Sore Throat

• Inflammatory
  –Allergy
  –Gastroesophageal reflux disease
  –Sinusitis resulting in postnasal drainage
• Tumors
  –Leukemia
  –Rhabdosarcomas
  –Squamous cell carcinoma secondary to oral ulcerations
• Trauma
  –Foreign body ingestion
  –Caustic ingestion
  –Soft tissue injury from accidental and nonaccidental trauma
• Systemic/rheumatologic disorders
  –Kawasaki disease: Mucocutaneous lymph node syndrome may have sore throat at presentation (other oral findings include strawberry tongue, fissured lips, mucosal erythema, fever, and lymphadenopathy)
  –Behçet syndrome
  –Reiter syndrome
  • Others
    –Cigarette smoke
    –Environmental pollutants
    –Pharyngeal drying: Mouth and pharynx can be dry from mouth breathing, more common in the winter months

Workup and Diagnosis

• Physical exam
  –Nasal exam: Evidence of rhinosinusitis
  –Mouth: Ulcerations, masses, tonsil size, erythema, exudates
  –Neck: Lymphadenopathy
  –Skin: Rash
  –Chest: Wheezes, asymmetry
• Studies
  –For pharyngitis: A major goal is to differentiate streptococcal pharyngitis from viral etiologies
  –Throat culture: 92% sensitive; 100% specific; requires 24–48 hours
  –Rapid strep test: 72–85% sensitive; 88–100% specific
  –CBC with differential for suspected mononucleosis
  –Chest X-ray (inspiratory and expiratory) for suspected foreign body
  –CT neck: When complication of infection is suspected such as abscess

Treatment

• Viral causes
  –Supportive care including hydration, acetaminophen or ibuprofen, bedrest, salt water rinses
  –Steroids may be considered to minimize upper airway obstruction
• Antibiotics for bacterial etiologies
  –For group A β-hemolytic strep: Shortens duration of symptoms and prevents rheumatic fever
• Consider inpatient admission when there is concern about adequate airway or oral intake
• Airway management: Intubation or tracheotomy
• When gastroesophageal reflux is suspected, treatment may include dietary changes, antireflux therapy
• Adenotonsillectomy for recurrent tonsillitis is considered depending on frequency of recurrence, i.e., 6–7 infections/year, or 4–5 infections/year for 2 years, or 3 infections/year for 3 years

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

More About Gastroesophageal Reflux Disease

• Back to disease: Gastroesophageal Reflux Disease: Introduction
• Next Book Extract About Gastroesophageal Reflux Disease: SORE THROAT (Differential Diagnosis in Primary Care)
• More Book Extracts: All Online Books for Gastroesophageal Reflux Disease

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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