15.5.1 Pharyngotonsilitis
Pharyngotonsilitis is an acute inflammation of the pharynx and tonsils, which is characterized by fever and a painful throat.
Pharmacological Treatment
A: Phenoxymethylpenicillin (PO) 500mg 8 hourly for 7 days. Children up to 5 years: 6 mg/kg 6 hourly for 10 days
OR
A: Azithromycin (PO) 500mg once daily for 3 days. Children: 10mg/kg once daily for 3 days
OR
B: Amoxicillin/Clavulanic acid (PO)
Adults: 625mg (500mg amoxicillin+125mg Clavulanic acid) 8 hourly for 7 days
Children: 375mg (250mg amoxicillin+125 Clavulanic acid) 12 hourly for 7 days;
AND
A: Paracetamol (PO) 1gm 8hourly until fever is controlled
Children 10 mg/kg body weight 8 hourly until the fever is controlled
| NOTE: Refer the patient with tonsillitis to the specialist for tonsillectomy if Chronic tonsillitis
• Recurrent tonsillitis (>3 attacks in a year or 5 or more attacks in 2 years) • Obstructive tonsillitis (causing an upper airway obstruction) |
15.5.2 Laryngitis
This is an infectious or non-infectious, acute or chronic inflammatory condition of the larynx. It becomes chronic when the condition lasts for more than 3 weeks. The picture of the disease is different in children and adults due to the small size of the larynx in children.
- Acute subglottic laryngitis occurs mainly in children under the age of seven, it is a viral infection
- Edema of the mucous membrane of the subglottic space causes breathing difficulties, especially on inspiration
- Laryngitis in children may require active treatment
Acute Laryngitis
Acute subglottic laryngitis occurs mainly in children under the age of seven, it is a viral infection.
Non-Pharmacological Treatment
- Parents should behave calmly and avoid frightening the child
- Bed rest
- Keep the air damp and cool
- Give extra fluid
Pharmacological Treatment
A: Epinephrine (adrenaline) inhalation effectively reduces symptoms
Table 15.1: Doses of Racemic Epinephrine Preparation
| Age | Racemic Epinephrine (20 mg/ml) | 0.9% Saline |
| 0-6 months | 0.1 ml | 2 ml |
| 6-12 months | 0.15 ml | 2 ml |
| >12 | 0.2 ml | 2 ml |
NOTE: The total fluid volume is inhaled in 5 minutes with the use of inhalator
Hospitalization
If severe symptoms persist or worsen after epinephrine inhalation, hospitalization is indicated.
Chronic Laryngitis
Non-Pharmacological Treatment:
- Voice rest
- Stop smoking
- Rehydration
- Refer to specialist for laryngoscopy
15.5.3 Acute Epiglottitis (AE)
Epiglottitis is an acute infectious inflammation of the epiglottis, supraglottic and hypopharynx which occurs both in children and adults. It is commonly caused by Haemophilus influenzae. Epiglottitis is a potentially lethal condition especially in children. Edema of the epiglottis may cause acute airway obstruction.
Diagnostic Criteria
- Throat pain and difficulty in swallowing
- Drooling
- Husky voice
- Fever often high and with chills
- Patient prefers sitting posture with an extended neck
- Laborious inspiration
- Cough in some cases
- Anxiety
Investigations: Plain X-ray of the neck, lateral view characteristically presents with a positive thumb sign (edematous epiglottis).
Non-Pharmacological Treatment:
- Immediate hospitalization, preferably in the ICU
- Transportation: sitting, with oxygen supplementation
- Be prepared to treat respiratory failure (intubation or tracheotomy)
Pharmacological Treatment
A: Phenoxymethylpenicillin (PO) 500mg 8 hourly for 7 days. Children up to 5 years: 6 mg/kg 6 hourly for 10 days
OR
A: Azithromycin (PO) 500mg once daily for 3 days. Children: 10mg/kg once daily for 3 days
OR
B: Amoxicillin/Clavulanic acid (PO)
Adults: 625mg (500mg amoxicillin+125mg Clavulanic acid) 8 hourly for 7 days
Children: 375mg (250mg amoxicillin+125 Clavulanic acid) 12 hourly for 7 days;
AND
A: Paracetamol (PO) 1gm 8hourly until fever is controlled. Children: 10 mg/kg body weight 8 hourly
15.5.4 Recurrent Respiratory Papillomatosis (Laryngeal Papillomas)
It is the commonest benign laryngeal tumor of the larynx caused by Human papilloma virus (HPV), occurring in both children and adults. It has a higher recurrence rate in children than in adults, among adults it may turn into a malignancy.
Diagnostic Criteria
- Hoarse voice, audible respiration (inspiratory stridor)
- Progressive difficulty in breathing
- Progressive inspiratory stridor
- On and off cough
Investigations:
- Perform a thorough respiratory system examination
- Indirect laryngoscopy for papilloma croups on the larynx
Non-Pharmacological Treatment:
- If in distress, perform a tracheostomy first then refer
Referral:
Refer the patient to the next facility with adequate expertise and facilities
15.5.5 Foreign Bodies in the Throat
If the foreign body is suspected to be in the hypopharynx, esophagus, trachea or bronchus
- Take a thorough history and do a thorough physical examination
- Do chest X ray to confirm your diagnosis (though some foreign bodies are radiolucent)
- Refer to a zonal hospital for removal
