SORE THROAT

Done by : Firas kafawi

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 and conditions. 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.

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.

Cont
Diagnosis depends on History and physical examination and lab tests. Treatment of a sore throat involves diagnosing and treating the underlying disease, disorder or condition causing it. Drink warm liquids, honey or lemon tea can help.

TONSILLITIS

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.

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

Etiology
Viral (most common) adenovirus, rhinovirus ,influenza Bacterial (2nd m.comm.)
- GABHS - Others (s.aureus, strep.pn, mycoplasma.pn, chlamydia.pn) less common

Symptoms
Sore throat may last >48 h. Dysphagia and odynophagia. Malaise. Headache. Otalgia referred pain. Halitosis. Voice changes.

Signs
Enlarged tonsils and hyperemic +/exudate pus. Pharyngeal wall inflamed. Pyrexia may lead to febrile convulsions in susceptible infants. Tender and enlarged cervical lymph nodes especially jugulodigastric.

Acute tonsillitis DDx

There are several causes that may induce inflamed tonsils or ulceration: Infection
- Acute tonsillitis - Infectious mononucleosis - Diphtheria - Vincent's angina

Blood diseases
- Agranulocytosis - Leukaemia

Other causes
- Aphthous ulcer - Behcet's syndrome - AIDS

Neoplasm
- Squamous cell carcinoma of the tonsil - Lymphoma - Salivary gland tumours

Infectious mononucleosis (glandular fever)

usually presents as severe membranous tonsillitis. EBV spread by close contact. The node enlargement is marked and malaise is more severe than expected from tonsillitis. Diagnosis confirmed by lymphocytosis within a week monospot test positive.

Diphtheria
Very rare insidious onset characterized by a grey membrane (difficult to remove) on the tonsils, fauces and uvula. Pyrexia usually low and diagnosis is confirmed by examination and culture of a swab.

Investigations
CBC. Throat swabs. ASO titre.

Treatment
Aim of Tt:
- prevention of complications. - symptomatic improvement. - bacterial eradication. - prevention of contamination. - reducing unnecessary antibiotic use.

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 1st line. - Erythromycin if allergy to penicillin. In case of viral cause, the length of illness depends on the virus involved.

Complications
Local:
- peritonsillar abscess. - retropharyngeal abscess. - parapharyngeal abscess. - chronic tonsillitis.

Systemic:

Regional:
- OM. - laryngitis. - bronchitis. - GE. - cervical lymphadenitis. - Cavernous sinus thrombosis.

- rheumatic fever. - Acute GN. - septicemia. - arthritis. - scarlet fever (strep tonsillitis + erythematous rash + strawberry tongue)

Immune complex deposition 2 to strep.tonsil

Peritonsillar abscess (Quinsy)

Definition:
- collection of pus forming outside the capsule of the tonsil in close relationship to its upper pole.

Etiology:
The infection spreads to the peritonsillar area (peritonsillitis). This region comprises loose connective tissue susceptible to formation of abscess. Both aerobic and anaerobic bacteria can be causative. Commonly involved species include streptococci, staphylococci and hemophilus.

Epidemiology:
- occur as complication of acute tonsillitis. - more in adults (15-30) than in children.

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 (Persistent
contraction of the masseter muscles due to failure of central inhibition)

Hot potato voice Unilateral referred otalgia

Complications
AW obstruction Bacteremia Aspiration pneumonia secondary to rupture of abscess

Treatment
IV antibiotics without delay surgical incision and drainage of pus forming outside the capsule -- relieving the pain dramatically. Under general anesthesia in children and anxious pts.

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