Sore Throat

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SORE THROAT



ANATOMY





TONSILLITIS



-Large body of lymphoid tissue.

-Role is still controversial:

URTI multiple in tonsilar crypt lymphoid tissuemanufactures 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 ) , URTIsymptoms

- 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, severedysphagia

- 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 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



• 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







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, whichnormally 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

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Sore Throat

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