior pharyngeal wall with either tongue
depressor. It is controlled by cranial nerve IX
(afferent or sensory) and cranial nerve X
(motor or efferent).
– Absent gag reex—Bulbar palsy (myas-
thenia gravis, ALS, botulism), lower cra-
nial nerve lesions.
– Present—normal person.
– Exaggerated (hyperactive gag reex or
hypersensitive gag reex)—anxiety, post-
nasal drip, chronic tonsillitis, stress,
unpleasant odours.
• Swelling
– Consistency of swelling—soft, rm and
hard.
• Palpation of enlarged styloid process—This is
usually palpable in tonsillar bed or by pressing
over anterior tonsillar pillar if it is enlarged.
• Squeeze test/Irwin’s moon sign—The pres-
sure on anterior tonsillar pillar will cause
release of pus or cheesy material. It is a sign of
chronic follicular tonsillitis.
7.2.3 Other Examination Includes
• Examination of cranial nerve—The glosso-
pharyngeal and vagus nerve should be
examined.
• Examination of neck—The neck is examined
for lymphadenopathy.
• Gag reex—Present or absent.
Causes of Dysphagia (Table7.8)
Causes of Cough (Table7.9)
Table 7.8 Causes of dysphagia
Neurologic disorders
• CVA
• Parkinson’s disease
• Multiple sclerosis
• Brain neoplasm
• Polio and post-polio syndrome
• Alzheimer’s syndrome
• Huntington disease
Myopathic disease
• Myositis
• Dermatomyositis
• Myasthenia gravis
• Muscular dystrophy
Metabolic disease
• Hyperthyroidism
Infectious disease
• Meningitis
• Diphtheria
• Botulism
• Lyme disease
• Syphilis
• Viral infection
• Pharyngitis
Inammatory disease
• Amyloidosis
• Sarcoidosis
• Systemic lupus erythematosus
Structural disease
• Abscess in pharynx
• Congenital web
• Neoplasm
• Zenker’s diverticulum
• Extrinsic compression
• Poor dentition
• Plummer–Vinson syndrome
Iatrogenic
• Surgical resection
• Radiation- induced
• Corrosive
• Corrosive ingestion
7.2 Examination ofOropharynx
Table 7.9 Causes of cough
Causes of cough with their anatomic
locations Mechanism
Nose and its sinuses
Rhinitis, sinusitis Postnasal drip irritating upper
airway cough receptor
Pharynx
Infection, neoplasm Irritation of pharyngeal cough
receptors
Zenker’s diverticulum Irritation of airways by compression
or by aspirated diverticular content
Larynx
Infection, allergy, neoplasm,
foreign body
Improper use of voice Vocal cord irritation Coughing with talking or singing
Trachea and bronchi
Acute tracheobronchitis Hyperreactivity of cough receptors,
Pertussis Hyperirritability of cough receptors
Chronic bronchitis Hypersecretion, ciliary dysfunction Chronic productive cough of
Bronchiectasis Hypersecretion, retained secretions Expectoration of large amounts of
Cystic brosis As in bronchiectasis, secretions
Neoplasm Mechanical irritation of cough
Bronchial asthma Airway hyperreactivity,
Aspiration Irritation of cough receptors by
Foreign body Mechanical stimulation of cough
Inhalation of irritating gases or
aerosols
Pulmonary parenchyma
Pneumonia Stimulation of peripheral cough
Lung abscess As in pneumonia Sudden onset or increase in amount
Tuberculosis and other chronic
infections
Hyperreactivity of laryngeal cough
receptors, mechanical irritation
increased secretions
from necrotizing inammation of
respiratory tract mucosa
more viscid
receptors by tumour, secretions or
secondary infection
bronchospasm, increased secretions
aspirated material, secondary
infection
receptors, infectious complication
Chemical irritation of cough
receptors
receptors, increased secretions
As in pneumonia Chronic, usually productive, cough;
Characteristic features and major
associated symptoms
Acute or chronic cough with
sensation of postnasal drip, frequent
hawking (throat clearing), nasal
stufness
Hacking cough with sore throat,
frequent hawking
Regurgitation of undigested food,
halitosis, dysphagia
Croupy or barking cough, change in
voice, inspiratory stridor
The most common cause of acute
self-limited cough
Paroxysms of coughing ending in a
loud, crowing, inspiratory sound
(whoop); expectoration of mucus
plug
smokers, worse upon arising in the
morning
foul-smelling sputum, haemoptysis
Chronic cough since early
childhood, progressive dyspnoea,
haemoptysis
Change of pattern of cough in a
long-time smoker, haemoptysis
Recurrent or chronic cough with or
without wheezing or dyspnoea
Nocturnal cough, frequent
heartburn, swallowing disorder
History of foreign body aspiration
(may be forgotten)
Onset of cough immediately after
exposure
Initial dry cough usually followed
by varying sputum production
dependent on the cause; systemic
symptoms of infection
of purulent, often foul-smelling
sputum
haemoptysis
(continued)
289
290
Table 7.9 (continued)
Causes of cough with their anatomic
locations Mechanism
Chronic inltrative or brosing
lung disease
Pulmonary oedema (cardiac or
non-cardiac)
Oesophagus
Swallowing disorders As in aspiration Frequent choking on food or drink
Oesophagotracheal and
oesophagobronchial stula
Heart and blood vessels
Left-side heart failure As in pulmonary oedema As in pulmonary oedema, nocturnal
Aortic aneurysm, left atrial
enlargement
Pulmonary thromboembolism Largely unknown; irritation of
Mediastinum
Mediastinal tumours Airway compression and
Pleura
Pleural effusion Irritation of pleural cough receptors,
External ear canal and tympanic
membrane
No organic causes
Psychogenic cough Habit cough (respiratory tic) Dry cough, absent during sleep
Intentional cough Deliberate cough for attention
Drug-induced cough (angiotensin-
converting enzyme inhibitors)
Irritation of peripheral receptors,
distortion of airways
Hypersecretion, airway
hyperreactivity from congestion
Stimulation of cough by passage of
swallowed liquid to airways
Compression of large airways Non-productive cough
peripheral or pleural cough receptors
with infarct
deformation
airway deformation with large
effusion
Stimulation of cough receptors by
hair, cerumen or foreign body
seeking or other personal gain
Not known Dry, annoying and often incessant
7 History andExamination ofOropharynx
Characteristic features and major
associated symptoms
Chronic dry cough, progressive
dyspnoea
Acute cough with severe dyspnoea,
frothy and blood-tinged sputum
Coughing upon swallowing liquids
cough
Acute cough, dyspnoea,
haemoptysis
Non-productive, ‘brassy’ cough,
sometimes related to body position
Dry cough, chest pain, dyspnoea
Occasional cause of dry cough
eliminated by removing the cause
Dry and noisy cough occurring only
in the presence of people
cough, disappearing after stopping
the drug
7.3 Colour Atlas
ofOropharyngeal Diseases
7.3.1 Clinical Atlas
ofOropharyngeal Diseases