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This chapter reviews conditions that can obstruct the upper airway. These disorders must be recognized quickly because early airway management may be lifesaving. Infections of the neck and upper airway include pharyngitis/tonsillitis, peritonsillar abscess, epiglottitis, retropharyngeal abscess, and odontogenic abscess. Cancers, congenital neck masses, ranulas, and mucoceles present as masses in the neck and upper airway and may become infected. Noninfectious causes of airway obstruction include posttonsillectomy hemorrhage, airway and esophageal foreign bodies, laryngeal papillomatosis, neck and facial trauma, and angioedema. If there is a possibility of surgical intervention in the neck, the patient should remain NPO after arrival at the ED.


Group A β-hemolytic Streptococcus (GABHS) is the most common bacterial organism causing pharyngitis (Table 241-1). Acute viral pharyngitis is most commonly caused by rhinovirus but can be caused by infectious mononucleosis [Epstein-Barr virus, (EBV)], acute retroviral syndrome [human immunodeficiency virus (HIV)], and cytomegalovirus infection. Less commonly, Mycoplasma pneumoniae and Chlamydia pneumonia have been isolated from patients with symptomatic pharyngitis.

Table 241-1 Microbial Causes of Acute Pharyngitis

An important goal of treatment is to identify patients who require specific antimicrobial agents and minimize the indiscriminate use of these agents. Patients with nonbacterial causes of pharyngitis only require symptomatic treatment, including gargling with warm saltwater, maintenance of adequate oral intake, antipyretics, analgesics, and rest. Patients unable to tolerate oral fluids or who become dehydrated should be given IV fluids. Severe throat pain may be temporarily relieved by over-the-counter lozenges with mild local anesthetics. A single dose of 10 milligrams PO dexamethasone reduces severe pharyngeal inflammatory pain, especially in patients with an identified bacterial pathogen, but should not be considered a routine treatment for pharyngitis.

Viral Pharyngitis

Viral pharyngitis generally displays a vesicular and petechial pattern on the soft palate and tonsils, is associated with rhinorrhea, but is without tonsillar exudate or cervical adenopathy. Most ...

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