Now we will explore some
common throat conditions.
First is pharyngitis.
This is inflammation of the mucous membranes
that line the pharynx of the throat.
This is a symptom, this is
what the patient feels.
They're gonna feel
a sore throat.
That's in contrast to tonsilitis which
is just inflammation of the tonsils.
This is an objective finding and this
may or may not be associated with pain.
Pharyngitis and tonsillitis can be
caused by many things, including:
viral infections, bacterial infections,
fungal infections, seasonal allergies,
just general inflammation and malignancies, although
this is uncommon in the pediatric population.
Bacteria and viruses can cause direct
invasion of the pharyngeal mucosa.
The body's gonna react by intiating the inflammatory
process that results in irritation, pain and edema.
Sometimes the irritation is secondary to
nasal secretions contacting the tissue
Such as with the rhinovirus
or the common cold.
When the patient has a runny nose, some of
that's gonna run down the back of the throat
and can irritate the local
tissues quite easily.
Let's explore the signs and
symptoms of pharyngitis.
The patient is gonna have pain
in the pharynx or in the throat.
They may have a dry throat
and a scratchy throat.
They may have tender or enlarged
lymph nodes in the neck.
When a patient has tonsillitis, they're
going to have enlarged, swollen tonsils.
Remember, -itis means
inflammation of, tonsils.
They may have a sore throat
and difficulty swallowing
and this can be a mechanical problem
due to the enlarged tonsillar size.
They may have changes in their voice,
they may sound like Kermit the frog,
and they'll also have tender or
enlarged lymph nodes in the neck.
These patients, depending on the source of their
tonsillitis may also have foul breath or halitosis.
On the left you'll
see a normal throat.
The uvula is pink, it's
midline, it's non-edematous.
The pharynx is clear, the soft palate is without any
discoloration and the patient has a normally sized tonsil.
On the right, on the abnormal throat, the
patient may have throat redness or erythema,
White spots on their tonsils called exudate
and their tonsils may be enlarged.
In the exam, we look in the throat and you see that
the patient may have pharyngeal mucosal congestion.
They may have swelling present,
and the uvula may be edematous
as well as the soft palate.
You're looking for redness and you're
feeling for swollen and tender lymph nodes.
When you look in, the
tonsils will be enlarged.
So how do we diagnose this?
We need to have a way to
describe tonsillar size.
We can't just say that a patient has small
tonsils, or medium tonsils or large size tonsils.
So there's a grading system.
Grade 0 tonsils are tonsils that are
fully inside the tonsillar pillars.
Grade 1 tonsils are hidden
within the tonsillar pillars.
Grade 2 is pretty typical tonsils,
these are extending to the pillars.
Grade 3 tonsils extend
beyond the pillars,
and grade 4, this is a problem.
This is where tonsils
extend to midline.
Sometimes they impinge on the uvula,
and sometimes these are
referred to as kissing tonsils.
Now let's say your patient
has had a tonsillectomy.
They don't have tonsils anymore.
The nurse can document that the
tonsils are surgically absent.
Remember, pharyngitis is a symptom.
And tonsilitis is an objective finding
that you see when you look in the throat.
So how do we manage
pharyngitis and tonsilitis?
Well, sometimes it hurts, right?
So over the counter analgesics, this
includes acetaminophen or NSAIDS.
I find that my patients get more relief when they take
NSAIDS because this also has anti-inflammatory properties
and a lot of the pain is
caused by the inflammation.
Patients can also suck on
throat lozenges or hard candy.
And this can help increase the salivary production
and help wash away some of that irritation.
Patients can also mix up warm salt
water and gargle it in their throat.
And I just tell patients, take a small cup
of water, add some salt and stir it up.
Gargle it in the back of their
throat and spit it out.
They can do this as
many times as needed.
How do we treat different conditions
that cause pharyngitis and tonsilitis?
Well, it depends on what's
causing the problem.
If it's a bacterial problem like strep throat,
we do need to treat these with antibiotics.
If the patient has a viral sore throat, they're
just gonna need rest, time and symptomatic care.
This will be self limiting.
If the patient's sore throat is caused by
allergies, we'll place them on antihistamines.
If the patient has fungal sore throat called
thrush, they're gonna need anti fungal therapy.
So patients can become dehydrated from both
the sore throat and the increased tonsil size
but these are for
In patients with pharyngitis
or sore throat,
they're gonna have pain with eating and
drinking, so they're going to avoid it.
And this is especially prevalent
in the pediatric population.
If you have a baby or a young child
then their throat is really hurting,
they're not going
to want to drink.
You have to treat their pain.
In tonsillitis, the pain can be involved,
but really, it's a mechanical issue.
Because food and fluid sometimes
can't pass beyond the tonsils.
In strep throat, the patients can
develop plenty of complications.
And in viral infections,
the patients have few.
So what are signs and
symptoms of dehydration?
Well in adults, they can
experience headache or dizziness.
They may feel faint and tired
and they may feel thirsty.
Their muscles may feel weak,
they may have dark yellow urine
and they may have a
decreased urinary output.
Kids can look pretty different
when they're dehydrated.
Sometimes they're usually
sleepy or drowsy,
They may cry but not produce tears, and
this is actually a late sign of dehydration
They may have a dry mouth or mucous
membranes and a dry or sticky tongue.
A high fever can
contribute to dehydration
and the patient may have a
decrease in wet diapers.
I always ask parents, "How many wet diapers
has your child made in the last 24 hours?"
And I use this to discern
if the child is dry.