Uvulitis: Difference between revisions
 
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==General==
==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===
*Major division: infectious vs. noninfectious etiology
*Major division: infectious vs. noninfectious etiology
*'''Infections''':  
*'''Infections''':  
**Most commonly H. Influenzae Type B & Group A Streptococcus
**Most commonly [[H. Influenzae]] Type B & [[Group A Streptococcus]]
***H. Influenzae
***[[H. Influenzae]]
****Frequently with Epiglottitis
****Frequently with [[Epiglottitis]]
***Group A Streptococcus
***[[Group A Streptococcus]]
****Frequently with Pharyngitis
****Frequently with [[Pharyngitis]]
**Less common
**Less common
***S. Pneumoniae
***[[S. Pneumoniae]]
****Adults
****Adults
***Anaerobic bacteria
***[[Anaerobic bacteria]]
***Candida Albicans
***[[Candida Albicans]]
*'''Noninfectious'''
*'''Noninfectious'''
**Trauma
**Trauma
**[[Angioedema]]
**[[Angioedema]]
**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
*[[Dysphagia]], sensation of something in their throat, gagging sensation
*Sensation of something in their throat
*Low-grade [[fever]]
*Gagging sensation
*Signs/symptoms of concomitant [[epiglottitis]]
*Low-grade fever
*Signs of Epiglottitis
**Sudden onset
**Sudden onset
***High fever
***High [[fever]]
***Dysphagia
***[[Dysphagia]]
***Dyspnea/SOB
***[[SOB]]
***Drooling
***Drooling
*Hx Sick Contacts
*+/- Features indicative of etiology:
*Exposure to Allergens
**Sick contacts
*Recent surgical procedure with site of entry via mouth (EGD, Laryngoscopy, Orogastric Tube Placement, etc)  
**Allergen exposure
*Recent inhalation of cannabis
**Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc)  
===PMH===
**Recent inhalation of cannabis
*Vaccination status
**Incomplete [[Vaccination schedule|vaccination]] status
** H. Influenzae - epiglottitis
***[[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
*HEENT
*Uvula
**Oropharynx
**Markedly erythematous and edematous
***Uvula
**Pinpoint hemorrhage is possible
****Markedly erythematous and edematous
**Vesicular lesions possible if viral etiology
****Pinpoint hemorrhage is possible
**Nonerythematous, pale, swollen (uvular hydrops) may indicate angioedema
****Vesicular lesions possible if viral etiology
*Tonsils
**** Nonerythematous, pale, swollen (uvular hydrops) may indicates angioedema
**Edematous vs. nonedematous
***Tonsils
**Exudative vs. nonexudative  
****Edematous vs. nonedematous
*Erythematous posterior pharynx
****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"
**Clear lungs bilaterally
**Typically clear lungs
 
==Differential Diagnosis==
==Differential Diagnosis==
*Uvulitis
*Uvulitis
**Infectious
**Infectious
***Group A Streptococcus
***Group A [[Streptococcus]]
****[[Streptococcal Pharyngitis]]
***[[H. Influenza]]
***H. Influenza
***[[Strep. Pneumoniae]]
****[[Epiglottitis]]
***[[Candida Albicans]]
***Strep. Pneumoniae
***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 Gingivostomatitis]]
*[[Herpes gingivostomatitis]]
 
==Evaluation==
==Evaluation==
*'''Labs'''
*Rapid strep throat swab
**Rapid strep throat swab
*Heterophile antibody (monospot) test
**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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*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
**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
**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
====Allergy====
====[[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
**Solumedrol 125mg IV
**[[Methylprednisolone]] 125mg IV
====[[Angioedema]]====
====[[Angioedema]]====
*Cover for allergic reaction with medications above
*Cover for allergic reaction with medications above
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*Stop [[ACE inhibitor]]
*Stop [[ACE inhibitor]]
*See [[Angioedema#Management|angioedema management]]
*See [[Angioedema#Management|angioedema management]]
====Inhalant irritation====
*[[Antihistamines]] IV
*[[Hydrocortisone]] or [[dexamethasone]] IV


====Inhalant irritation====
*Antihistamines IV
*Hydrocortisone or dexamethasone IV
==Disposition==
==Disposition==
*Determined by severity, complications, etc.
*Determined by severity, complications, etc.
==Also See==
 
==See Also==
*[[Epiglottitis]]  
*[[Epiglottitis]]  
*[[Retropharyngeal Abscess]]
*[[Retropharyngeal abscess]]
 
==External Links==
==External Links==
==References==
==References==
*Yellon R, Chi D. Atlas of pediatric physical diagnosis. 6th Ed. 2012; 23: Philadelphia, PA: Saunders/Elsevier; 2012: 913-960
<references/>
* 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
[[Category:ENT]]
*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

Latest revision as of 21:37, 13 November 2024

Background

Anatomy of the posterior pharynx.
Midline neck anatomy on lateral view.
  • 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

Clinical Features

Uvulitis with edematous uvula on exam.
Pediatric uvulitis with edematous uvula on exam.

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

Differential Diagnosis

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

Management

Infectious

Epiglottitis

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

C. Albicans

Noninfectious

Trauma

Allergic Reaction

Angioedema

Inhalant irritation

Disposition

  • Determined by severity, complications, etc.

See Also

External Links

References

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