8 - Sore Throat

8/13/2019 8 - Sore Throat

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SORE THROAT

Done by :

Firas kafawi


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SORE THROAT

A condition characterized by pain or

discomfort on swallowing.

It is a symptom of a wide variety of mild to

serious diseases, disorders andconditions. Could result from: URTI,

adenoid disorders, tonsillitis, allergy,

laryngitis, pharyngitis, trauma, GERD,

malignancy, AW obstruction and other

abnormal processes.

Can occur in any age group or population.


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Cont

Depending on the cause, a sore throat can

be short-term and disappear quickly or

chronic and ongoing over a long period of

time.

A sore throat often occurs in conjunction

with other symptoms such as fever,

swallowing difficulties, swollen

glandsetc.


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Cont

Diagnosis depends on History and

physical examination and lab tests.

Treatment of a sore throat involves

diagnosing and treating the underlyingdisease, disorder or condition causing it.

Drink warm liquids, honey or lemon tea

can help.


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TONSILLITIS


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WALDEYER'S TONSILLAR RING, CONSISTING OF AN UNPAIRED

PHARYNGEAL TONSIL IN THE ROOF OF THE PHARYNX, PAIRED

PALATINE TONSILS AND LINGUAL TONSILS SCATTERED IN THE

ROOT OF THE TONGUE.


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Tonsillitis

It is inflammation of the palatine tonsils.

Acute vs. Chronic.

Can occur in any age but more commonly

in children < 9 years old.

Spread by droplet infection.

Commonest in winter and spring.

3/10/2010 9


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Etiology

Viral (most common)

adenovirus, rhinovirus ,influenza

Bacterial (2ndm.comm.)- GABHS

- Others (s.aureus, strep.pn, mycoplasma.pn,

chlamydia.pn)less common


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Symptoms

Sore throatmay last >48 h.

Dysphagia and odynophagia.

Malaise.

Headache. Otalgia referred pain.

Halitosis.

Voice changes.


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Signs

Enlarged tonsils and hyperemic +/-

exudate pus.

Pharyngeal wall inflamed.

Pyrexia

may lead to febrile convulsionsin susceptible infants.

Tender and enlarged cervical lymph nodes

especially jugulodigastric.


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Acute tonsillitis DDx

Infect ion

- Acute tonsillitis

- Infectious mononucleosis

- Diphtheria

- Vincent's angina

Neoplasm- Squamous cell carcinoma of the

tonsil

- Lymphoma

- Salivary gland tumours

Bloo d diseases- Agranulocytosis

- Leukaemia

Other causes- Aphthous ulcer

- Behcet's syndrome

- AIDS

There are several causes that may induce inflamedtonsils or ulceration:


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Diphtheria

Very rare

insidious onset

characterized by a grey membrane

(difficult to remove) on the tonsils, faucesand uvula.

Pyrexia usually low and diagnosis is

confirmed by examination and culture of a

swab.


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Investigations

CBC.

Throat swabs.

ASO titre.


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Treatment

Aim of Tt:

- prevention of complications.

- symptomatic improvement.

- bacterial eradication.

- prevention of contamination.

- reducing unnecessary antibiotic use.


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Treatment

Bed rest.

Soft diet with fluid replacement.

Warm salt water gargle to relieve sore

throat. Analgesics and antipyretics.

Antibiotic in case of bacterial

- Penicillin 1stline.

- Erythromycinif allergy to penicillin. In case of viral cause, the length of illness depends

on the virus involved.


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Complications

Local :- peritonsillar abscess.

- retropharyngeal abscess.

- parapharyngeal abscess.- chronic tonsillitis.

Regional:- OM.

- laryngitis.

- bronchitis.

- GE.

- cervical lymphadenitis.

- Cavernous sinus thrombosis.

Systemic:- rheumatic fever.

- Acute GN.

- septicemia.- arthritis.

- scarlet fever (strep tonsillitis +

erythematous rash + strawberry

tongue)

Immune

complex

deposition 2

to strep.tonsil


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Peritonsillar abscess

(Quinsy)

Defini t ion:- collection of pus forming outside the capsule of the

tonsil in close relationship to its upper pole.

Etio logy:The infection spreads to the peritonsillar area (peritonsillitis).

This region comprises loose connective tissuesusceptible to

formation of abscess. Both aerobic and anaerobic bacteria can

be causative. Commonly involved species

include streptococci, staphylococciand hemophilus.

Epidemiology:- occur as complication of acute tonsillitis.

- more in adults (15-30) than in children.
http://en.wikipedia.org/wiki/Streptococcihttp://en.wikipedia.org/wiki/Staphylococcihttp://en.wikipedia.org/wiki/Hemophilushttp://en.wikipedia.org/wiki/Hemophilushttp://en.wikipedia.org/wiki/Staphylococcihttp://en.wikipedia.org/wiki/Streptococci


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Clinical features

Fever, dehydration.

severe dysphagia

Edema of soft palate

Uvular deviation (downward and medially) Involvement of motor branch of CN V

increased salivation and trismus (Persistentcontraction of the masseter muscles due to failure of central

inhibition)

Hot potato voice

Unilateral referred otalgia


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Complications

AW obstruction

Bacteremia

Aspiration pneumonia secondary to

rupture of abscess


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Treatment

IV antibioticswithout delay

surgical incision and drainage of pus

forming outside the capsule -- relieving the

pain dramatically.

Under general anesthesiain children

and anxious pts.


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THANK YOU

8 - Sore Throat

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