Tongue Lesions: When to Seek ENT Evaluation - Otolaryngology

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When it comes to tongue lesions, particularly in an elderly patient like your father, it's important to approach the situation with caution and awareness of potential underlying issues. Given that your father is 87 years old and has experienced a tongue injury, there are several factors to consider regarding whether he should seek an evaluation from an Ear, Nose, and Throat (ENT) specialist.

Firstly, the presence of a white patch or lesion on the tongue can be indicative of several conditions. In many cases, such lesions may be benign and related to trauma, such as the injury from biting the tongue. The fact that he has been applying topical treatments and using mouth rinses suggests that you are already taking steps to manage the situation. However, the persistence of the lesion, especially if it has changed in appearance or has not improved after a reasonable period of home treatment (typically a week or two), warrants further investigation.

The characteristics of the lesion you described—specifically, the white patch that can be lifted and causes pain when manipulated—could potentially indicate a few different conditions. Some possibilities include:
1. Traumatic Ulcer: This is common after an injury and may take time to heal. If the lesion is not healing, it may require further evaluation to rule out other issues.

2. Candidiasis (Oral Thrush): This fungal infection can present as white patches on the tongue and may cause discomfort. It is more common in individuals with weakened immune systems, which can be a concern in older adults.

3. Leukoplakia: This condition presents as white patches that cannot be scraped off and may be benign or precancerous. It is important to monitor these lesions, especially in older adults or those with a history of tobacco use.

4. Oral Squamous Cell Carcinoma: While less common, any persistent lesion in the oral cavity, especially in an older adult, raises the concern for malignancy. Early detection is crucial for better outcomes.

Given these considerations, I would recommend that your father see an ENT specialist for a thorough evaluation. An ENT can perform a detailed examination of the oral cavity and may recommend a biopsy if there is any suspicion of a more serious condition. This is particularly important if the lesion has not improved or if there are any changes in size, color, or symptoms.

In addition to the physical examination, the ENT specialist may also inquire about other symptoms, such as difficulty swallowing, changes in taste, or any other systemic symptoms that might suggest a broader issue. They may also consider your father's overall health, medications, and any other risk factors that could contribute to oral lesions.

In summary, while some tongue lesions can be benign and self-limiting, the persistence of a lesion, especially in an elderly patient, should not be overlooked. Seeking an evaluation from an ENT specialist is a prudent step to ensure that any serious conditions are ruled out and to provide appropriate management for your father's symptoms. Early intervention can lead to better outcomes, so it is always better to err on the side of caution when it comes to health concerns, particularly in older adults.