View source for Sore throat

==Background==
*Sore throat is one of the most common chief complaints in the ED and primary care
*Most cases are viral and self-limited
*The primary ED goals are to identify dangerous causes (peritonsillar abscess, retropharyngeal abscess, epiglottitis, Ludwig's angina) and appropriately test/treat for Group A Strep
[[File:Gray1014.png|thumb|Anatomy of the posterior pharynx.]]
[[File:Infrahyoid deep neck spaces.png|thumb|Infrahyoid deep neck spaces]]

==Clinical Features==
*Key history: onset, severity, dysphagia, drooling, voice change ("hot potato voice"), trismus, neck stiffness/swelling, fever, rash
*Red flags suggesting dangerous cause:
**Inability to swallow secretions/drooling
**Trismus (inability to open mouth)
**Stridor or respiratory distress
**Unilateral swelling or uvular deviation
**Toxic appearance
**Neck swelling (especially floor of mouth)
*Physical exam:
**Pharyngeal erythema, exudates, tonsillar enlargement
**Uvular deviation → [[peritonsillar abscess]]
**Floor of mouth swelling → [[Ludwig's angina]]
**Cervical lymphadenopathy
**Assess for trismus, drooling, and airway compromise

==Differential Diagnosis==
{{Sore throat DDX}}

===Chronic Sore Throat===
*[[GERD]]
*Obstructive sleep apnea
*[[Fungal infections]] (e.g., [[Candidiasis|candida]])
*Chronic [[sinusitis]] with post-nasal drip
*Inhalation of irritants (smoke, [[chlorine gas]])
*Glossopharyngeal neuralgia
*Tumor (tongue, larynx, thyroid)
*[[Thyroiditis]]
*[[Esophageal foreign body|Retained foreign body]]

==Evaluation==
*Centor criteria (modified/McIsaac) to guide Group A Strep testing:<ref>McIsaac WJ, et al. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998;158(1):75-83.</ref>
**Tonsillar exudates (+1)
**Tender anterior cervical lymphadenopathy (+1)
**Fever >38°C / 100.4°F (+1)
**Absence of cough (+1)
**Age 3-14 (+1), Age 15-44 (0), Age ≥45 (-1)
*Score ≤1: No testing needed; unlikely GAS
*Score 2-3: Rapid strep test; treat if positive
*Score ≥4: Rapid strep test (or empiric treatment); treat if positive
*CT neck with IV contrast if deep space infection suspected (peritonsillar abscess, retropharyngeal abscess, Ludwig's angina)
*Consider [[monospot]] or [[EBV]] testing if infectious mononucleosis suspected (especially adolescents/young adults with prolonged symptoms, significant lymphadenopathy, hepatosplenomegaly)
*[[Lateral soft tissue neck X-ray]] — if [[epiglottitis]] or [[retropharyngeal abscess]] suspected (prevertebral soft tissue widening)
*[[Flexible nasopharyngoscopy]] if airway concern or supraglottic pathology suspected

==Management==
*Most sore throats are viral → supportive care:
**NSAIDs and/or acetaminophen for pain
**Encourage PO fluids
**Warm salt water gargles, throat lozenges
*Group A Strep pharyngitis:
**[[Penicillin V]] or [[amoxicillin]] x 10 days (first line)
**[[Azithromycin]] if penicillin allergic
**See [[Streptococcal pharyngitis]]
*[[Peritonsillar abscess]]:
**Needle aspiration or incision and drainage
**Antibiotics (see [[PTA]])
*[[Epiglottitis]]:
**Emergent airway management, avoid agitating patient
**IV antibiotics (see [[Epiglottitis]])
*[[Ludwig's angina]]:
**Emergent airway management
**IV antibiotics, surgical consultation
*Dexamethasone single dose (10 mg IV or 0.6 mg/kg PO) may reduce pain in moderate-severe pharyngitis<ref>Hayward G, et al. Corticosteroids for the common cold. Cochrane Database Syst Rev. 2015;(10):CD008116.</ref>

==Disposition==
*Admit:
**Peritonsillar abscess (if unable to tolerate PO after drainage, or bilateral/complicated)
**Retropharyngeal abscess
**Epiglottitis
**Ludwig's angina
**Airway compromise
**Severe dehydration
*Discharge with follow-up:
**Viral pharyngitis
**Strep pharyngitis with appropriate antibiotics
**Successfully drained PTA with ability to tolerate PO
**Return precautions: difficulty breathing, inability to swallow, worsening symptoms

==See Also==
*[[Pharyngitis]]
*[[Streptococcal pharyngitis]]
*[[Peritonsillar abscess]]
*[[Retropharyngeal abscess]]
*[[Epiglottitis]]
*[[Ludwig's angina]]
*[[Infectious mononucleosis]]
*[[Uvulitis]]
*[[Neck mass]]

==External Links==

==References==
<references/>

[[Category:ENT]]
[[Category:Symptoms]]