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INTRODUCTION

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 Chapter 260, “Trauma to the Neck,” and angioedema is discussed in Chapter 14, “Allergy and Anaphylaxis.” Management of upper airway and neck infections in children are discussed in Chapter 124, “Mouth and Throat Disorders in Infants and Children,” and Chapter 126, “Stridor and Drooling in Infants and Children.”

NECK AND UPPER AIRWAY INFECTIONS

PHARYNGITIS/TONSILLITIS

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

TABLE 246-1Microbial Causes of Acute Pharyngitis

VIRAL PHARYNGITIS

Features traditionally associated with viral pharyngitis include a vesicular or petechial pattern on the soft palate and tonsils, cough, and rhinorrhea.2 It remains difficult, however, to determine the causative agent based on clinical features alone. For example, in patients with nonstreptococcal pharyngitis (mostly viral), 16% have tonsillar exudate, 55% have cervical adenopathy, and 64% lack cough.3 Most cases of viral pharyngitis require no specific diagnostic testing. There are three notable exceptions where testing may be indicated: suspected influenza, infectious mononucleosis, or acute retroviral syndrome. See Centers for Disease Control and Prevention influenza website for testing and treatment recommendations (http://www.cdc.gov/flu/). Infectious mononucleosis, influenza, herpesvirus, and cytomegalovirus infections are discussed in Chapter 154, “Serious Viral Infections.” The acute retroviral syndrome of early human immunodeficiency virus infection can also mimic mononucleosis. See Chapter 155, “Human Immunodeficiency Virus Infections,” for recommendations on testing and treatment. Apart from the viral causes of pharyngitis discussed earlier, viral pharyngitis should be treated symptomatically with oral ...

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