Diphtheria is an infection caused by the bacterium Corynebacterium diphtheriae. Signs and symptoms may vary from mild to severe. They usually start two to five days after exposure. Symptoms often come on fairly gradually, beginning with a sore throat and fever. In severe cases, a grey or white patch develops in the throat. This can block the airway and create a barking cough as in croup. The neck may swell in part due to enlarged lymph nodes.

The disease may remain manageable, but in more severe cases, lymph nodes in the neck may swell, and breathing and swallowing are more difficult. People in this stage should seek immediate medical attention, as obstruction in the throat may require intubation or a tracheotomy. Abnormal cardiac rhythms can occur early in the course of the illness or weeks later, and can lead to heart failure. Diphtheria can also cause paralysis in the eye, neck, throat, or respiratory muscles. Patients with severe cases are put in a hospital intensive care unit and given a diphtheria antitoxin (consisting of antibodies isolated from the serum of horses that have been challenged with diphtheria toxin). Since antitoxin does not neutralize toxin that is already bound to tissues, delaying its administration increases risk of death. Therefore, the decision to administer diphtheria antitoxin is based on clinical diagnosis, and should not await laboratory confirmation.
Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The Centres for Disease Control and Prevention recommends either:
Metronidazole
Erythromycin is given (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), or
Procaine penicillin G is given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg); patients with allergies to penicillin G or erythromycin can use Rifampicin or clindamycin.

Cholesteatoma is a special form of chronic otitis media in which keratinizing squamous epithelium grows from the tympanic membrane or the auditory canal into the middle ear mucosa or mastoid. The presence of abnormal epithelium in an abnormal location triggers an inflammatory response that can destroy surrounding structures such as the ossicles. Cholesteatomas may be congenital or acquired later in life. Acquired cholesteatomas are usually associated with chronic middle ear infection. Cardinal symptoms are painless otorrhea and progressive hearing loss. Important diagnostic procedures include mastoid process x-rays, temporal bone CT scans, and audiometric tests. Left untreated, erosion of the surrounding bone by a cholesteatoma can lead to facial nerve palsy, extradural abscess, and/or sigmoid sinus thrombosis. Therefore, even if a cholesteatoma is asymptomatic, surgery is always indicated. Surgical treatment involves tympanomastoidectomy to excise the cholesteatoma, followed by repair of the damaged middle ear structures.

Sjogren syndrome (SS) is a long-term autoimmune disease that affects the body’s moisture-producing glands. Primary symptoms are a dry mouth and dry eyes. Other symptoms can include dry skin, vaginal dryness, a chronic cough, numbness in the arms and legs, feeling tired, muscle and joint pains, and thyroid problems. Those affected are at an increased risk (5%) of lymphoma. It primarily affects women in their peri and post-menopausal years of life.

The preauricular sinus is a benign congenital malformation of the preauricular soft tissues. Mostly it is noted during routine ear, nose and throat examination, though can present as an infected and discharging sinus. Preauricular sinus is more often unilateral, only occasionally are bilateral forms inherited. The right side is more often involved and females more than males. Most sinuses are clinically silent, eventual, however not rare, appearance of symptoms is related to an infectious process. Erythema, swelling, pain and discharge are familiar signs and symptoms of infection. The most common pathogens causing infection are Staphylococcal species and, less frequently Proteus, Streptococcus and Peptococcus species.

Courses of treatment typically include the following:
– Draining the pus occasionally as it can build up a strong odour
– Antibiotics when infection occurs.
– Surgical excision is indicated with recurrent fistula infections, preferably after significant healing of the infection.
In case of a persistent infection, infection drainage is performed during the excision operation. The operation is generally performed by an appropriately trained specialist surgeon e.g. a otolaryngologist or a specialist General Surgeon.
The fistula can be excised as a cosmetic operation even though no infection appeared. The procedure is considered an elective operation in the absence of any associated complications.

Patients with a Quinsy or peritonsillar abscess (PTA) typically present with a history of acute pharyngitis accompanied by tonsillitis and worsening unilateral pharyngeal discomfort. Patients also may experience malaise, fatigue, and headaches. They often present with a fever and asymmetric throat fullness. Associated halitosis, odynophagia, dysphagia, and a hot potato–sounding voice occurs.
The presentation may range from acute tonsillitis with unilateral pharyngeal asymmetry to dehydration and sepsis. Most patients have severe pain. Examination of the oral cavity reveals marked erythema, asymmetry of the soft palate, tonsillar exudation, and contralateral displacement of the uvula.
Indications for considering the diagnosis of a PTA include the following:
Unilateral swelling of the peritonsillar area
Unilateral swelling of the soft palate, with anterior displacement of the ipsilateral tonsil
Nonresolution of acute tonsillitis, with persistent unilateral tonsillar enlargement
A PTA ordinarily is unilateral and located at the superior pole of the affected tonsil, in the supratonsillar fossa. At the level of the supratonsillar fold, the mucosa may appear pale and even show a small pimple. Palpation of the soft palate often reveals an area of fluctuance. Flexible nasopharyngoscopy and laryngoscopy are recommended in patients experiencing airway distress. The laryngoscopy is key to ruling out epiglottitis and supraglottitis, as well as vocal cord pathology.

