This chapter reviews conditions that can obstruct the upper airway.
These disorders must be recognized quickly because early airway
management may be lifesaving. Infections of the neck and upper airway
include pharyngitis/tonsillitis, peritonsillar abscess,
epiglottitis, retropharyngeal abscess, and odontogenic abscess.
Cancers, congenital neck masses, ranulas, and mucoceles present
as masses in the neck and upper airway and may become infected.
Noninfectious causes of airway obstruction include posttonsillectomy
hemorrhage, airway and esophageal foreign bodies, laryngeal papillomatosis,
neck and facial trauma, and angioedema. If there is a possibility
of surgical intervention in the neck, the patient should remain
NPO after arrival at the ED.
Group A β-hemolytic Streptococcus (GABHS)
is the most common bacterial organism causing pharyngitis (Table 241-1). Acute viral pharyngitis is
most commonly caused by rhinovirus but can be caused by infectious
mononucleosis [Epstein-Barr virus, (EBV)], acute
retroviral syndrome [human immunodeficiency virus (HIV)],
and cytomegalovirus infection. Less commonly, Mycoplasma
pneumoniae and Chlamydia pneumonia have
been isolated from patients with symptomatic pharyngitis.
Table 241-1 Microbial Causes
of Acute Pharyngitis |Favorite Table|Download (.pdf)
Table 241-1 Microbial Causes
of Acute Pharyngitis
|Pathogen||Syndrome/Disease||Estimated Percentage of Cases*|
|Rhinovirus (100 types, 1 subtype)||Common cold||20|
|Coronavirus (3+ types)||Common cold||>5|
|Adenovirus (types 3, 4, 7, 14, 21)||Pharyngoconjunctival fever, acute respiratory disease||5|
|Herpes simplex virus (type 1, 2)||Gingivitis, stomatitis, pharyngitis||4|
|Parainfluenza virus (types 1–4)||Common cold, croup||2|
|Influenzavirus (types A, B)||Influenza||2|
|Coxsackievirus A (types 2, 4, 5, 6, 8, 10)||Herpangina||<1|
|Epstein-Barr virus||Infectious mononucleosis||<1|
|Human immunodeficiency virus type 1||Acute retroviral syndrome||<1|
|Streptococcus pyogenes (GABHS)||Pharyngitis, tonsillitis, scarlet fever||15–30|
|Group C β-hemolytic streptococci||Pharyngitis, tonsillitis||5|
|Chlamydia pneumonia||Pneumonia, bronchitis, pharyngitis||<1|
|Mycoplasma pneumonia||Pneumonia, bronchitis, pharyngitis||<1|
An important goal of treatment is to identify patients who require
specific antimicrobial agents and minimize the indiscriminate use
of these agents. Patients with nonbacterial causes of pharyngitis
only require symptomatic treatment, including gargling with warm
saltwater, maintenance of adequate oral intake, antipyretics, analgesics,
and rest. Patients unable to tolerate oral fluids or who become
dehydrated should be given IV fluids. Severe throat pain may be
temporarily relieved by over-the-counter lozenges with mild local
anesthetics. A single dose of 10 milligrams PO dexamethasone
reduces severe pharyngeal inflammatory pain, especially in patients
with an identified bacterial pathogen, but should not be
considered a routine treatment for pharyngitis.
Viral pharyngitis generally displays a vesicular and petechial
pattern on the soft palate and tonsils, is associated with rhinorrhea,
but is without tonsillar exudate or cervical adenopathy. Most cases of
viral pharyngitis require no specific diagnostic testing. ...