1. Pharmaceutical guidelines of patients with pathology of breathing organs. Symptomatic treatment of THROAT PAIN

2. PHISIOLOGY of the THROAT Breathing Breathing Swallowing Swallowing Separating (channelization) Separating (channelization) Speech (articulation) Speech (articulation)

3. INFLAMMATORY DISORDERS OF THE PHARYNX Inflammatory disorders of the pharynx most commonly present as throat or neck pain. Disphagia, odynophagia, and airway obstruction are other frequent complaints. The pharynx is a dynamic conduit for inspired air and ingested matter, responsible for diverting each into the trachea or esophagus, respectively. This process may be impaired by anything which obstructs or restricts the mobility of the pharynx. Inflammatory disorders of the pharynx most commonly present as throat or neck pain. Disphagia, odynophagia, and airway obstruction are other frequent complaints. The pharynx is a dynamic conduit for inspired air and ingested matter, responsible for diverting each into the trachea or esophagus, respectively. This process may be impaired by anything which obstructs or restricts the mobility of the pharynx.

4. EVALUATION Key historical considerations Key historical considerations Age of patient Age of patient Onset and duration Onset and duration History of recent trauma (including possible foreign body) History of recent trauma (including possible foreign body) Inflammatory symptoms - fever, pain, malaise, malodorous breath Inflammatory symptoms - fever, pain, malaise, malodorous breath Status of nasal airway: congestion, obstruction, rhinorrhea, purulent discharge, allergic history, snoring Status of nasal airway: congestion, obstruction, rhinorrhea, purulent discharge, allergic history, snoring Reflux symptoms such as heartburn or water brash Reflux symptoms such as heartburn or water brash Associated ear pain Associated ear pain Disphagia or odynophagia Disphagia or odynophagia Dyspnea or stridor Dyspnea or stridor Other associated symptoms Other associated symptoms Recent exposure to infectious discharge Recent exposure to infectious discharge Cancer risk factors: smoking history Cancer risk factors: smoking history

5. Acute Viral or Bacterial Pharyngitis Pharyngitis is caused by a variety of microorganisms. Most cases are viral and include the virus causing the common cold, flu (influenza virus), adenovirus, mononucleosis, HIV among various others. Bacterial causes include Group A streptococcus which causes strep throat (15% of cases), in addition to Corynebacterium, Arcanobacterium, Neisseria gonorrhoeae, Chlamydia pneumoniae and others. In up to 30% of cases, no organism is identified. Pharyngitis is caused by a variety of microorganisms. Most cases are viral and include the virus causing the common cold, flu (influenza virus), adenovirus, mononucleosis, HIV among various others. Bacterial causes include Group A streptococcus which causes strep throat (15% of cases), in addition to Corynebacterium, Arcanobacterium, Neisseria gonorrhoeae, Chlamydia pneumoniae and others. In up to 30% of cases, no organism is identified.Group A streptococcusstrep throatGroup A streptococcusstrep throat

6. Strep throat Strep throat Strep often produces white patches in the throat and on the tonsils, as well as red, swollen tonsils. Pus may be seen in the back of the throat.

7. Strep throat may cause the lymph nodes in the neck to become swollen and tender.

8. Acute Viral or Bacterial Pharyngitis (cont’d) Most cases of pharyngitis occur during the colder months -- during respiratory disease season. Spread among household members is common. The medical importance of recognizing strep throat as a cause of pharyngitis stems from the need to prevent its complications which can include acute rheumatic fever, kidney dysfunction and severe disease such as bacteremia and rarely streptococcal toxic shock syndrome. Most cases of pharyngitis occur during the colder months -- during respiratory disease season. Spread among household members is common. The medical importance of recognizing strep throat as a cause of pharyngitis stems from the need to prevent its complications which can include acute rheumatic fever, kidney dysfunction and severe disease such as bacteremia and rarely streptococcal toxic shock syndrome.

