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pharyngotonsillitis causes and diffrent treatment.pptx
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- 2. Viral Pharyngitis Themost frequent cause of viral pharyngitis is the “common cold,” or URI. A multitude of viral pathogens may cause pharyngitis, including : rhinovirus influenza virus parainfluenza virus adenovirus coxsackievirus echovirus Epstein-Barr virus (EBV) reovirus respiratory syncytial virus (RSV). Rarely human cytomegalovirus (CMV), measles, and rubella may cause systemic viral disease.
- 3. symptoms Rhinorrhea Congestion mild to moderate sore throat dyspahagia Hoarseness low-grade fever Exam oropharyngeal erythema and/or tonsillar hypertrophy without exudate
- 4. cold sore Herpessimplex virus (HSV) commonly causes the well-known “cold sore.” HSV can also cause exudative or nonexudative pharyngitis, mainly in older children and young adults.
- 5. Hand-foot-mouth disease ismost commonly caused by coxsackievirus A16 and enterovirus it is associated with high fever and malaise vesicular eruptions in the mouth that cause oral and throat pain and a maculopapular rash or vesicles on the palms of the hands, soles of the feet, and buttocks. Children with hand-foot-mouth disease are highly contagious and should be kept away from other children until they are no longer symptomatic.
- 6. Herpangina Is causedby coxsackievirus characterized by small vesicles with erythematous bases that become ulcers and spread over the anterior tonsillar pillars, palate, and posterior pharynx sometimes with associated cutaneous rash
- 7. Treatment Treatment strategiesfor patients with acute pharyngitis are based on epidemiologic factors, signs and symptoms, and results of laboratory tests. Rest, oral fluids, and salt-water gargling (for soothing effect) are the main supportive measures in patients with viral pharyngitis Analgesics and antipyretics may be used for relief of pain or pyrexia. Hospitalization for intravenous hydration may be necessary when odynophagia is intense. Antibiotics do not hasten recovery or reduce the frequency of bacterial complications. The risks of prescribing antibiotics in patients with viral pharyngitis include the common side effects of antibiotics (diarrhea, rashes, candidiasis, unplanned pregnancy secondary to oral-contraceptive failure) and the rare occurrence of anaphylaxis.
- 8. Epstein-Barr Virus alsoknown as infectious mononucleosis Is typically transmitted by oral contact. EBV is especially common in adolescents; younger children tend to be asymptomatic and to have chiefly abdominal complaints. The mononucleosis syndrome consists of fever, general malaise, headache, pharyngitis, dysphagia, and odynophagia. Exam findings may include normal-sized or hypertrophic tonsils, palatal petechiae, and large tender cervical lymph nodes. Tonsils may have a green or gray exudate, which is indistinguishable from streptococcal pharyngitis . Rash is rare unless patients have been treated with amoxicillin or ampicillin. Most patients have splenomegaly, and some have hepatomegaly
- 10. Management ofEBV mononucleosis is based on symptoms. Recovery may take weeks, and pain control, primarily with nonsteroidal anti inflammatory drugs (NSAIDs), is important. Antibiotics are not indicated unless treatment for concomitant bacterial infection is required. β-lactam antibiotics, particularly amoxicillin and ampicillin, are relatively contraindicated because of the risk of precipitating a rash in up to some 30% of patients.
