sore throat
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7/21/2019 Sore Throat
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SORE THROAT
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ANATOMY
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TONSILLITIS
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-Large body of lymphoid tissue.
-Role is still controversial:
URTI multiple in tonsilar crypt lymphoid tissuemanufactures antibodies enlargement of tonsil
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Tonsillitis
• Inflammation of tonsil, causing sore throat:
• > Acute - viral / bacterial
•
> Sub-acute - bacterium Actinomyces• > Chronic – bacterial
• Etiology:
• Virus ( 80 % ) adenovirus, enterovirus, EBV
• Bacteria ( 20 % ) mainly Group A Strep, M pneumonia
• Fungal Candida sp.
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Grading the size of tonsils
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Tonsillitis
• History
- Viral sore throat ( often mild ) dysphagia ,URTI
symptoms
- Bacterial
sore throat ( may be severe ) , URTIsymptoms
- Referred pain to ear
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Tonsillitis
• Physical examination
- Viral afebrile , absent / mild tonsillar exudates, minor
and non-tender adenopathy, viral exanthems
- Bacterial
febrile , tonsillar erythema and exudates,enlarged > 1cm and tender anterior cervical lymph node
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Jugulo- diagastic node
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Tonsillitis
• Investigations
- buccal swab for culture and sensitivity test to identify
organism
- CBC for elevated WBC and lymphocytes
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Tonsillitis
• Complications :
- Chronic tonsillitis
- Peritonsillar abcess
- Septicemia- Snoring , obstructive sleep apnea
- Rheumatic fever
- Acute otitis media
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Tonsillitis
• Management
- Saline gargle
- Analgesics & Antipyretics PCM, Ibuprofen
- Increase fluid intake- Soothing lozenges
- Antibiotics for GAS penicillin
- Consider tonsillectomy if recurrent
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Tonsillectomy
• Absolute indications
- Sleep disordered breathing
- Recurrent throat infections
- Tonsillar hypertrophy causing UAO, OSA, severedysphagia
- Suspicion of maglinancy
- Orofacial / dental deformities
- Hemorrhagic tonsillitis
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Tonsillectomy
• Relative indications
- Recurrent throat infections ( at least 7 episodes / year ; 5
episodes /year for 2 yr ; 3 episodes / year for 3 yr ) + sore
throat & 1 / more the following :
T0 > 38.3 0C ; cervical adenopathy ; tonsillar exudates ; +
GAS ( Paradise criteria )
- Chronic tonsillitis with bad halitosis / sore throat
- Complications of tonsilitis- FTT
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Tonsillectomy
• Relative contraindications
- Velopharyngeal insufficiency : covert of cleft palate ;
impaired palatal functions
- Hematologic functions : coagulopathy , anaemia- Infectious : active local infection w/o urgent obstructive
abnormalities
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Tonsillectomy
• Complications
- Hemorrhage : early – within 24h ; delayed 7-10d
- Odynophagia and / or otalgia : dehyration 20 to
odynophagia- Infection
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ACUTE PHARYNGITIS
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Definition
• Pharyngitis is inflammation of the pharynx, which
is in the back of the throat.
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Etiology
• Viral > 90%
- Rhinovirus - common cold
- Coronavirus - common cold
- Adenovirus - pharyngoconjunctival fever,
acute respiratory illness- Parainfluenza virus - common cold ;croup
- Coxsakie virus – herpangina
- EBV – infective mononucleosis
- HIV• Bacteria
- Group A beta haemolytic Strep
- Pneumococcus
- H. Influenza
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Symptoms
• Sore, dry, scrathcy throat
• sneezing
• runny nose
• headache• cough
• fatigue
• body aches
• chills
• fever (a low-grade fever with a cold and higher-grade fever with the flu)
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Symptoms of infectious mononucleosis
• swollen lymph nodes
• severe fatigue
• fever
• muscles aches
• general malaise
• loss of appetite
• rash
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Symptoms of strep throat
• difficulty in swallowing
• red throat with white or gray patches
• swollen lymph nodes
• fever
• chills
• loss of appetite
• nausea
• unusual taste in the mouth
• general malaise
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Diagnosis
• Culture of throat swab. 90% Group A streptococci.
Diphtheria cultured on special media.
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Treatment
- fluids, warm saline gargles, analgesics
- Streptococcal pharyngitis – Penicillin G/ benzathine
penicillin G. If allergy, use erythromycin.
- Diphtheria – antitoxin, penicillin / erythromycin
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CHRONIC
PHARYNGITIS(Chronic inflammatory condition of pharynx)
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• Common in adults who work or live in dusty surrounding,
faulty voice production (overuse) , suffer from chronic
cough, and habitually use alcohol and tobacco.
• Types :
- Chronic catarrhal pharyngitis – congestion, vascular
engorgement, increased secretions
- Chronic hypertrophic (granular) pharyngitis –
pharyngeal wall thick, edematous, congested mucosa and
dilated vessels.
- post. pharyngeal wall studded with reddish nodules dt
sub epithelial lymphoid follicle hypertrophy.
- uvula congested and elongated.
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Symptoms
-discomfort in throat, foreign body sensation in
throat,
voice tiredness, cough
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QUINSY
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Quinsy•
Definition: COLLECTION OF PUS AROUND THETONSIL (outside the tonsil capsule)
• Clinical features:
SYMPTOMS: Fever, headache, dehydration, dysphagia,odynophagia, drooling of saliva, difficulty/pain when openmouth, trismus, dysphonia(muffled voice), bad breath,unilateral referred otalgia, swelling around face or neck
SIGNS: Extensive peritonsillar swelling, oedema of softpalate, uvula deviation to unaffected side, cervicallymphadenitis
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• Complication: Airway obstruction, aspiration pneumonitis,
lung abscess, cellulitis of jaw/neck/chest, post-
streptococcal sequelae
• Management: Analgesics, antipyretics, lozenges/ gargles,
fluid & soft meals, antibiotics, needle aspiration,
INCISION & DRAINAGE, tonsillectomy
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GASTROESOPHAGEAL
REFLUX DISEASE
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GERD
• chronic symptom of mucosal damage caused by stomach
acid coming up from the stomach into the esophagus
• caused by changes in the barrier between
the stomach and the esophagus, including abnormal
relaxation of the lower esophageal splinter, whichnormally holds the top of the stomach closed, impaired
expulsion of gastric reflux from the esophagus
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Sign and symptoms
• Heartburn
• Regurgitation
• Sore throat
•
Dysphagia• Water brash
• Chest pain
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Causes
• Hiatus hernia
• Obesity
• Zollinger Ellison syndrome
•
High blood calcium
increase gastrin production
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Diagnosis
• Based on typical symptoms that are presence
• current gold standard for diagnosis of GERD is
esophageal pH monitoring
• Esophagogastroduodenoscopy
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Management
• lifestyle modifications (weight loss and elevating the head
of bed)
• Medication (proton-pump inhibitors, h2 receptor blocker
and antacid)
• Surgery- Nissen fundoplication
- upper part of the stomach is wrapped around the lower
esophageal sphincter to strengthen the sphincter and
prevent acid reflux and to repair a hiatal hernia
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