Pharmaceutical Pharmaceutical guidelines of guidelines of patients with patients with pathology of pathology of

breathing organs. breathing organs. Symptomatic Symptomatic treatment of treatment of TTHROATHROAT PAIN PAIN

PHISIOLOGY of the PHISIOLOGY of the THROATTHROAT

BreathingBreathing SwallowingSwallowing Separating Separating

(channelizatio(channelization)n)

Speech Speech (articulation)(articulation)

INFLAMMATORY DISORDERS INFLAMMATORY DISORDERS OF THE PHARYNXOF THE PHARYNX

Inflammatory disorders of the pharynx Inflammatory disorders of the pharynx most commonly present as throat or most commonly present as throat or neck pain. Disphagia, odynophagia, neck pain. Disphagia, odynophagia, and airway obstruction are other and airway obstruction are other frequent complaints. The pharynx is a frequent complaints. The pharynx is a dynamic conduit for inspired air and dynamic conduit for inspired air and ingested matter, responsible for ingested matter, responsible for diverting each into the trachea or diverting each into the trachea or esophagus, respectively. This process esophagus, respectively. This process may be impaired by anything which may be impaired by anything which obstructs or restricts the mobility of obstructs or restricts the mobility of the pharynx.the pharynx.

EVALUATIONEVALUATION Key historical considerations Key historical considerations

Age of patient Age of patient Onset and duration Onset and duration History of recent trauma (including possible foreign History of recent trauma (including possible foreign

body) body) Inflammatory symptoms - fever, pain, malaise, Inflammatory symptoms - fever, pain, malaise,

malodorous breath malodorous breath Status of nasal airway: congestion, obstruction, Status of nasal airway: congestion, obstruction,

rhinorrhea, purulent discharge, allergic history, rhinorrhea, purulent discharge, allergic history, snoring snoring

Reflux symptoms such as heartburn or water brash Reflux symptoms such as heartburn or water brash Associated ear pain Associated ear pain Disphagia or odynophagia Disphagia or odynophagia Dyspnea or stridor Dyspnea or stridor Other associated symptoms Other associated symptoms Recent exposure to infectious discharge Recent exposure to infectious discharge Cancer risk factors: smoking historyCancer risk factors: smoking history

Acute Viral or Bacterial Acute Viral or Bacterial PharyngitisPharyngitis

Pharyngitis is caused by a variety of Pharyngitis is caused by a variety of microorganisms. Most cases are viral and microorganisms. Most cases are viral and include the virus causing the common include the virus causing the common cold, flu (influenza virus), adenovirus, cold, flu (influenza virus), adenovirus, mononucleosis, HIV among various mononucleosis, HIV among various others. Bacterial causes include others. Bacterial causes include Group A streptococcusGroup A streptococcus which causes which causes strep throatstrep throat (15% of cases), in addition to (15% of cases), in addition to Corynebacterium, Arcanobacterium, Corynebacterium, Arcanobacterium, Neisseria gonorrhoeae, Chlamydia Neisseria gonorrhoeae, Chlamydia pneumoniae and others. In up to 30% of pneumoniae and others. In up to 30% of cases, no organism is identified. cases, no organism is identified.

Strep throatStrep throat Strep often Strep often

produces white produces white patches in the patches in the throat and on the throat and on the tonsils, as well as tonsils, as well as red, swollen red, swollen tonsils. Pus may be tonsils. Pus may be seen in the back of seen in the back of the throat.the throat.

Strep throat may Strep throat may cause the lymph cause the lymph nodes in the neck nodes in the neck to become swollen to become swollen and tender. and tender.

Acute Viral or Bacterial Acute Viral or Bacterial Pharyngitis (cont’d)Pharyngitis (cont’d)

Most cases of pharyngitis occur during Most cases of pharyngitis occur during the colder months -- during respiratory the colder months -- during respiratory disease season. Spread among disease season. Spread among household members is common. The household members is common. The medical importance of recognizing medical importance of recognizing strep throatstrep throat as a cause of pharyngitis as a cause of pharyngitis stems from the need to prevent its stems from the need to prevent its complications which can include acute complications which can include acute rheumatic fever, kidney dysfunction and rheumatic fever, kidney dysfunction and severe disease such as bacteremia and severe disease such as bacteremia and rarely streptococcal toxic shock rarely streptococcal toxic shock syndrome.syndrome.

