SORE THROAT
ANATOMY
TONSILLITIS
-Large body of lymphoid tissue.
-Role is still controversial:
URTI multiple in tonsilar crypt lymphoid tissue
manufactures antibodies enlargement of tonsil
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.
Grading the size of tonsils
Tonsillitis
History
- Viral sore throat ( often mild ) dysphagia ,URTI
symptoms
- Bacterial sore throat ( may be severe ) , URTI
symptoms
- Referred pain to ear
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
Jugulo- diagastic node
Tonsillitis
Investigations
- buccal swab for culture and sensitivity test to identify
organism
- CBC for elevated WBC and lymphocytes
Tonsillitis
Complications :
- Chronic tonsillitis
- Peritonsillar abcess
- Septicemia
- Snoring , obstructive sleep apnea
- Rheumatic fever
- Acute otitis media
Tonsillitis
Management
- Saline gargle
- Analgesics & Antipyretics PCM, Ibuprofen
- Increase fluid intake
- Soothing lozenges
- Antibiotics for GAS penicillin
- Consider tonsillectomy if recurrent
Tonsillectomy
Absolute indications
- Sleep disordered breathing
- Recurrent throat infections
- Tonsillar hypertrophy causing UAO, OSA, severe
dysphagia
- Suspicion of maglinancy
- Orofacial / dental deformities
- Hemorrhagic tonsillitis
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
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
Tonsillectomy
Complications
- Hemorrhage : early within 24h ; delayed 7-10d
- Odynophagia and / or otalgia : dehyration 20 to
odynophagia
- Infection
ACUTE PHARYNGITIS
Definition
Pharyngitis is inflammation of the pharynx, which
is in the back of the throat.
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
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)
Symptoms of infectious mononucleosis
swollen lymph nodes
severe fatigue
fever
muscles aches
general malaise
loss of appetite
rash
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
Diagnosis
Culture of throat swab. 90% Group A streptococci.
Diphtheria cultured on special media.
Treatment
- fluids, warm saline gargles, analgesics
- Streptococcal pharyngitis Penicillin G/ benzathine
penicillin G. If allergy, use erythromycin.
- Diphtheria antitoxin, penicillin / erythromycin
CHRONIC
PHARYNGITIS
(Chronic inflammatory condition of pharynx)
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.
Symptoms
-discomfort in throat, foreign body sensation in
throat,
voice tiredness, cough
QUINSY
Quinsy
Definition: COLLECTION OF PUS AROUND THE
TONSIL (outside the tonsil capsule)
Clinical features:
SYMPTOMS: Fever, headache, dehydration, dysphagia,
odynophagia, drooling of saliva, difficulty/pain when open
mouth, trismus, dysphonia(muffled voice), bad breath,
unilateral referred otalgia, swelling around face or neck
SIGNS: Extensive peritonsillar swelling, oedema of soft
palate, uvula deviation to unaffected side, cervical
lymphadenitis
Complication: Airway obstruction, aspiration pneumonitis,
lung abscess, cellulitis of jaw/neck/chest, poststreptococcal sequelae
Management: Analgesics, antipyretics, lozenges/ gargles,
fluid & soft meals, antibiotics, needle aspiration,
INCISION & DRAINAGE, tonsillectomy
GASTROESOPHAGEAL
REFLUX DISEASE
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, which
normally holds the top of the stomach closed, impaired
expulsion of gastric reflux from the esophagus
Sign and symptoms
Heartburn
Regurgitation
Sore throat
Dysphagia
Water brash
Chest pain
Causes
Hiatus hernia
Obesity
Zollinger Ellison syndrome
High blood calcium increase gastrin production
Diagnosis
Based on typical symptoms that are presence
current gold standard for diagnosis of GERD is
esophageal pH monitoring
Esophagogastroduodenoscopy
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
