Otolaryngology Book

http://www.fpnotebook.com/

PharyngitisAka: Sore Throat

Advertisement

  1. Epidemiology
    1. One of four most common episodic clinic visit reasons
  2. Anatomy: Waldeyer's tonsillar ring
    1. Nasopharynx
      1. Adenoids (pharyngeal tonsils) at posterior wall
    2. Oropharynx
      1. Faucial (palatine tonsils) at lateral wall)
    3. Hypopharynx
      1. Lingual tonsil at Tongue base
  3. Causes
    1. See Pharyngitis Causes
  4. Symptoms
    1. Sore Throat
    2. Dysphagia (Difficulty swallowing)
    3. Odynophagia (pain with swallowing)
    4. Generalized symptoms
      1. Fever, Chills, Malaise
      2. Headache
      3. Abdominal Pain
      4. Nausea or Vomiting
    5. Symptoms suggestive of viral illness
      1. Coryza
      2. Conjunctivitis
      3. Hoarseness
  5. Signs
    1. Viral
      1. Non-exudative pharyngeal erythema
        1. Exception: Tonsillar exudate in Mononucleosis (EBV)
      2. Vesicular OR ulcerative oral lesions
      3. Conjunctivitis in Adenovirus and Kawasaki Disease
    2. Streptococcus and other bacteria
      1. Enlarged tonsils with or without exudate
      2. Petechiae on Soft Palate (pathognomonic)
      3. Erythema
      4. Tender cervical Lymphadenopathy
      5. Strawberry Tongue (in Scarlet Fever)
    3. Peritonsillar Cellulitis or Peritonsillar Abscess
      1. Unilateral erythema of Soft Palate
      2. Uvula deviated
      3. Dysphagia
      4. Odynophagia
      5. Fever
    4. Diphtheria
      1. Gray membranous exudate covers tonsils and pharynx
      2. Exudate bleeds easily on removal
    5. Kawasaki Disease
      1. Pharyngitis with strawberry Tongue in age <5 years
      2. Non-purulent Conjunctivitis (also in Adenovirus)
      3. Palmar erythema and cracked red lips after 3 days
  6. Diagnosis
    1. See Strep Score
  7. Labs
    1. Leukocytosis on Complete Blood Count (CBC)
      1. WBC greater than 12.5 with bacterial Pharyngitis
      2. Lymphocytes more than 10% atypical in EBV
    2. Streptococcal Rapid Antigen Test
    3. Throat Culture
    4. Epstein Bar Virus (Mononucleosis)
      1. Mono-Spot (False negative in young children)
      2. Heterophil Antibody Test (Positive if Titre >= 1:56)
    5. Diphtheria: Fluorescent antibody
    6. Fungus: Sabouraud dextrose agar Fungal Culture
    7. Gonorrhea Culture
    8. Consider laryngoscopy for severe or refractory symptoms
  8. Management
    1. Sore Throat Symptomatic Treatment
    2. Group A Streptococcal Pharyngitis
      1. AntibioTic Management
    3. Consider other important etiologies if atypical
      1. Kawasaki Disease
      2. Diphtheria
      3. Gonorrhea
      4. Epiglottitis
      5. Bacterial Tracheitis
  9. References
    1. Degowin (1987) Diagnostic Exam p. 149-151
    2. Gwaltney in Mandell (2000) Infectious Dis, p. 656-61
    3. Vincent (2004) Am Fam Physician 69(6):1465

Navigation Tree