9. Pharyngitis. Symptoms Pharyngitis. Symptoms sore throat sore throat sore throat sore throat additional symptoms are dependent on the underlying microorganisms additional symptoms are dependent on the underlying microorganisms step throat may be accompanied by fever, headache, swollen lymph nodes in the neck step throat may be accompanied by fever, headache, swollen lymph nodes in the neckfeverswollen lymph nodesfeverswollen lymph nodes viral pharyngitis may be associated with runny nose (rhinorrhea) and postnasal discharge viral pharyngitis may be associated with runny nose (rhinorrhea) and postnasal discharge severe cases of pharyngitis may be accompanied by difficulty swallowing and rarely difficulty breathing severe cases of pharyngitis may be accompanied by difficulty swallowing and rarely difficulty breathingdifficulty swallowingdifficulty swallowing Signs and tests. A physical exam with attention to the pharynx to assess whether drainage/coating (exudates) are present, as well as skin, eyes, neck lymph nodes is frequently done. Signs and tests. A physical exam with attention to the pharynx to assess whether drainage/coating (exudates) are present, as well as skin, eyes, neck lymph nodes is frequently done.

10. Oropharyngoscopy Swollen, erythematous mucosa of the oropharynx and hypopharynx, often with edema of the uvula and soft palate. Swollen cyanotic lymphatic follicles on the posterior wall Mucous or purulent discharges on the posterior wall

11. Complications complications of strep throat: rheumatic fever, rheumatic fever, rheumatic fever, rheumatic fever, glomerulonephritis (kidney inflammation), glomerulonephritis (kidney inflammation), chorea, chorea, bacteremia (bloodstream infection) and rarely streptococcal shock syndrome bacteremia (bloodstream infection) and rarely streptococcal shock syndrome in some severe forms of pharyngitis (e.g., severe mononucleosis-pharyngitis) in some severe forms of pharyngitis (e.g., severe mononucleosis-pharyngitis) airway obstruction may occur airway obstruction may occur peritonsillar abscess, retropharyngeal abscess peritonsillar abscess, retropharyngeal abscess

12. A sore throat caused by a cold virus usually resolves in one to two weeks without treatment. On the other hand, a sore throat caused by the streptococcus bacterium (strep throat) should be treated with antibiotics to prevent damage to the heart valves (. Generally, streptococcus bacteria cause a more severe sore throat and a higher fever than viral sore throats. A sore throat caused by a cold virus usually resolves in one to two weeks without treatment. On the other hand, a sore throat caused by the streptococcus bacterium (strep throat) should be treated with antibiotics to prevent damage to the heart valves (phenoxymethylpenicillin 500 mg four times a day or cefaclor 250 mg three times daily). Generally, streptococcus bacteria cause a more severe sore throat and a higher fever than viral sore throats.strep throatstrep throat In some cases, strep may cause In some cases, strep may cause nausea, a lack of appetite, nausea, a lack of appetite, or pain in the head and abdomen. or pain in the head and abdomen.

13. A less common sign of strep infection is a rash that appears on the neck and chest, eventually spreading to the rest of the body. When this rough, sandpaper-like rash develops, the infection is known as scarlet fever. Although the full body rash may be alarming, it will start to fade after a few days A less common sign of strep infection is a rash that appears on the neck and chest, eventually spreading to the rest of the body. When this rough, sandpaper-like rash develops, the infection is known as scarlet fever. Although the full body rash may be alarming, it will start to fade after a few days

14. Sneezing, runny nose, and cough more frequently accompany sore throats due to a cold virus, rather than streptococcus infections. Sometimes, a throat culture is necessary to establish the cause of the sore throat. Sneezing, runny nose, and cough more frequently accompany sore throats due to a cold virus, rather than streptococcus infections. Sometimes, a throat culture is necessary to establish the cause of the sore throat. Antibiotic treatment may lessen symptoms and duration of illness and decrease the chance for complications

15. Acute Tonsillitis The most common organism is beta hemolytic streptococcus, but viral organisms can also cause exudative tonsillitis. Other causative organisms include staphylococcus aureus, streptococcus viridans, and various hemophilus species. The most common organism is beta hemolytic streptococcus, but viral organisms can also cause exudative tonsillitis. Other causative organisms include staphylococcus aureus, streptococcus viridans, and various hemophilus species.

