Uvulitis: Difference between revisions
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===History=== | ===History=== | ||
*Throat pain | *Throat pain | ||
*Dysphagia | *Dysphagia, sensation of something in their throat, gagging sensation | ||
*Low-grade fever | *Low-grade fever | ||
*Signs of | *Signs of Epiglottis | ||
**Sudden onset | **Sudden onset | ||
***High fever | ***High fever | ||
***Dysphagia | ***Dysphagia | ||
*** | ***Dyspepsia/SOB | ||
***Drooling | ***Drooling | ||
* | *History of sick contacts | ||
* | *Allergen exposure | ||
*Recent surgical procedure with site of entry via mouth (EGD, | *Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc) | ||
*Recent inhalation of cannabis | *Recent inhalation of cannabis | ||
===PMH=== | ===PMH=== | ||
*Vaccination status | *Vaccination status | ||
** H. Influenzae - | ** H. Influenzae - epiglottis | ||
**First H. Influenzae vaccine at 2 months, last booster 12-15 months | **First H. Influenzae vaccine at 2 months, last booster 12-15 months | ||
*Hereditary | *Hereditary angioedema | ||
===Physical Exam=== | ===Physical Exam=== | ||
*General | *General | ||
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**Range non-labored breathing to respiratory distress | **Range non-labored breathing to respiratory distress | ||
**Stridor | **Stridor | ||
** | **"Hot Potato Voice" | ||
**Clear lungs bilaterally | **Clear lungs bilaterally | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 107: | Line 105: | ||
*General Treatment | *General Treatment | ||
**Airway protection with fiberoptic intubation or tracheostomy | **Airway protection with fiberoptic intubation or tracheostomy | ||
**Dexamethasone 0.15mg/kg | **[[Dexamethasone]] 0.15mg/kg | ||
**Nebulized epinephrine | **Nebulized epinephrine | ||
*Antibiotic treatment | *Antibiotic treatment | ||
| Line 119: | Line 117: | ||
**Amoxicillin 50mg/kg PO once daily x 10 days | **Amoxicillin 50mg/kg PO once daily x 10 days | ||
*Adults | *Adults | ||
**Penicillin V 500mg PO BID x 10 days | **[[Penicillin V]] 500mg PO BID x 10 days | ||
**If compliance is unlikely | **If compliance is unlikely | ||
***Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose | ***Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose | ||
**If allergic to PCN | **If allergic to PCN | ||
***Clindamycin 300mg PO q8h x 10days | ***[[Clindamycin]] 300mg PO q8h x 10days | ||
====C. Albicans==== | ====C. Albicans==== | ||
*Topical nystatin | *Topical [[nystatin]] | ||
===Noninfectious=== | ===Noninfectious=== | ||
====Trauma==== | ====Trauma==== | ||
*Acetaminophen | *[[Acetaminophen]] | ||
*Local anesthetic lozenges | *Local anesthetic lozenges | ||
==== | ====[[Allergic Reaction]]==== | ||
*Treatment determined by severity of illness | *Treatment determined by severity of illness | ||
**Epinephrine 0.3mg 1:1,000 IM | **[[Epinephrine]] 0.3mg 1:1,000 IM | ||
**Diphenhydramine 50mg IV | **[[Diphenhydramine]] 50mg IV | ||
**Ranitidine 150mg | **[[Ranitidine]] 150mg | ||
** | **[[Methylprednisolone]] 125mg IV | ||
====[[Angioedema]]==== | ====[[Angioedema]]==== | ||
*Cover for allergic reaction with medications above | *Cover for allergic reaction with medications above | ||
| Line 144: | Line 142: | ||
====Inhalant irritation==== | ====Inhalant irritation==== | ||
*Antihistamines IV | *Antihistamines IV | ||
*Hydrocortisone or dexamethasone IV | *[[Hydrocortisone]] or [[dexamethasone]] IV | ||
==Disposition== | ==Disposition== | ||
*Determined by severity, complications, etc. | *Determined by severity, complications, etc. | ||
Revision as of 14:34, 4 November 2016
General
- Uvulitis is characterized by inflammation and edema of uvula
- Isolated uvular inflammation is rare
- More commonly manifests with other inflammatory diseases of oropharynx:
- Rarely causes life threatening respiratory distress
Etiologies
- Major division: infectious vs. noninfectious etiology
- Infections:
- Most commonly H. Influenzae Type B & Group A Streptococcus
- H. Influenzae
- Frequently with Epiglottitis
- Group A Streptococcus
- Frequently with Pharyngitis
- H. Influenzae
- Less common
