SORE THROAT

ANATOMY

TONSILLITIS

-Large body of lymphoid tissue.

-Role is still controversial:
URTI multiple in tonsilar crypt lymphoid tissue
manufactures 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 ) , URTI
symptoms
- 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, severe

dysphagia
- 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 THE

TONSIL (outside the tonsil capsule)

Clinical features:

SYMPTOMS: Fever, headache, dehydration, dysphagia,

odynophagia, drooling of saliva, difficulty/pain when open
mouth, trismus, dysphonia(muffled voice), bad breath,
unilateral referred otalgia, swelling around face or neck
SIGNS: Extensive peritonsillar swelling, oedema of soft
palate, uvula deviation to unaffected side, cervical
lymphadenitis

 Complication: Airway obstruction, aspiration pneumonitis,

lung abscess, cellulitis of jaw/neck/chest, poststreptococcal 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, which
normally 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