16. General Symptoms Rapid onset of throat pain with pain on swallowing associated with Rapid onset of throat pain with pain on swallowing associated with Fever, often 38°-39° C Fever, often 38°-39° C Malaise Malaise fatigue fatigue Chill Chill Pain in extremities, muscles and joints Pain in extremities, muscles and joints

17. Catharal and Follicular Tonsilitis The tonsils are red, enlarged and painfulness with an exudate or studded with white follicles. Tender, firm cervical adenopathy is often present

18. Tonsillar hypertrophy

19. Treatment Taking antibiotics unnecessarily can contribute to the growing problem of microbial resistance. When bacteria are frequently exposed to antibiotics, they may become "superbugs" that can't be treated with standard medications. Taking antibiotics unnecessarily can contribute to the growing problem of microbial resistance. When bacteria are frequently exposed to antibiotics, they may become "superbugs" that can't be treated with standard medications.

20. Treatment Since fever and painful swallowing can lead to dehydration, it's important to increase intake of fluids to combat it. Water and ginger ale are good choices. A patient should avoid citrus drinks which can irritate an inflamed throat.

21. Treatment Medications that are available OTC for the temporary relief of sore throat due to the common cold usually contain anesthetics such as benzocaine and dyclonine or menthol and come in the form of Medications that are available OTC for the temporary relief of sore throat due to the common cold usually contain anesthetics such as benzocaine and dyclonine or menthol and come in the form of lozenges, lozenges, gargles, gargles, sprays. sprays.

22. Treatment Pain Relievers Pain Relievers Over-the-counter pain relievers, like acetaminophen, ibuprofen, or naproxen, can temporarily dull the pain of a sore throat. (Do not give aspirin to children and teenagers because of the risk of the rare but potentially fatal Reye's syndrome.) Over-the-counter pain relievers, like acetaminophen, ibuprofen, or naproxen, can temporarily dull the pain of a sore throat. (Do not give aspirin to children and teenagers because of the risk of the rare but potentially fatal Reye's syndrome.)

23. Use a decongestant decongestant Decongestants make breathing easier by shrinking swollen mucous membranes in the nose, allowing air to pass through. They also help relieve a runny nose and postnasal drip, which can cause a sore throat. Decongestants make breathing easier by shrinking swollen mucous membranes in the nose, allowing air to pass through. They also help relieve a runny nose and postnasal drip, which can cause a sore throat. Decongestants can be taken orally or used as decongestant nasal sprays. Oral decongestants (pills) are probably more effective and provide longer relief but may cause more side effects. Decongestants can be taken orally or used as decongestant nasal sprays. Oral decongestants (pills) are probably more effective and provide longer relief but may cause more side effects. decongestant nasal sprays decongestant nasal sprays These medicines may not be safe for young children or for people who have certain health problems. These medicines may not be safe for young children or for people who have certain health problems.

24. Threatning symptoms Any sore throat that has a rapid onset and is associated with a fever or tenderness of the front of the neck may be serious and should be seen by a health care professional. Any sore throat that has a rapid onset and is associated with a fever or tenderness of the front of the neck may be serious and should be seen by a health care professional. Any sore throat that causes a patient to have difficulty swallowing (not just pain with swallowing) or breathing should be seen by a health care professional. Any sore throat that causes a patient to have difficulty swallowing (not just pain with swallowing) or breathing should be seen by a health care professional. Any sore throat that lasts for more than a week should be evaluated by a health care professional. Any sore throat that lasts for more than a week should be evaluated by a health care professional.

25. Persistent Sore Throat If a sore throat lasts over a week or gets worse, this is the indication for doctor visiting, even if an initial strep test came back negative. A persistent sore throat could be a sign of acid reflux, mononucleosis, or another condition. In rare cases, a sexually transmitted disease may be to blame (). If a sore throat lasts over a week or gets worse, this is the indication for doctor visiting, even if an initial strep test came back negative. A persistent sore throat could be a sign of acid reflux, mononucleosis, or another condition. In rare cases, a sexually transmitted disease may be to blame (pharyngeal gonorrhea).

26. Noninfectious sore throat Not all sore throats are caused by infection. Postnasal drip can irritate the throat and make it sore. It can be caused by hay fever and other allergies that irritate the sinuses. Environmental and other conditions, such as heavy smoking or breathing secondhand smoke, heavy alcohol consumption, breathing polluted air or chemical fumes, or swallowing substances that burn or scratch the throat can also cause pharyngitis. Dry air, like that in airplanes or from forced hot air furnaces, can make the throat sore. People who breathe through their mouths at night because of nasal congestion often get sore throats that improve as the day progresses. Sore throat caused by environmental conditions is not contagious.