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INTRODUCTION

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This chapter reviews infectious and noninfectious conditions that can obstruct the upper airway. These disorders must be recognized quickly because early airway management may be lifesaving. Neck trauma is discussed in the chapter 260, "Trauma to the Neck," and angioedema is discussed in the chapter 14, "Anaphylaxis, Allergies, and Angioedema."

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NECK AND UPPER AIRWAY INFECTIONS

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PHARYNGITIS/TONSILLITIS

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Viruses account for the majority of cases of pharyngitis or tonsillitis. Acute viral pharyngitis is most commonly caused by rhinovirus but can be caused by multiple other viral agents (Table 246-1).1

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TABLE 246-1Microbial Causes of Acute Pharyngitis
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VIRAL PHARYNGITIS
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Viral pharyngitis generally displays a vesicular or petechial pattern on the soft palate and tonsils and is associated with rhinorrhea. However, in patients with nonstreptococcal pharyngitis (mostly viral), 16% have tonsillar exudate, 55% have cervical adenopathy, and 64% lack cough.2 Most cases of viral pharyngitis require no specific diagnostic testing. There are three notable exceptions where testing may be indicated: suspected influenza, infectious mononucleosis, and acute retroviral syndrome. See Centers for Disease Control and Prevention influenza Web site for testing and treatment recommendations (http://www.cdc.gov/flu/). Infectious mononucleosis, influenza herpesvirus, and cytomegalovirus infections are discussed in the chapter 153, "Serious Viral Infections." The acute retroviral syndrome of early human immunodeficiency virus infection can also mimic mononucleosis. Symptoms of pharyngitis develop 2 to 4 weeks after exposure and resolve within 2 weeks. See the chapter 154, "Human Immunodeficiency Virus Infection" for recommendations on testing and treatment. Non–human immunodeficiency virus, noninfluenza viral pharyngitis should be treated symptomatically with oral hydration, antipyretics, analgesics, and rest. Patients unable to tolerate oral fluids or who become dehydrated should be given IV fluids.

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BACTERIAL PHARYNGITIS
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