Anatomy: The pharynx is the medical term used to define the throat. It is divided into three subunits: The nasopharynx, the oropharynx, and the hypopharynx. Overall, the pharynx acts as a conduit to pass all substances inhaled or swallowed. Therefore, abnormalities of the pharynx can lead to difficulties in the functions of swallowing and breathing. We will discuss the subunits of the pharynx separately.
Nasopharynx: As the name implies, the nasopharynx is the portion of the throat or pharynx that lies directly behind the nasal cavities. It is where the adenoids lie and also where the Eustachian tubes that connect the throat to the ears can be found. Tumors or infections in this are can cause a variety of symptoms such as nose bleeds, nasal congestion, and backup of fluid into the ears causing ear infections and hearing loss. Symptoms such as nasal congestion and bleeding from the nose are concerning if they progress and worsen with time. Having an evaluation by a head and neck surgeon becomes increasingly important as more time passes with such symptoms. This is especially true if symptoms are worse on one side. In the complete evaluation, nasal endoscopy will likely be necessary to get a good look at the internal structures of the nose and nasopharynx to make sure no tumors are present.
Oropharynx: The oropharynx is the portion of the throat that is visible through the mouth. The tonsils, soft palate, uvula, and the base of tongue are all parts of the oropharynx. The oropharynx is a major area of airway blockage while sleeping, leading to snoring and, in extreme cases, sleep apnea. This is surprising to most people because many incorrectly believed that snoring is caused by obstruction at the level of the nose.
The oropharynx is a common site of throat infections. The best example is tonsillitis, which is an infection inducing swelling and inflammation of the tonsils. Pain is a major factor during oropharyngeal infections because the area is often in a state of motion due to constant swallowing. Generally, infections will run their course over a few weeks. With antibiotic therapy, bacterial infections may resolve much faster. In any case, if pain or discomfort last longer than a few weeks you should see a doctor. Evaluation by a head and neck surgeon will often be recommended to rule out any dangerous conditions.
Tumors of the oropharynx can cause a variety of symptoms including pain, airway blockage, and bleeding. The type and severity of symptoms will depend on the location of the tumor and whether it is benign or cancerous. Keep in mind, however, that symptoms alone can never predict whether a tumor is benign or malignant. Any tumor that lasts more that a few weeks should be evaluated by a head and neck surgeon as it will likely need to be biopsied.
Hypopharynx: The hypopharynx is the lowest portion of the pharynx. It is the lowest portion of the throat and the last area where food, liquid and air pass together. Below this area, air will go in front through the voice box into the lungs and food and liquid will pass in back into the esophagus towards the stomach. Similar to the other subunits of the pharynx, infections and tumors can affect the hypopharynx and cause symptoms of pain, bleeding, and airway obstruction. Again, all throat symptoms lasting more than a few weeks are concerning and should be evaluated by a head and neck surgeon. In the case of the hypopharynx, this is especially important as the evaluation will usually include an office endoscopy. This procedure allows inspection of the lower portion of the throat which is not visible through the mouth and also of the upper nasopharynx which is behind the nasal airway. Endoscopy is a relatively quick office procedure that can provide significant diagnostic information and, in some cases, lead to early diagnosis of a malignant tumor.
Throat Cancer: Pharyngeal cancer is also related to tobacco and alcohol abuse. Alcohol and tobacco are even more dangerous when combined. Symptoms vary and can include pain, bleeding, swallowing difficulty, and shortness of breath. Unlike oral cancer, treatment of throat cancer will more often depend on radiation than chemotherapy. Surgery can still be used for small cancers or in cases where radiation and chemotherapy are not successful in curing the throat cancer. Usually, however, surgery will be left as a last option so that as to avoid removing tissue that is important to the speech and swallowing functions.