- 11. The majorityof patients with mononucleosis-associated mild upper airway obstructive symptoms or tonsillopharyngitis may be treated with oral or parenteral corticosteroids alone. If the obstruction is severe, a nasopharyngeal airway may be helpful; rarely, tonsillectomy, intubation, or tracheotomy may be necessary
- 12. Streptococcal Tonsillitis-Pharyngitis GroupA β-hemolytic Streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis. GABHS is implicated in up to 37% of all children who present with acute pharyngitis. Acute streptococcal pharyngitis is a disease of childhood and adolescence with a peak incidence at 5 to 6 years of age
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- 14. diagnosis The diagnosisof acute pharyngitis cannot be made reliably on clinical grounds alone because the manifestations of streptococcal and nonstreptococcal pharyngitis overlap so broadly. Accurate diagnosis is essential to limit transmission, improve recovery, reduce complications, and avoid the use of antibiotics for viral illnesses. If symptoms are strongly suggestive of a viral etiology—cough, rhinorrhea, hoarseness, and oral ulcers—further testing is not Required Throat culture is the diagnostic test of choice for GABHS infection
- 16. Treatment A 10-daycourse of penicillin or amoxicillin has traditionally been first-line treat. Recent data suggest that macrolides and cephalosporins may be more effective as first-line therapy and that cephalosporins, clindamycin, and amoxicillin/clavulanic acid are all preferred for penicillin failures for acute GABHS infection
- 19. Peritonsillar abscess Peritonsillarabscess remains the most common deep infection of the head and neck. The condition occurs primarily in young adults. A peritonsillar abscess is a polymicrobial infection, but Group A streptococcus is the predominate organism. Symptoms generally include fever, malaise, sore throat, dysphagia, and otalgia.
- 20. Physical findingsmay include trismus and a muffled voice (also called “hot potato voice. Drainage of the abscess, antibiotics, and supportive therapy for maintaining hydration and pain control are the foundation of treatment
- 21. Adenoid The nasopharyngealtonsil, "adenoid pad," or "the adenoids," is a grouping of lymphoid tissue located on the posterior wall of the nasopharynx at the level of the soft palate. The adenoids are present at birth and enlarge throughout childhood, reaching peak size by age seven. In most individuals, they will regress in size during puberty and may be nearly absent by adulthood. For this reason, adenoiditis is commonly a problem in childhood and adolescence.
- 22. Adenoiditis occurswhen there is inflammation of the adenoid tissue resulting from infection, allergies, or irritation from stomach acid as a component of laryngopharyngeal reflux (LPR). Adenoiditis rarely occurs on its own and is more often involved in a more extensive disease process such as adenotonsillitis, pharyngitis, rhinosinusitis, etc. Continual irritation may lead to adenoid hypertrophy, which is responsible for many of the complications of adenoid disease, including Eustachian tube dysfunction and recurrent acute otitis media. Adenoiditis can be classified as acute or chronic.
- 23. he mostcommon bacterial pathogens cultured from adenoid specimens are: Haemophilus influenza Streptococcus pneumoniae Streptococcus pyogenes Staphylococcus aureus
- 24. Chronic adenoiditisis more often a polymicrobial infection and may include anaerobic pathogens. Chronic adenoiditis frequently results from biofilm development and may contribute to recurrent upper respiratory tract infections in children. In most cases of pediatric rhinosinusitis, adenoiditis is involved as well. Allergies are believed to play a role in adenoiditis and subsequent adenoid hypertrophy. Allergens inhaled through the nose come in contact with the adenoid tissue; the adenoid will then proliferate in order to create a response to allergens and produce IgA. Chronic irritation from stomach acid in the setting of gastroesophageal reflux disease (GERD) may also play a role in adenoiditis and adenoid hypertrophy, particularly in infants and young children
- 25. The patientmay also have a history of recurrent acute otitis media, chronic nasal obstruction with mouth-breathing, chronic otitis media, sleep- disordered breathing/obstructive sleep apnea, or GERD/LPR. Physical findings include purulent rhinorrhea, post-nasal drip, nasal obstruction, snoring, fever, mouth breathing, and halitosis. Long-standing adenoiditis with subsequent adenoid hypertrophy in early childhood can lead to the development of what is known as adenoid facies or long-face syndrome. Enlarged adenoids block the nasopharynx and result in obligate mouth breathing, which can lead to craniofacial abnormalities, including a high-arched palate and retrognathic mandible
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- 27. Treatment Observation AntibioticTreatment Allergy Treatment Reflux Treatment Adenoidectomy
- 28. Adenoidectomy In theabsence of symptomatic improvement after treatment with amoxicillin- clavulanate or if the patient has multiple episodes of adenoiditis requiring antibiotic treatment, referral to an otolaryngologist is warranted for further evaluation and potential surgical intervention. Depending on the circumstances, surgical procedures may include adenoidectomy with or without tonsillectomy, myringotomy with tympanostomy tube placement, or endoscopic sinus surgery. If the patient meets the Paradise criteria for tonsillectomy, most otolaryngologists will remove the adenoids at the same time to remove another possible source of recurrent infections. Similarly, most otolaryngologists will remove the adenoids if patients require repeat tympanostomy and placement of pressure equalization tubes after the first set due to the potential for adenoid hypertrophy to cause chronic Eustachian tube dysfunction
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- 30. Malignant tumors: Theoropharynx is a common site for presentation of upper aerodigestive tract malignancies. the majority of which are squamous cell carcinoma (SCC) histopathologically. SCC can vary from keratinizing (KSCC) to nonkeratinizing (NKSCC) and well- differentiated to poorly differentiated.
