Otorhinolaryngology (ENT)
Oesophagus, Thyroid and Miscellaneous ENT Conditions
Oesophageal and thyroid ENT topics for MBBS: dysphagia, pharyngeal pouch, Plummer-Vinson syndrome, thyroid swellings and surgical complications, mapped to NMC codes EN3 and EN4.
MedNext Academy | 3 min read
Oesophagus, Thyroid and Miscellaneous ENT Conditions
Oesophageal and thyroid ENT topics for MBBS: dysphagia, pharyngeal pouch, Plummer-Vinson syndrome, thyroid swellings and surgical complications, mapped to NMC codes EN3 and EN4.
This chapter gathers the oesophageal, thyroid and miscellaneous problems that fall to the ENT surgeon. It covers dysphagia and its causes, swallowed foreign bodies and corrosive injury, pharyngeal pouch and Plummer-Vinson syndrome, thyroid swellings and their surgical complications, and common throat symptoms such as globus and reflux.
High-yield: Oesophagus, Thyroid and Miscellaneous ENT Conditions
- Dysphagia that is progressive and painless, especially in an older person, raises concern for oesophageal carcinoma.
- A swallowed foreign body most often lodges at the cricopharyngeal sphincter, the narrowest point of the oesophagus.
- A pharyngeal pouch (Zenker diverticulum) causes regurgitation of undigested food, halitosis and a gurgling neck swelling in the elderly.
- Plummer-Vinson syndrome is iron deficiency anaemia with a post-cricoid web and dysphagia, and carries a risk of post-cricoid carcinoma.
- A sharp or button battery in the oesophagus needs urgent removal because a battery can cause rapid corrosive perforation.
- The thyroid gland moves up on swallowing because it is enclosed in the pretracheal fascia.
- A large multinodular goitre can cause tracheal compression, stridor and retrosternal extension.
- A solitary thyroid nodule that is hard, fixed or associated with a hoarse voice raises concern for malignancy.
- Recurrent laryngeal nerve injury is a recognised complication of thyroid surgery and causes vocal cord palsy.
- Hypocalcaemia from inadvertent parathyroid injury is another important complication after total thyroidectomy.
- Corrosive ingestion can cause oesophageal burns and later stricture, and early endoscopy assesses the extent.
- Globus sensation is a persistent feeling of a lump in the throat without a true swallowing difficulty and needs other causes excluded first.
- Reflux of stomach acid to the larynx (laryngopharyngeal reflux) can cause throat clearing, hoarseness and a globus feeling.
- Any progressive dysphagia deserves endoscopy to exclude an oesophageal or post-cricoid tumour.
Causes of dysphagia to remember
- **Oesophageal carcinoma:** Progressive painless dysphagia, weight loss, in an older person.
- **Pharyngeal pouch (Zenker):** Regurgitation of food, halitosis, gurgling neck swelling in the elderly.
- **Plummer-Vinson syndrome:** Iron deficiency, post-cricoid web, dysphagia. Risk of post-cricoid cancer.
- **Foreign body / corrosive:** Impacts at cricopharynx; button battery needs urgent removal.
NMC competencies in this chapter
- **EN3.5:** Diseases of the oesophagus relevant to ENT practice
- **EN4.52:** Dysphagia, oesophageal foreign bodies and disorders
- **EN4.53:** Thyroid swellings and miscellaneous ENT conditions
Frequently Asked Questions
What causes progressive painless dysphagia in an older person?
It should be treated as oesophageal carcinoma until proven otherwise. Endoscopy is needed to look for a tumour or a post-cricoid lesion and to obtain a biopsy.
What is a pharyngeal pouch?
A Zenker diverticulum, an outpouching at the weak area above the cricopharyngeus. It causes regurgitation of undigested food, bad breath and a gurgling neck swelling, usually in older patients.
What is Plummer-Vinson syndrome?
The combination of iron deficiency anaemia, a post-cricoid oesophageal web and dysphagia. It is important because it carries a risk of post-cricoid carcinoma.
What are the main complications of thyroid surgery?
Recurrent laryngeal nerve injury causing vocal cord palsy and hypocalcaemia from parathyroid damage are the key complications, along with bleeding that can compress the airway.
Continue reading
MBBSAll Otorhinolaryngology (ENT) chapters
Continue through the Otorhinolaryngology (ENT) chapter map.
Continue studying Otorhinolaryngology (ENT)
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans