This symptom can mean several things, and a careful history is necessary to tease out the precise problem: Difficulty in initiating swallowing; a sensation of food sticking somewhere; painful swallowing; also included here is the sensation of ‘something in the throat’ even when not trying to swallow anything.
Hoarseness may start suddenly and last a few days (acute), or arise gradually and continue for weeks or months (chronic). The history will clarify this and point the way forward in management. Acute hoarseness rarely causes any diagnostic problem or concern; the less common chronic case raises more worrying possibilities and usually requires referral.
A lump in the neck usually means just one thing to a patient: Cancer. This is rarely the cause in practice, and a careful examination and explanation can be more anxiolytic than a bucket-load of benzodiazepines. Occasionally, further investigation is needed. For a more detailed analysis of ‘Swollen glands’, including cervical glands, see the ‘Swollen glands’ section.
This presenting symptom is the king of superlatives in general practice. It is the commonest – the average GP will see about 120 cases each year – the most over-treated, the most controversial and usually the most mundane. It is also probably the most welcome, as consultations are often short, even when self-management is explained rather than a prescription given.
The most common causes of acute neck stiffness are benign and easily managed in general practice. However, this symptom causes disproportionate panic in parents of febrile children thanks to extensive media coverage of meningitis. This anxiety can spill over into adult illness behaviour, with the result that a troublesome but harmless symptom may be misinterpreted as the harbinger of serious pathology.
Acute stridor is a very frightening experience for both child and parents. The respiratory effort can lead to hyperventilation, making things worse. ‘Difficult’ or ‘noisy’ breathing in a child quite commonly leads to a request for an out-of-hours visit in winter. The usual cause is viral croup, producing mild, harmless stridor – but serious cases do occur. A calm exterior and a methodical approach are the keys to effective management.