EENT - Throat Flashcards
symptoms of sore throat - children
lethargy and fever
symptoms of sore throat
a painful throat, especially when swallowing
a dry, scratchy throat
redness in the back of the mouth
bad breath
a mild cough
swollen neck glands
causes of sore throat
laryngitis
tonsillitis
strep throat (a bacterial pharyngitis)
glandular fever
define Pharyngitis
inflammation of the pharyngeal mucosa
how is acute pharyngitis characterised as
rapid onset of sore throat and pharyngeal inflammation (with or without exudate).
what does the absence of cough, nasal congestion and discharge suggest?
bacterial aetiology
types of acute pharyngitis (aeotiology)
Viral pathogens (almost always): e.g., rhinovirus
Bacterial pathogens: e.g., group A Streptococcus (GAS)
Fungal pathogens: e.g., Candida albicans
inflammation of the tonsillar tissues, what is it called?
tonsillitis
facts about tonsillitis
Self-limiting condition
Common cause is viral
Bacterial cause is suspected if lasting ˃ 3 days
symptoms of tonsillitis
Swollen/ erythematous tonsils
Exudate on tonsils
Cervical lymphadenopathy
Stertor (noisy breathing )
Pyrexia
Sore throat
Odynophagia & dysphagia
Cough
diagnosis of sore throat
History taking (e.g., other symptoms, previous episode, other medical condition, other medications)
Diagnostic tools
FeverPain criteria or Centor criteria
Rapid antigen detection tests (RADT) – allow immediate point of care assessment of GAS pharyngitis
Differential diagnosis
of sore throat
Hand, foot, and mouth disease
Epiglottis
COVID-19
HIV
Gonorrhoea
Measles
Leukaemia
Oropharyngeal cancer
Lemierre syndrome
Kawasaki disease
Red flags symptoms
of sore throat
difficulty breathing
difficulty swallowing
dehydration
rash
excessive drooling
blood in saliva or phlegm
patient severely unwell
immunosuppressant use
FeverPAIN criteria (max 5 points)
Higher scores suggest more severe symptoms and likely bacterial (streptococcal) cause.
0 or 1 score – 13 to 18% likelihood of isolating GAS
2 or 3 score – 34 to 40% likelihood of isolating GAS
4 or 5 score – 62 to 65% likelihood of isolating GAS
Centor criteria max 4 points
A score of 0, 1 or 2 – associated with a 3 to 17% likelihood of isolating GAS
A score of 3 or 4 – associated with a 32 to 56% likelihood of isolating GAS
treatment of sore throat
Self-care
Oral analgesia: e.g., paracetamol or ibuprofen
Medicated lozenges – help to reduce pain
Other interventions: e.g., mouth wash
Antibiotics (based on FeverPAIN or Centor score)
Corticosteroids is NOT recommended for the treatment of acute pharyngitis (lack of evidence)
patient education
managing symptoms
safety netting
severe?»_space; tonsillectomy
can i prescribe antibiotic therapy for acute sore throat?
YES
antibiotics target against common pathogen
Streptococcus pyogenes
Phenoxymethylpenicillin –
first line
Clarithromycin – penicillin allergy
Erythromycin – penicillin allergy in pregnancy
Complications of streptococcal pharyngitis/tonsillitis
Scarlet fever
Suppurative complications
Otitis media (most common).
Acute sinusitis — rare
Peri-tonsillar abscess (quinsy)
Non-suppurative complications include acute rheumatic fever, acute glomerulonephritis and reactive arthritis, although these are rare in developed countries.
Fungal infection of the mouth
Management depends on the types of oropharyngeal candidiasis
Pseudomembranous candidiasis (Thrush) – Antifungal
Acute erythematous candidiasis – Antifungal
Denture stomatitis – Denture cleanse with disinfectant solution, brushing, Miconazole?
Pseudomembranous candidiasis (thrush)
acute infec
symptoms of thrush
Patches of curd-like, white or yellowish plaques
Burning & itching sensation (minimal)
Dysphagia and chest pain (chronic form)
Risk factors
of thrush
Extremes of age
Immunocompromise or systemic immunosuppression
Patients with serious systemic disease associated with reduced immunity (e.g., leukaemia, other malignancies, and HIV infection)
Patient receiving chemotherapy and radiotherapy
Recent or concurrent use of drugs that promote candida growth
Patient receiving ICS, chemotherapy, broad-spectrum antibiotics
Diabetes mellitus
Dental prostheses and poor dental hygiene
Smoking
Local trauma
Poor diet and nutritional deficiencies
Impaired salivary function
management of oral candidiasis in primary care - adult
- no risk factor > prescribe antifungal
- risk factor > refer
mild infec - thrust treatemnt
Localised and mild infection
Topical antifungal for 14 days
Miconazole oral gel – 1st line
Life style advice
Extensive and severe infection
Systemic antifungal for 14 days
Oral fluconazole
Life style advice
Review & extend Tx for 7 days
What to prescribe for children
prescribe TOPICAL anti-fungal
Miconazole oral gel for 14 days (children ≥ 4 months) – 1st line
Or
Oral Nystatin suspension (if miconazole is unsuitable)
Give life style advice
or refer to a paediatrician
Non-pharmacologic management
good dental hygiene
inhaler technique/ rinse mouth
smoking cessation
denture cleanse and removal
brush mucosal surface w soft brush
what are the don’ts of thrush
do not wear your dentures at night
do not keep wearing dentures if they don’t fit properly
don’t smoke
