Sore Throat

40 Sore Throat

Jason Leibowitz and Jason G. Newman

image Throat pain is a ubiquitous symptom. It may be acute or chronic, constant or intermittent, and mild to severe. The time course of the pain is a critical factor in establishing the diagnosis because acute pain tends to be associated with infectious etiologies or trauma, whereas chronic pain may be associated with chronic inflammation or neoplasm. Key points of the history include the following:

image Time course of symptoms

image Otalgia (unilateral otalgia in the absence of ear disease may indicate an underlying malignancy)

image Dysphagia or odynophagia

image Stridor or other respiratory symptoms (may indicate an underlying airway obstruction)

image Reflux or heartburn-related symptoms

image Neck mass

image Hemoptysis

image Inflammatory symptoms such as fever and malaise

image Constitutional symptoms such as weight loss or night sweats

image Patient risk factors (tobacco, alcohol, sick contacts, trauma, or foreign body ingestion)

A full head and neck exam is essential. Careful attention should be paid to the ears, mucosal membranes of the upper aerodigestive tract, and neck.

image Infectious Causes of Throat Pain

Infectious causes of throat pain include the following:

image Pharynx

image Viral pharyngitis: Most common infectious etiology. Sore throat associated with malaise, low-grade fever, and upper respiratory infection (URI) symptoms. Commonly caused by adenovirus and rhinovirus. Other causes of acute viral pharyngitis include the following:

Herpes simplex virus: Sore throat may be seen in both primary infection and reactivation with associated vesicular or ulcerative lesions.

Measles: Sore throat, coryza, and conjunctivitis. Intraoral Koplik spots (erythematous spots on buccal mucosa) are pathognomonic.

Infectious mononucleosis: Epstein-Barr virus (EBV). Symptoms include severe sore throat with odynophagia, dysphagia, high fevers, posterior cervical lymphadenopathy, rashes, exudative tonsillitis, and hepatosplenomegaly.

HIV: Initial infection presents with acute retroviral syndrome (similar to EBV) with myalgias, photophobia, joint pain and rash.

image Bacterial pharyngitis: Acute onset, significant throat pain with otalgia, dysphagia, odynophagia, cervical adenitis, and high fevers. May see tonsillar and posterior pharyngeal erythema with exudates on physical exam. Most common bacterial cause is group A β-hemolytic streptococcus. Other bacterial causes include the following:

Staphylococcus: Mucopurulent drainage and localized pustules on the tonsils

Diphtheroid: Usually seen in children > 6 years old who are not immunized. Exam reveals gray-black membrane firmly adherent to the underlying pharyngeal mucosa, with extension to the larynx or nasopharynx. Symptoms include sore throat and airway obstruction.

Pertussis: Acute onset of sore throat in children associated with a whooping cough.

Gonorrhea: Sexually active patient with sore throat, tonsillar hypertrophy, and cervical adenitis

Syphilis: May appear as a painless papule that ulcerates in the primary stage in the tonsils, or as a pharyngitis/tonsillitis in later stages (painless superficial erosions with raised erythematous margins in the pharynx).

Jun 5, 2016 | Posted by in OTOLARYNGOLOGY | Comments Off on Sore Throat
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