Dear doctor;

I have had difficulty swallowing for six days now. But the onset found me in the village and my relatives say something must be removed from my throat. In the past, I have seen people in the village have something, maybe the epiglottis, cut apparently to cure a disease. Is this a medical practice or will antibiotic tablets help me?

Uwimana 19.

Dear Uwimana,

Is it the first time you have this problem of difficulty in swallowing or is it recurrent? Along with it, is there throat pain, headache and or fever?

The most common cause for difficulty in swallowing (dysphagia) in a young adult is inflammation of the tonsils known as tonsillitis. This occurs due to bacterial infections like staphylococcus and streptococci.  These microbes are usually present in the mouth as commensals. In conditions of reduced immunity they may multiply and cause inflammation of the throat. The infection can be acquired  through droplets present in the atmosphere.  This results in pain and redness causing pain in swallowing and speaking. It is completely curable by antibiotics and anti inflammatory medicines.

At times dysphagia can occur due to fungal infections of the throat, tongue and or palate (roof of oral cavity) or proximal portion of the esophagus or food pipe .Inflammation of the proximal portion of food pipe also causes painful swallowing.  This infection is also curable by antifungal drugs. One may have difficulty in swallowing due to narrowing of the proximal portion of the esophagus, which can be due to malignancy or chronic inflammation but this is not common in young adults. This condition is diagnosed by endoscopy or barium meal X-ray and is treatable by surgery.

Ulcers anywhere in the oral cavity due to very hot spicy food, loose tooth, some sexually transmitted diseases, anaerobic infections can make swallowing difficult. These are all curable conditions. Tumors  of the esophagus can make swallowing difficult  but  are rare in young age(exception being Kaposi’s sarcoma which occurs in immune compromised people). Here also the pain is reduced after palliative therapy including surgery. There is absolutely no need for undergoing the tradition curettage where the uvula (a fibrous strand from palate) or part of tonsils is cut. This surgery is mostly done by unskilled hands and sterile measures are not adopted. Severe infection, sepsis and even death are the sequel to this kind of traditional treatment. Best way is to consult in a hospital and take complete course of medicines after cause is detected by investigations.