Presentation is loading. Please wait.

Presentation is loading. Please wait.

APPROACH TO SORE THROAT & PERITONSILLAR ABSCESS MR 8/3/09 J.Chen.

Similar presentations


Presentation on theme: "APPROACH TO SORE THROAT & PERITONSILLAR ABSCESS MR 8/3/09 J.Chen."— Presentation transcript:

1 APPROACH TO SORE THROAT & PERITONSILLAR ABSCESS MR 8/3/09 J.Chen

2 General Approach  R/O Life Threatening causes  R/O non-infectious causes  Determine whether or not treatment is required

3 Life Threatening Causes  Airway Compromise  Sitting in sniffing position  Toxic appearing  Drooling  Voice change  Fever

4 Life Threatening Causes  Epiglottitis  Retropharyngeal abscess  Peritonsillar abscess  Significant tonsillar hypertrophy  Diphtheria

5 Management  NPO  Supplemental O2  Consider airway adjunct (NP airway)  IV access (if pt can tolerate)  Anesthesia

6 Non-infectious Causes  Environmental  Irritative pharyngitis Smoke Dry air Chemicals  Trauma  Burns  Foreign Body  Retained  Laceration to posterior pharynx

7 Non-infectious Causes  Allergic/Inflammatory  Allergens causing chronic postnasal drip  Eosinophilic esophagitis  Tumors  Rare in pediatric population

8 Infectious Causes  Bacterial:  Group A Beta Hemolytic Streptococcus  Group C Strep  Group G Strep  Neisseria Gonorrhoeae  Tularemia  Chlamydia  Mycoplasma  Diptheria

9 Infectious Causes  Viral Causes  Adenovirus  Influenza  Parainfluenza  Epstein-Barr Virus  Cytomegalovirus  HIV  Stomatitis  HSV  Coxsackievirus

10 History  Drooling?  Voice Change?  Fever?  Exposure?  Foreign Body?  Headache?  Abdominal Pain?  URI symptoms?  Immunization status?  Sexual activity?

11 Physical Exam  General Appearance  Drooling  Stridor  LAD  Pharyngeal erythema/exudate  Asymmetric Enlargement of tonsillar pillar  Deviation of uvula  Cobblestoning of posterior pharyngeal mucosa  Vesicular or ulcerative lesions in oropharynx

12 Laboratory Aids  Throat Culture  Lateral Neck X-ray  CBC  Monospot

13 Peritonsillar Abscess  Suppurative infection of the tissues adjacent to the palatine tonsil  Most common abscess of the head and neck

14 Background  Gradual onset  Progression from peritonsillar cellulitis  2 mechanisms  Direct spread of inadequately treated bacterial tonsillitis  Abscess formed in a group of salivary glands (Weber glands) in the supratonsillar fossa  30 per 100,000 person/year (25-30% Pediatric)

15 Cause  Bacterial Growth often polymicrobial  Aerobic organisms Group A beta-hemolytic streptococcus pyogenes Staphlococcus aureus Alpha-hemolytic strep Coag-negative staph Streptococcus pneumoniae  Anaerobic organisms Gram neg bacilli Provetella Bacteroides Peptostreptococcus Fusobacterium

16 History  Sore Throat/Dysphagia 5-7 days  Trismus (2 nd to inflammation of internal pterygoid muscle)  Fever  Drooling  Muffled Voice  Referred Ear Pain

17 Physical Exam  Asymettric swelling of the soft tissue lateral and superior aspect of tonsil  Fluctuant area palpable  Uvula displaced to contral Lateral side Soft palate red/swollen

18 Physical Exam  Moderately uncomfortable appearing  Febrile  Potential resp distress  Trismus  Halitosis  Cervical adenopathy

19 Laboratory Tests  CBC with diff-leukocytosis with neutrophil predominance  Needle aspiration for culture and sensativity

20 Imaging  CT scan  Sensitivity 100%, Specificity 75%  Abscess appears as low attenuation mass with ring- enhancing wall  US  Sensitivity 89%, Specificity 100%  Intraoral approach prefered

21 Complications  Airway Compromise  Aspiration of abscess contents  Parapharyngeal abscess  Sepsis  Hemorrhage  Contiguous spread to pterygomaxillary space

22 Treatment  Hydration  Analgesia  Antibiotics  Admit patients for:  Airway Compromise  Dehydration, inability to take PO  Poor Compliance  Systemic complication  Toxic Appearing  Unclear diagnosis

23 Antibiotics  Augmentin (amox+clavulanate) is DOC  Unasyn (amp+sulbactan) for inpatient  Ceftriaxone and clindamycin or imipenem for severe or complicated cases

24 Surgical Drainage  Needle Aspiration  90% success rate after one aspiration  Another 5-10% after second  Complications: resp distress, aspiration, hemorrhage  Contraindications: uncertain diagnosis, uncooperative, very young, airway management problem

25  I&D  Wider Drainage  More Painful  Containdications: same as needle aspiration  Tonsillectomy  Definitive Therapy  May decrease overall duration of stay  Requires OR and intubation


Download ppt "APPROACH TO SORE THROAT & PERITONSILLAR ABSCESS MR 8/3/09 J.Chen."

Similar presentations


Ads by Google