- Most commonly H. Influenzae Type B & Group A Streptococcus
- Noninfectious
- Trauma
- Angioedema
- Inhalant irritation
- Inhaled cannabinoids
- Allergy
Clinical Features
History
- Throat pain
- Dysphagia, sensation of something in their throat, gagging sensation
- Low-grade fever
- Signs of Epiglottis
- Sudden onset
- High fever
- Dysphagia
- Dyspepsia/SOB
- Drooling
- Sudden onset
- History of sick contacts
- Allergen exposure
- Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc)
- Recent inhalation of cannabis
PMH
- Vaccination status
- H. Influenzae - epiglottis
- First H. Influenzae vaccine at 2 months, last booster 12-15 months
- Hereditary angioedema
Physical Exam
- General
- Range from well appearing to toxic
- HEENT
- Oropharynx
- Uvula
- Markedly erythematous and edematous
- Pinpoint hemorrhage is possible
- Vesicular lesions possible if viral etiology
- Nonerythematous, pale, swollen (uvular hydrops) may indicates angioedema
- Tonsils
- Edematous vs. nonedematous
- Exudative vs. nonexudative
- Erythematous posterior pharynx
- Uvula
- Oropharynx
- Respiratory
- Range non-labored breathing to respiratory distress
- Stridor
- "Hot Potato Voice"
- Clear lungs bilaterally
Differential Diagnosis
- Uvulitis
- Infectious
- Group A Streptococcus
- H. Influenza
- Strep. Pneumoniae
- Candida Albicans
- Noninfectious
- Trauma
- Angioedema
- Inhalant irritation
- Allergy
- Infectious
- Epiglottitis
- Streptococcal Pharyngitis
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Herpes Gingivostomatitis
Evaluation
- Labs
- Rapid strep throat swab
- Heterophile antibody (monospot) test
- If patient is ill appearing consider:
- CBC
- CMP
- Blood culture
- Imaging
- If concern for epiglottitis
- Lateral neck x-ray
- If concern for retropharyngeal abscess
- CT neck with contrast
- If concern for epiglottitis
Management
- ABC’s and Resuscitation if necessary
- Management guided by association with Epiglottitis or Streptococcal Pharyngitis
Infectious
Epiglottitis
- General Treatment
- Airway protection with fiberoptic intubation or tracheostomy
- Dexamethasone 0.15mg/kg
- Nebulized epinephrine
- Antibiotic treatment
- Pediatric:
- (Cefotaxime 50mg/kg IV q8h and Ceftriaxone 50mg/kg IV q24hr) plus Vancomycin 15mg/kg IV q12h
- Adult:
- (Cefotaxime 2gm IV q4-8h or Ceftriaxone 2gm IV q24h) plus Vancomycin
- Pediatric:
Streptococcal Pharyngitis
- Pediatrics
- Penicillin V 250mg PO BID x 10 days
- Amoxicillin 50mg/kg PO once daily x 10 days
- Adults
- Penicillin V 500mg PO BID x 10 days
- If compliance is unlikely
- Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose
- If allergic to PCN
- Clindamycin 300mg PO q8h x 10days
C. Albicans
- Topical nystatin
Noninfectious
Trauma
- Acetaminophen
- Local anesthetic lozenges
Allergic Reaction
- Treatment determined by severity of illness
- Epinephrine 0.3mg 1:1,000 IM
- Diphenhydramine 50mg IV
- Ranitidine 150mg
- Methylprednisolone 125mg IV
Angioedema
- Cover for allergic reaction with medications above
- If true angioedema, will not resolve symptoms
- Stop ACE inhibitor
- See angioedema management
Inhalant irritation
- Antihistamines IV
- Hydrocortisone or dexamethasone IV
Disposition
- Determined by severity, complications, etc.
Also See
External Links
References
- Yellon R, Chi D. Atlas of pediatric physical diagnosis. 6th Ed. 2012; 23: Philadelphia, PA: Saunders/Elsevier; 2012: 913-960
- Wald Ellen. Feigin and Cherry’s Textbook of Pediatric Infectious Disease, 7th ed. Philadelphia, PA : Elsevier/Saunders; 2014: 165-167
- Guarisco J, Cheney M, Lejeune F, Reed H. Isolated uvulitis secondary to marijuana use. Laryngoscope. 1988; 98:1309-131
- Boyce S, Quigley M. Uvulitis and partial upper airway obstruction following cannabis inhalation. Emergency medicine. 2002; 14:106-108
- Westerman E, Hutton J. Acute uvulitis associated with epiglotitis. Arch Otolaryngol Head Neck Surg. 1986; 12:448-449
- Peghlnl P, Salcedo J, Al-Kawas F. Traumatic uvulitis: a rare complication of upper GI endoscopy. Gastrointestinal Endoscopy. 2001; 53:818-820
- Lee S, Schwatz R, Babadori R. Retropharyngeal abscess: epiglottitis of the new mellennium. The Journal of Pediatrics. 2001; 138:435-437