E.N.T. Dr Katie Bleksley GPST1

Aims Coverage of the common conditions affecting the throat presenting to General practice.

Objectives Recognise the following conditions and know how to manage / refer to secondary care Sore throats Foreign bodies Bleeding post-tonsillectomy Hoarseness

Sore throat 70% Viral vs. 30% Bacterial – usually clinically indistinguishable DDx: Viral Bacterial tonsillitis +/- quinsy EBV

Sore throat: Ix Ix usually not done Swabs not felt to be useful (can’t distinguish commensals from infecting organisms, expensive, delayed in getting result)

Sore Throat: Rx Analgesics, inc fluids intake, gargle salt water Antibiotics?? Benefits of ABx: sl dec risk of some complications (quinsy, OM) but not RhF or acute GN Risks of ABx: S/Es, resistant organisms, encourages re-attendence for sore throats

Sore throat – when to give ABx CENTOR criteria (3/4 of … suggests give ABx) h/o fever Absence of cough Cervical LNs Tonsillar exudate Or if significant comorbidities Or if Gp A haem strep isolated

Tonsillitis

Tonsillitis Management Analgesia – aspirin gargles Penicillin V 500mg qds +/- metronidazole (erythro/clarith if pen allergy), treat for 10days Maintain hydration Dysphagia ?retropharyngeal abcess Quinsy (peritonsillar abcess) Systemic upset / Dehydration

Quinsy

When to refer for tonsillectomy Recurrent tonsillitis (>5 per yr for 2y) Recurrent quinsy Obstructive Sxs Chr tonsillitis >3 mo with hallitosis Unilat tonsillar enlargement ? malig

Glandular Fever

Glandular Fever Infectious Mononucleosis Suspect in teenagers and young adults with sore throat lasting >1 wk Malaise LNs/spleen Palatal petechiae and rash Exudative pharyngitis (+/- white membrane)

Glandular Fever Rx Ix: FBC (atypical lymph) and monospot (maybe neg). Rx: rest, fluids, paracetamol, aspirin gargles (if >14y). Treat secondary infection with ABx. Counsel pt about ongoing Sxs (several months), avoiding contact sports. Don’t give ampicillin / amoxil for sore throat

Foreign Bodies in the Throat

Foreign bodies in the Throat Various types fish / chicken bones dental plates Features Pain on swallowing Tender neck Respiratory problems Fever

Foreign bodies in the Throat Management ABC’s Assess swallowing Look Close inspection Good light Good tongue depression ? Attempt removal ? Refer all, except those with mildest symptoms Advise to return if not settling in 24 hours Animal bone –urgent removal

Bleeding post tonsillectomy

Bleeding post tonsillectomy Usually recurs 3-10 d post-op. Management Refer all immediately Augmentin IV

Hoarseness DDx: Neurol /Local causes Local causes: Acute: laryngitis, shouting Chronic: vocal cord nodules, functional, reflux malig Hoarseness >3wks refer to ENT to r/o malig

Summary We have covered: Sore throats: when to give ABx, when to consider EBV, what complications to look out for Foreign bodies: very low threshold for referral, and urgent referral if animal bone. Bleeding post-tonsillectomy: refer to ENT Hoarseness: refer if >3wks

Questions ?