Uvulitis: Difference between revisions
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**If concern for retropharyngeal abscess | **If concern for retropharyngeal abscess | ||
***CT neck with contrast | ***CT neck with contrast | ||
==Management == | |||
==Management== | |||
*ABC’s and Resuscitation if necessary | *ABC’s and Resuscitation if necessary | ||
*Management guided by association with [[Epiglottitis]] or [[Streptococcal Pharyngitis]] | *Management guided by association with [[Epiglottitis]] or [[Streptococcal Pharyngitis]] | ||
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*Stop [[ACE inhibitor]] | *Stop [[ACE inhibitor]] | ||
*See [[Angioedema#Management|angioedema management]] | *See [[Angioedema#Management|angioedema management]] | ||
====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. | ||
==Also | |||
==See Also== | |||
*[[Epiglottitis]] | *[[Epiglottitis]] | ||
*[[Retropharyngeal | *[[Retropharyngeal abscess]] | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | |||
[[Category:ENT]] | [[Category:ENT]] | ||
Revision as of 01:08, 10 July 2017
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.