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SORE THROAT

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

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SORE THROAT

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    1. SORE THROAT Done by : Firas kafawi

    2. 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.

    3. 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 glands…etc.

    4. 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.

    5. TONSILLITIS

    8. 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.

    9. 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

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

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

    12. 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.

    14. Acute tonsillitis DDx Infection - Acute tonsillitis - Infectious mononucleosis - Diphtheria - Vincent's angina Neoplasm - Squamous cell carcinoma of the tonsil - Lymphoma - Salivary gland tumours Blood diseases - Agranulocytosis - Leukaemia Other causes - Aphthous ulcer - Behcet's syndrome - AIDS

    15. 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.

    16. 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.

    17. Investigations CBC. Throat swabs. ASO titre.

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

    19. 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.

    20. 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)

    21. 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.

    22. 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

    24. Complications AW obstruction Bacteremia Aspiration pneumonia secondary to rupture of abscess

    25. 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.

    26. THANK YOU

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