Uvulitis: Difference between revisions
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== | ==Background== | ||
[[File:Gray1014.png|thumb|Anatomy of the posterior pharynx.]] | |||
[[File:Human anatomy, including structure and development and practical considerations (1911) (14594049867).jpg|thumb|Midline neck anatomy on lateral view.]] | |||
*Uvulitis is characterized by inflammation and edema of uvula | *Uvulitis is characterized by inflammation and edema of uvula | ||
*Isolated uvular inflammation is rare | *Isolated uvular inflammation is rare | ||
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**[[Epiglottitis]] | **[[Epiglottitis]] | ||
**[[Pharyngitis]] | **[[Pharyngitis]] | ||
*Rarely causes life threatening respiratory distress | *Rarely causes life threatening [[respiratory distress]] | ||
===Etiologies=== | ===Etiologies=== | ||
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**Inhalant irritation | **Inhalant irritation | ||
***Inhaled [[cannabinoids]] | ***Inhaled [[cannabinoids]] | ||
**Allergy | ***Smoking | ||
**[[Acute allergic reaction|Allergy]] | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Swollen Uvula.jpg|thumb|Uvulitis with edematous uvula on exam.]] | |||
[[File:Swollenuvula.jpg|thumb|Pediatric uvulitis with edematous uvula on exam.]] | |||
===History=== | ===History=== | ||
*Throat pain | *[[sore throat|Throat pain]] | ||
*Dysphagia, sensation of something in their throat, gagging sensation | *[[Dysphagia]], sensation of something in their throat, gagging sensation | ||
*Low-grade fever | *Low-grade [[fever]] | ||
*Signs of | *Signs/symptoms of concomitant [[epiglottitis]] | ||
**Sudden onset | **Sudden onset | ||
***High fever | ***High [[fever]] | ||
***Dysphagia | ***[[Dysphagia]] | ||
*** | ***[[SOB]] | ||
***Drooling | ***Drooling | ||
* | *+/- Features indicative of etiology: | ||
*Allergen exposure | **Sick contacts | ||
*Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc) | **Allergen exposure | ||
*Recent inhalation of cannabis | **Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc) | ||
**Recent inhalation of cannabis | |||
*Vaccination status | **Incomplete [[Vaccination schedule|vaccination]] status | ||
** H. Influenzae - epiglottis | ***[[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 angioedema | **Hereditary [[angioedema]] | ||
===Physical Exam=== | ===Physical Exam=== | ||
*General | *General | ||
**Range from well appearing to toxic | **Range from well appearing to toxic | ||
*Uvula | |||
**Markedly erythematous and edematous | |||
**Pinpoint hemorrhage is possible | |||
**Vesicular lesions possible if viral etiology | |||
**Nonerythematous, pale, swollen (uvular hydrops) may indicate angioedema | |||
*Tonsils | |||
**Edematous vs. nonedematous | |||
**Exudative vs. nonexudative | |||
*Erythematous posterior pharynx | |||
*Respiratory | *Respiratory | ||
**Range non-labored breathing to respiratory distress | **Range non-labored breathing to (rarely) [[respiratory distress]] | ||
**Stridor | **[[Stridor]] | ||
**"Hot Potato Voice" | **"Hot Potato Voice" | ||
** | **Typically clear lungs | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Uvulitis | *Uvulitis | ||
**Infectious | **Infectious | ||
***Group A | ***Group A [[Streptococcus]] | ||
***[[H. Influenza]] | |||
***H. Influenza | ***[[Strep. Pneumoniae]] | ||
***[[Candida Albicans]] | |||
***Candida Albicans | |||
**Noninfectious | **Noninfectious | ||
***Trauma | ***[[Trauma]] | ||
***[[Angioedema]] | ***[[Angioedema]] | ||
***Inhalant irritation | ***Inhalant irritation | ||
***Allergy | ***[[allergic reaction|Allergy]] | ||
*[[Epiglottitis]] | *[[Epiglottitis]] | ||
*[[Streptococcal Pharyngitis]] | *[[Streptococcal Pharyngitis]] | ||
*[[Peritonsillar Abscess]] | *[[Peritonsillar Abscess]] | ||
*[[Retropharyngeal Abscess]] | *[[Retropharyngeal Abscess]] | ||
*[[Herpes | *[[Herpes gingivostomatitis]] | ||
==Evaluation== | ==Evaluation== | ||
*Rapid strep throat swab | |||
*Heterophile antibody (monospot) test | |||
*'''If patient is ill appearing consider:''' | *'''If patient is ill appearing consider:''' | ||
**CBC | **CBC | ||
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**Blood culture | **Blood culture | ||
*'''Imaging''' | *'''Imaging''' | ||
** If concern for epiglottitis | **If concern for epiglottitis | ||
*** Lateral neck x-ray | ***Lateral neck x-ray | ||
**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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**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 | ||
**Pediatric: | **Pediatric: | ||
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====[[Streptococcal Pharyngitis]]==== | ====[[Streptococcal Pharyngitis]]==== | ||
*Pediatrics | *Pediatrics | ||
** Penicillin V 250mg PO BID x 10 days | **Penicillin V 250mg PO BID x 10 days | ||
**Amoxicillin 50mg/kg PO once daily x 10 days | **Amoxicillin 50mg/kg PO once daily x 10 days | ||
*Adults | *Adults | ||
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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]] | ||
Latest revision as of 21:37, 13 November 2024
Background
_(14594049867).jpg)
- 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
- Smoking
- Allergy
Clinical Features
History
- Throat pain
- Dysphagia, sensation of something in their throat, gagging sensation
- Low-grade fever
- Signs/symptoms of concomitant epiglottitis
- +/- Features indicative of etiology:
- Sick contacts
- Allergen exposure
- Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc)
- Recent inhalation of cannabis
- Incomplete 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
- Uvula
- Markedly erythematous and edematous
- Pinpoint hemorrhage is possible
- Vesicular lesions possible if viral etiology
- Nonerythematous, pale, swollen (uvular hydrops) may indicate angioedema
- Tonsils
- Edematous vs. nonedematous
- Exudative vs. nonexudative
- Erythematous posterior pharynx
- Respiratory
- Range non-labored breathing to (rarely) respiratory distress
- Stridor
- "Hot Potato Voice"
- Typically clear lungs
Differential Diagnosis
- Uvulitis
- Infectious
- Noninfectious
- Trauma
- Angioedema
- Inhalant irritation
- Allergy
- Epiglottitis
- Streptococcal Pharyngitis
- Peritonsillar Abscess
- Retropharyngeal Abscess
- Herpes gingivostomatitis
Evaluation
- 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.