27th march 17 throat and sinus problems

Sinus and Throat Problems

Bayalpata Hospital CMELast updated: 27th March, 2017

Contributors: Dr. Pawan KB Agrawal, MDGP & Dr. Lena Wong, MD.

05/02/2023 PPT by Dr. Pawan KB Agrawal 2

ObjectivesAfter this session, participants should be able to1) Diagnose and manage pharyngitis2) Diagnose and manage complicated throat infections3) Diagnose and manage influenza4) Diagnose and manage sinusitis5) Diagnose and manage noninfectious throat problems6) Recognize signs of throat cancer


Clinical Case #1A 17 years girl visits your OPD with complain of sore throat. She complains of malaise and doesnot have fever.


QuestionsWhat are the questions you would like to ask her?

What would you like to examine?

What can be the complications of sore throat?

How do you differentiate bacterial vs viral vs noninfectious sore throat?


Viral pharyngitis• Most common cause of pharyngitis, 70%

(Stillerman et al., 1961)

• How do you differentiate from bacterial?


Bacterial pharyngitis• Group A Streptococus is the most common cause.

• Centor’s Criteria • Fever (1 point)

• Absence of cough (1 point)

• Cervical lymphadenopathy (1 point)

• Tonsillar exudate (1 point)

• A score of > 1 is likely for GAS pharyngitis. More useful in pediatric population compared to adults.


Modified Centor Criteria


Question to Staff Physicians

• Another important but very less common cause of bacterial tonsillitis?


Diphtheria


Incidence in Nepal


Oral Candidiasis• Predisposing factors• Neonates• Immunocompromised

• When are we worried about esophageal spread?


Key Point #1 Consider the possibility of bacterial pharyngitis

especially in children with sore throat because it can get complicated.


Clinical Case #2A child was brought to OPD by her mother with complain of passing red urine.


Question for HA and CMAs

How would you approach this patient?


Question for doctorsWhat can be the possible complications of bacterial tonsillitis?


Tonsillar abscess• What are other abscesses in the oropharyngeal

space?• How can we see this on ultrasound?


Epiglottitis• Major cause: URTI by H. influenzae

• Symptoms: • Sore throat; fever; drooling of saliva; shortness of breath

• X-ray:• Soft tissue neck > Thumb sign


Key Point #2Please order X ray soft tissue neck in a young child

with difficulty breathing and drooling saliva.


Clinical Case #3A 24 years male comes to you with complain of fever with sore throat and fatigue for last 2 days.

What are the differential diagnosis?


Influenza• Cause : Influenza viruses and some other viruses like

adenovirus, enterovirus.

• Danger signs:• ??

• Treatment:• Bed rest;• Antiviral medication( amantadine; oseltamivir)• Yearly vaccines also available.


Croup• Aka acute laryngotracheobronchitis

• Common in children

• Causes by viruses (usually parainfluenza)

• Has barky cough

• Steeple sign on Chest Xray.


Key Point #3Please look for steeple sign in CXR if lung fields are

clear in a child with respiratory distress


Clinical Case #4A 30 years male comes with complain of stuffy nose and facial pain.

What is the provisional diagnosis?


Acute rhinosinusitis • Inflammation of lining of paranasal sinuses.

• Often viral (rhinovirus) to start with and may progress to bacterial (S aureus, pneumococcus & H influenzae).

• Symptoms: ??

• Treatment: Supportive for initial 7 days; X ray & antibiotics (amoxicillin or amoxiclav)

(2015 American Academy of Otolaryngology- Head and Neck Surgery Foundation)


Key Point #4Use amoxicillin or amoxiclav if you suspect acute

bacterial rhinosinusitis.


Clinical Case #5A 18 years female presents with complain of recurrent cough and sneezing.

Differentials??


Allergic rhinitis


Allergic rhinitis• Treatment:• Avoidance of allergen• Oral antihistaminics• Intranasal steroid spray.


Aphthous ulcers• Ulcers involving the buccal mucosa

• Associated with stress and malnutrition

• Heals on its own within 3-5 days.


Throat Cancer• Typical symptoms:• Lumps• Cervical lymph nodes• Difficulty swallowing • Hoarseness of voice• Weight loss

• Consult and refer.


Key Point #5Recurrent cough and sneezing can be allergic in

nature.


Summary• Consider the possibility of bacterial pharyngitis

especially in children with sore throat because it can get complicated.• Please order X ray soft tissue neck in a young child

with difficulty breathing and drooling saliva.• Please look for steeple sign in CXR if lung fields are

clear in a child with respiratory distress• Use amoxicillin or amoxiclav if you suspect acute

bacterial rhinosinusitis.• Recurrent cough and sneezing can be allergic in

nature.


Thank you!

27th march 17 throat and sinus problems

Healthcare

Transcript of 27th march 17 throat and sinus problems