Pharyngitis.Pharyngitis. Symptoms   Symptoms   soresore throatthroat additional symptoms are dependent on the additional symptoms are dependent on the

underlying microorganisms underlying microorganisms step throat may be accompanied by step throat may be accompanied by feverfever, ,

headache, swollen lymph nodes in the neck headache, swollen lymph nodes in the neck viral pharyngitis may be associated with runny viral pharyngitis may be associated with runny

nose (rhinorrhea) and postnasal discharge nose (rhinorrhea) and postnasal discharge severe cases of pharyngitis may be accompanied severe cases of pharyngitis may be accompanied

by difficulty swallowing and rarely difficulty by difficulty swallowing and rarely difficulty breathingbreathing

Signs and tests.    A physical exam with attention Signs and tests.    A physical exam with attention to the pharynx to assess whether drainage/coating to the pharynx to assess whether drainage/coating (exudates) are present, as well as skin, eyes, neck (exudates) are present, as well as skin, eyes, neck lymph nodes is frequently done. lymph nodes is frequently done.

OropharyngoscopyOropharyngoscopy

•Swollen, erythematous mucosa of the oropharynx and hypopharynx, often with edema of the uvula and soft palate.•Swollen cyanotic lymphatic follicles on the posterior wall•Mucous or purulent discharges on the posterior wall

Complications   Complications   complications of strep throat: complications of strep throat: rheumatic fever, rheumatic fever, glomerulonephritis (kidney inflammation),glomerulonephritis (kidney inflammation), chorea,chorea, bacteremia (bloodstream infection) and bacteremia (bloodstream infection) and

rarely streptococcal shock syndrome rarely streptococcal shock syndrome in some severe forms of pharyngitis (e.g., in some severe forms of pharyngitis (e.g.,

severe mononucleosis-pharyngitis) severe mononucleosis-pharyngitis) airway obstruction may occur airway obstruction may occur peritonsillar abscess, retropharyngeal peritonsillar abscess, retropharyngeal

abscessabscess

A sore throat A sore throat caused by a cold viruscaused by a cold virus usually resolves in usually resolves in one to two weeks one to two weeks without treatmentwithout treatment. On the other hand, . On the other hand, a sore throat a sore throat caused by the caused by the streptococcus bacteriumstreptococcus bacterium (strep throat) (strep throat) should be treated with antibiotics to should be treated with antibiotics to prevent damage to the heart prevent damage to the heart valvesvalves ((phenoxymethylpenicillin 500 mg four times a day or cefaclor 250 mg three times daily).. Generally, Generally, streptococcus bacteria cause streptococcus bacteria cause a more severe sore throat and a higher a more severe sore throat and a higher fever than viral sore throats.fever than viral sore throats.

In some cases, strep may cause In some cases, strep may cause nausea, a lack of appetite, nausea, a lack of appetite, or pain in the head and abdomen.or pain in the head and abdomen.

A less common sign of strep infection A less common sign of strep infection is a rash that appears on the neck and is a rash that appears on the neck and chest, eventually spreading to the rest chest, eventually spreading to the rest of the body. When this rough, of the body. When this rough, sandpaper-like rash develops, the sandpaper-like rash develops, the infection is known as infection is known as scarlet feverscarlet fever. . Although the full body rash may be Although the full body rash may be alarming, it will start to fade after a alarming, it will start to fade after a few daysfew days

Sneezing, runny nose, and cough Sneezing, runny nose, and cough more frequently accompany sore more frequently accompany sore throats due to a cold virus, throats due to a cold virus, rather than streptococcus rather than streptococcus infections. Sometimes, a throat infections. Sometimes, a throat culture is necessary to establish culture is necessary to establish the cause of the sore throat.the cause of the sore throat.

Antibiotic treatment may Antibiotic treatment may lessen symptoms lessen symptoms and duration of illness and duration of illness and decrease and decrease

the chance for complicationsthe chance for complications

Acute TonsillitisAcute Tonsillitis

The most common organism is The most common organism is beta beta hemolytic streptococcushemolytic streptococcus, but viral , but viral organisms can also cause exudative organisms can also cause exudative tonsillitis. Other causative organisms tonsillitis. Other causative organisms include staphylococcus aureus, include staphylococcus aureus, streptococcus viridans, and various streptococcus viridans, and various hemophilus species. hemophilus species.

