Ebook ABC of ear, nose and throat (5/E): Part 2
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Ebook ABC of ear, nose and throat (5/E): Part 2
CHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2 majority of such symptoms are due to viral nfectons with symptoms that last fora few days, and most will respond to simple analgesics.•A bacterial infection genera ly presents with soreness, otalgia and dysphagia With systemic upset and pyrexia, and requires analgesia as wel as antibiotics for 7+ d Ebook ABC of ear, nose and throat (5/E): Part 2ays.•Indication for tonsillectomy currently remains ccntro.ersia', but. when performed, great symptomatic re ef ts reported by the majority of patentsEbook ABC of ear, nose and throat (5/E): Part 2
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Bacteria are the primary pathogens identified in less than a thin! of cases.PresentationRelevant factors in the history include duration,severity (inCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2e may indicate peritonsillar abscess (quinsy-, see below). Referred pain to the ear is common, and sore throat radiating to the ear raises a possibility of neoplasm, particularly in older patients. Other causes Ilf sore throat include infectious millionucleosis and rare conditions such as vasculitis Ebook ABC of ear, nose and throat (5/E): Part 2, agranulocytosis and neoplasms, as well as complications of tonsillitis including deep neck space abscess. Sore throat, which may be associated withEbook ABC of ear, nose and throat (5/E): Part 2
a potential airway obstruction, can present and affect all patient age groups, as the cause and source of the obstruction may be located at the epigloCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2 referred urgently.Diagnosis and treatmentIn most cases, the diagnosis of acute sore throat is straightforward, and symptomatic management with analgesia and gargles is all that is required. Antibiotic use in sore throat is controversial, as is the place tor tonsillectomy.lhere arc no clinical or la Ebook ABC of ear, nose and throat (5/E): Part 2boratory tests that reliably differentiate bacterial from viral sore throat quickly enough to help the general practitioner. Throat swabs may grow patEbook ABC of ear, nose and throat (5/E): Part 2
hogenic bacteria, including beta haemolytic streptococci. even if the infection is primarily viral, anil rapid antigen texting has variable specificitCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2ence of lhe septic complica lions of tonsillitis, such as otitis media, sinusitis and peritonsillar abscess, and shorten the duration of the illness somewhat. Ibis modest benefit needs to be balanced against the adverse effects of diarrhoea, skin rashes and (rarely) severe allergic reaction. There i Ebook ABC of ear, nose and throat (5/E): Part 2s also the danger of encouraging antibiotic-resistant organisms.It is wise to manage most sore throats without antibiotics, apart from those with seveEbook ABC of ear, nose and throat (5/E): Part 2
re systemic upset or worsening symptoms. Penicillin V remains the drug of choice with erythromycin for those who are penicillin allergic and cephalospCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2leosis.50Figure 11.1 Acute Iniv.ililr.Indications for tonsillectomyIndications for tonsillectomy have become more stringent recently, with a reduction in numbers as risk/benefit analysis has developed (Fig. 11.1). There is also a better understanding of the natural history, al least in children with Ebook ABC of ear, nose and throat (5/E): Part 2 relatively mild symptoms who are likely to improve over 3 years. Tonsillectomy is reasonable if the infect inn is due lu I rue tonsillitis, is severeEbook ABC of ear, nose and throat (5/E): Part 2
enough to preclude normal activity and has (seen recurring on am) off foral least a year, with al least five episodes. Tile benefits must lie balanceCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2 of surgery diminishes with age, particularly over 30. There is a distinct group of adults with low-grade continuing sore throat symptoms, punctuated by occasional acute episodes due to chronic tonsil sepsis, who may be helped by tonsillectomy.Sore throats with cervical adenopathySevere sore throat Ebook ABC of ear, nose and throat (5/E): Part 2with marked neck lymphademipathy in young jMMiple. particularly with no history Ilf recurrent sore throat, may lie due Io infectious mononucleosis, anEbook ABC of ear, nose and throat (5/E): Part 2
d the rnomispol lest should be checked in these cases. Management is sup[K>rtive, but severe cases may need admission tor intravenous rchydration. AntCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2 common. Epstein-Barr virus is the most common cause, although cytomegalovirus, toxoplasmosis, rubella and human immunodeficiency virus (HIV) arc also implicated. During recovery, patients should lie warned to avoid contact sports for at least 6 weeks because of a risk of damage to an enlarged liver Ebook ABC of ear, nose and throat (5/E): Part 2 and spleen, and abnormal liver function should lie monitored until recovery is complete.Complications of throat sepsisQuinsyPeritonsillar abscess (quEbook ABC of ear, nose and throat (5/E): Part 2
insy) presents as a unilateral erythematous swelling lateral to the tonsil, and in a patient with systemic upset is the commonest septic complication.CHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2because of the risk of aspiration of pus) has been replaced by aspiration with a large-bore hypodermic needle. Antibiotics, usually penicillin V, with or without metronidazole are administered.Parapharyngeal abscessDeep neck space infection secondary to tonsil, or sometimes dental, sepsis is less co Ebook ABC of ear, nose and throat (5/E): Part 2mmon, but needs management in hospital, sometimes with airway protection by intubation or tracheostomy before surgi cal incision and drainage and infuEbook ABC of ear, nose and throat (5/E): Part 2
sion of intravenous antibiotics (see Fig. 11.2). Tile commonest variety is parapharyngeal ahscews present ing in a severely ill patient with marked unCHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. The Ebook ABC of ear, nose and throat (5/E): Part 2in the immune compromised (Fig. 11.3). Airway protection before incision and drainage, which may be peroral, is essential. tuberculosis is a rare cause for chronic retropharyngeal abscess nowadays in Western countries, but needs to be excluded.Sore throat with acute airway distress Ebook ABC of ear, nose and throat (5/E): Part 2CHAPTER 11Sore ThroatsWilliam McKerrow, Patrick I BradleyOVERVIEW•A sore throat as 3 presenting symptom to a general practitioner IS very common. TheGọi ngay
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