1. E.N.T.
Dr Katie Bleksley GPST1

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

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

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

5. 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)

6. 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

7. 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

8. Tonsillitis

9. 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

10. Quinsy

11. 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

12. Glandular Fever

13. 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)

14. 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

15. Foreign Bodies in the Throat

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

17. 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

18. Bleeding post tonsillectomy

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

20. 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

21. 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

22. Questions ?