General Symptoms General Symptoms Rapid onset of throat pain with pain Rapid onset of throat pain with pain

on swallowing associated with on swallowing associated with Fever, often 38°-39° CFever, often 38°-39° C Malaise Malaise fatigue fatigue ChillChill Pain in extremities, muscles and jointsPain in extremities, muscles and joints

Catharal and Follicular Catharal and Follicular TonsilitisTonsilitis

•The tonsils are red, enlarged and painfulnesswith an exudate or studded with white follicles. •Tender, firm cervical adenopathy is often present

Tonsillar hypertrophyTonsillar hypertrophy

TTreatmentreatment Taking antibiotics Taking antibiotics

unnecessarily can unnecessarily can contribute to the contribute to the growing problem of growing problem of microbial resistance. microbial resistance. When bacteria are When bacteria are frequently exposed frequently exposed to antibiotics, they to antibiotics, they may become may become "superbugs" that "superbugs" that can't be treated with can't be treated with standard standard medications.medications.

TTreatmentreatment Since fever and Since fever and

painful swallowing painful swallowing can lead to can lead to dehydration, it's dehydration, it's important to increase important to increase intake of fluids to intake of fluids to combat it. Water and combat it. Water and ginger ale are good ginger ale are good choices. A patient choices. A patient should avoid citrus should avoid citrus drinks which can drinks which can irritate an inflamed irritate an inflamed throat.throat.

TTreatmentreatment

Medications that are available OTC Medications that are available OTC for the temporary relief of sore for the temporary relief of sore throat due to the common cold throat due to the common cold usually contain anesthetics such as usually contain anesthetics such as benzocainebenzocaine and and dycloninedyclonine or or mentholmenthol and come in the form of and come in the form of

lozenges, lozenges, gargles, gargles, sprays. sprays.

TTreatmentreatment Pain RelieversPain Relievers Over-the-counter Over-the-counter

pain relievers, like pain relievers, like acetaminophen, acetaminophen, ibuprofen, or ibuprofen, or naproxen, can naproxen, can temporarily dull the temporarily dull the pain of a sore throat. pain of a sore throat. (Do not give aspirin (Do not give aspirin to children and to children and teenagers because of teenagers because of the risk of the rare the risk of the rare but potentially fatal but potentially fatal Reye's syndrome.)Reye's syndrome.)

Use a decongestantUse a decongestant

Decongestants make breathing easier by Decongestants make breathing easier by shrinking swollen mucous membranes shrinking swollen mucous membranes in the nose, allowing air to pass in the nose, allowing air to pass through. They also help relieve a runny through. They also help relieve a runny nose and postnasal drip, which can nose and postnasal drip, which can cause a sore throat. cause a sore throat.

Decongestants can be taken orally or Decongestants can be taken orally or used as decongestant nasal sprays. Oral used as decongestant nasal sprays. Oral decongestants (pills) are probably more decongestants (pills) are probably more effective and provide longer relief but effective and provide longer relief but may cause more side effects. may cause more side effects.

These medicines may not be safe for These medicines may not be safe for young children or for people who have young children or for people who have certain health problems. certain health problems.

ThreatningThreatning symptomssymptoms Any sore throat that has a rapid onset Any sore throat that has a rapid onset

and is associated with a fever or and is associated with a fever or tenderness of the front of the neck may tenderness of the front of the neck may be serious and should be seen by a be serious and should be seen by a health care professional. health care professional.

Any sore throat that causes a patient to Any sore throat that causes a patient to have difficulty swallowing (not just pain have difficulty swallowing (not just pain with swallowing) or breathing should be with swallowing) or breathing should be seen by a health care professional. seen by a health care professional.

Any sore throat that lasts for more than Any sore throat that lasts for more than a week should be evaluated by a health a week should be evaluated by a health care professional. care professional.

Persistent Sore ThroatPersistent Sore Throat

If a sore throat If a sore throat lasts over a week lasts over a week or gets worseor gets worse, this is the indication , this is the indication for doctor visiting, even if an initial for doctor visiting, even if an initial strep test came back negative. A strep test came back negative. A persistent sore throat could be a persistent sore throat could be a sign of acid reflux, mononucleosis, sign of acid reflux, mononucleosis, or another condition. In rare cases, a or another condition. In rare cases, a sexually transmitted disease may be sexually transmitted disease may be to blame (to blame (pharyngeal gonorrhea).).

Noninfectious sore throat Not all sore throats are caused by infection.

Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.