- 31. Symptoms Dysphagia, foreignbody sensation or pain in the throat, oral bleeding, referred otalgia (through sensory afferents of cranial nerves IX and X), or neck mass Risk factors, such as smoking and the consumption of alcohol, xenobiotic exposure at the workplace and in the environment should be evaluated; dietary and social habits are also worth evaluating.
- 32. Physical exam: patientsshould be carefully investigated with a focus on the tongue (appearance and movement), tonsillar fossae, retromolar trigone, soft palate (appearance and mobility), base of tongue, vallecula, and pharyngeal walls. Examination should include inspection and palpation, especially of the tongue base and tonsillar fossa; sensate testing; and an office endoscopy, either flexible or rigid. All cancer patients should undergo a complete head and neck investigation to exclude synchronous cancers. Bimanual palpation of the neck is mandatory to assess lymph node status and possible regional metastatic spread.
- 33. Kaposi sarcoma Kaposisarcoma (KS) is a locally aggressive, growing neoplasm that can present cutaneously, but it can also present as a mucosal lesion that shows multiple patches and nodules. it is associated with gamma-2 human herpesvirus 8 (HHV 8) infections Isolated KS of the oropharynx is rare but can present in the soft palate or tonsil
- 34. KS canoccur as any of four variants: indolent/sporadic: in elderly men in the Mediterranean region and Eastern Europe; endemic disease in Africans iatrogenic in immunosuppressed patients, mainly after organ transplantation epidemic in association with human immunodeficiency virus (HIV) infection.
- 35. Non-Hodgkin lymphomas arefound in the palatine tonsils, palate, base of the tongue, and other oropharyngeal sites. Etiologic factors are unknown in most patients, although some lymphoma patients might suffer from an immunodeficiency. The lesions present as exophytic masses, submucosal swelling, and sometimes ulcerations Clinical symptoms can include fullness of the throat, dysphagia, snoring, and pain. Systemic symptoms are rare.
- 36. Nasopharyngeal Carcinoma Themajority of patients with NPC are diagnosed with advanced disease. The main factors believed to be associated with the development of NPC are genetic and environmental factors as well as EBV. Virtually all NPC patients are symptomatic at the time of diagnosis. less than 1% of NPC patients are asymptomatic and diagnosed incidentally, which may occur when imaging is performed for some other indication.
- 37. The mostcommon presentation in NPC is that of a palpable neck Lump(due to metastatic disease in the cervical lymph nodes.)
- 38. Examination ofthe nasopharynx in NPC patients usually reveals an exophytic mass that may occupy the whole postnasal space
- 39. diagnosis The goldstandard in the diagnosis of NPC is histologic confirmation by NP biopsy. This is performed transnasally under local anesthesia using rigid endoscopy. The biopsy of the tumor is thereby performed under direct visualization.
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