Sore Throat
Sore Throat: Excerpt from In A Page: Pediatric Signs and Symptoms
Most sore throats and coughs are due to infection. Children may have 5–8 upper respiratory infections per year. The primary differential is between viral and bacterial etiologies, especially group A β-hemolytic streptococcus.
Differential Diagnosis
Infectious
–Viral
–Adenovirus
–Rhinovirus
–Parainfluenza
–Influenza
–Coronavirus
–Others: EBV RSV, CMV, HSV
–Bacterial
–Streptococcus
–Haemophilus
–Moraxella
–Staphylococcus
–Corynebacterium
–Fungal
–Candida
-
Inflammatory
–Allergy
–Gastroesophageal reflux disease
–Sinusitis resulting in postnasal drainage
-
Tumors
–Leukemia
–Rhabdosarcomas
–Squamous cell carcinoma secondary to oral
ulcerations
-
Trauma
–Foreign body ingestion
–Caustic ingestion
–Soft tissue injury from accidental and
nonaccidental trauma
-
Systemic/rheumatologic disorders
–Kawasaki disease: Mucocutaneous lymph node syndrome may have sore throat at presentation (other oral findings include strawberry tongue, fissured lips, mucosal erythema, fever, and lymphadenopathy)
–Behçet syndrome
–Reiter syndrome
- Others
–Cigarette smoke
–Environmental pollutants
–Pharyngeal drying: Mouth and pharynx can
be dry from mouth breathing, more common in the winter months
Workup and Diagnosis
History
–Duration, onset, severity, frequency, odynophagia, dysphagia, daycare, sick contacts, fever, malaise, headache
–Foreign body and caustic ingestion
–Days of school or work missed
–Immunization history
–Medical history: Systemic disease, connective tissue
disorder
-
Physical exam
–Nasal exam: Evidence of rhinosinusitis
–Mouth: Ulcerations, masses, tonsil size, erythema,
exudates
–Neck: Lymphadenopathy
–Skin: Rash
–Chest: Wheezes, asymmetry
-
Studies
–For pharyngitis: A major goal is to differentiate streptococcal pharyngitis from viral etiologies
–Throat culture: 92% sensitive; 100% specific; requires
24–48 hours
–Rapid strep test: 72–85% sensitive; 88–100% specific
–CBC with differential for suspected mononucleosis
–Chest X-ray (inspiratory and expiratory) for suspected
foreign body
–CT neck: When complication of infection is suspected such as abscess
Treatment
-
Viral causes
–Supportive care including hydration, acetaminophen or ibuprofen, bedrest, salt water rinses
–Steroids may be considered to minimize upper airway obstruction
-
Antibiotics for bacterial etiologies
–For group A β-hemolytic strep: Shortens duration of symptoms and prevents rheumatic fever
-
Consider inpatient admission when there is concern about adequate airway or oral intake
-
Airway management: Intubation or tracheotomy
-
When gastroesophageal reflux is suspected, treatment may include dietary changes, antireflux therapy
-
Adenotonsillectomy for recurrent tonsillitis is considered depending on frequency of recurrence, i.e., 6–7 infections/year, or 4–5 infections/year for 2 years, or 3 infections/year for 3 years
Book Source Details
- Book Title: In A Page: Pediatric Signs and Symptoms
- Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
- Year of Publication: 2007
- Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: In A Page: Pediatric Signs and Symptoms
Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
Publisher: Lippincott Williams & Wilkins
Copyright: 2007
ISBN: 1-4051-0427-9
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