A thyroglossal duct cyst (TGDC) is the most common mass found in the midline of the neck. The mass is usually located at or below the level of the hyoid bone, although a TGDC can be located anywhere from the foramen cecum to the level of the thyroid gland.
Most patients with a TGDC present with asymptomatic masses in the midline of the neck.
Recurrent inflammation associated with infection of a TGDC is not uncommon. When an infection is present, the cyst often enlarges and an abscess may form. Spontaneous rupture with secondary sinus tract formation can also occur.

The surgical treatment of choice for thyroglossal cysts is the Sistrunk operation, in which an en block resection of the sinus tract and above (including the midportion of the hyoid bone) is performed. Recurrence is approximately 3-5% and is increased by incomplete excision and a history of recurrent infections.

Congenital neck masses are developmental anomalies typically seen in infants or children. Common conditions include thyroglossal duct cysts, branchial cleft cysts, and cystic hygromas. These malformations present as painless neck masses, which can cause dysphagia, respiratory distress, and neck pain due to compression of surrounding structures. The location of the mass depends on the embryological structure the cysts arise from. Diagnosis is made based on clinical findings and imaging results (ultrasound, CT, MRI), which also help in surgical planning. Treatment consists of complete surgical resection to prevent recurrence and complications such as infection or abscess formation.
The thyroglossal cyst is present from birth and usually detected during early childhood. It presents as a painless, firm midline neck mass, usually near the hyoid bone, which elevates with swallowing and tongue protrusion. May cause dysphagia or neck/throat pain if the cyst enlarges.

Unilateral vocal fold paralysis (UVFP) occurs from a dysfunction of the recurrent laryngeal (inferior laryngeal nerve) or vagus nerve innervating the larynx. It causes a characteristic breathy voice often accompanied by swallowing disability, a weak cough, and the sensation of shortness of breath. This is a common cause of neurogenic hoarseness. When this paralysis is properly evaluated and treated, normal speaking voice is typically restored. Specifically, thyroidectomy, carotid endarterectomy, anterior cervical spine surgery, thoracic, or mediastinal surgery most often result in a presentation of UVFP.

This patient has aphonia due to bilateral damage to the recurrent laryngeal nerve. Bilateral recurrent laryngeal nerve (RLN) injury is rare for benign thyroid lesions (0.2%). After extubation-stridor, respiratory distress, aphonia occurs due to the closure of the glottic aperture necessitating immediate intervention and emergency intubation or tracheostomy. Intra-operative identification and preservation of the RLN minimizes the risk of injury.
The recurrent laryngeal nerves control all intrinsic muscles of the larynx except for the cricothyroid muscle. These muscles act to open, close, and adjust the tension of the vocal cords, and include the posterior cricoarytenoid muscles, the only muscle to open the vocal cords. The nerves supply muscles on the same side of the body, with the exception of the interarytenoid muscle, which is innervated from both sides.

The nerves also carry sensory information from the mucous membranes of the larynx below the lower surface of the vocal fold, as well as sensory, secretory and motor fibres to the cervical segments of the oesophagus and the trachea.

A cholesteatoma consists of squamous epithelium that is trapped within the skull base and that can erode and destroy important structures within the temporal bone. They often become infected and can result in chronically draining ears. Treatment almost always consists of surgical removal. The majority (98%) of people with cholesteatoma have ear discharge or conductive hearing loss or both in the affected ear.

Other more common conditions (e.g. otitis externa) may also present with these symptoms, but cholesteatoma is much more serious and should not be overlooked. If a patient presents to a doctor with ear discharge and hearing loss, the doctor should consider cholesteatoma until the disease is definitely excluded.

Other less common symptoms (all less than 15%) of cholesteatoma may include pain, balance disruption, tinnitus, earache, headaches and bleeding from the ear. There can also be facial nerve weakness. Balance symptoms in the presence of a cholesteatoma raise the possibility that the cholesteatoma is eroding the balance organs in the inner ear.