HEENT: Mouth and Neck Questions With Complete
Solutions
Inflammation of vocal folds and larynx
• WBCs remove pathogens creating edema & vibration affected
Hoarseness/raspy voice/difficulty speaking
• Sore throat
• Rhinorrhea, congestion, dysphagia, dyspnea
acute laryngitis
etiology of acute plargitis
mostly VIRAL (rhinovirus, RSV)
vocal strain (singing, screaming)
management for acute laryngitis
• Voice rest
• Warm saline gargles + hydration
• Humidified air
< 3 weeks
chronic laryngitis > 3 weeks causes
• GERD, vocal misuse, cigarette smoking, allergic rhinitis
• Others: ICS use, thyroid abnormality, malignancy, laryngeal
nerve
chronic laryngitis management
• Eliminate reversible cause (if possible)
,• Refer to ENT for laryngoscopy
Abscess accumulation in tissues around tonsils
Ages of highest incidence: 15-35
• Severe sore throat
• Fever
• Neck pain
• Deviation of soft palate & uvula
• Ipsilateral lymphadenopathy
• Muffled / “hot potato” voice
• Trismus
• Drooling
peritonsillar ascess
bacterial causes of peritonsilar abscess
GAS, spreads rapidly
risk with peritonisillar abscess
risk of airway obstructions
diagnostic work-up for peritonsillar/retropharyngeal abscess
lateral neck x-ray or CT w/ IV contrast, may get needle
aspiration to culture
rapid strep (+ culture)
peritonsillar abscess managment
, • Protect airway
• Incision and drainage (ENT/specialist)
• Fluids, antipyretics
• Antibiotics: amox-clav or clindamycin
Deep space infection in neck
• Behind posterior pharyngeal wall
• Most common ages 2-4 y/o
Dental infection
retropharyngeal abscess
describe the presentation of retropharyngeal abscess
• Fever, agitation
• Retropharyngeal bulge
• Neck pain/stiffness
• Torticollis-> difficulty moving neck due to pain
• Dysphagia/odynophagia/drooling
• Poor oral intake, lethargy, respiratory distress
retropharyngeal abscess mangament
CT neck with IV contrast
ER/hospital
Abx
oxygen, fluids, monitoring
Solutions
Inflammation of vocal folds and larynx
• WBCs remove pathogens creating edema & vibration affected
Hoarseness/raspy voice/difficulty speaking
• Sore throat
• Rhinorrhea, congestion, dysphagia, dyspnea
acute laryngitis
etiology of acute plargitis
mostly VIRAL (rhinovirus, RSV)
vocal strain (singing, screaming)
management for acute laryngitis
• Voice rest
• Warm saline gargles + hydration
• Humidified air
< 3 weeks
chronic laryngitis > 3 weeks causes
• GERD, vocal misuse, cigarette smoking, allergic rhinitis
• Others: ICS use, thyroid abnormality, malignancy, laryngeal
nerve
chronic laryngitis management
• Eliminate reversible cause (if possible)
,• Refer to ENT for laryngoscopy
Abscess accumulation in tissues around tonsils
Ages of highest incidence: 15-35
• Severe sore throat
• Fever
• Neck pain
• Deviation of soft palate & uvula
• Ipsilateral lymphadenopathy
• Muffled / “hot potato” voice
• Trismus
• Drooling
peritonsillar ascess
bacterial causes of peritonsilar abscess
GAS, spreads rapidly
risk with peritonisillar abscess
risk of airway obstructions
diagnostic work-up for peritonsillar/retropharyngeal abscess
lateral neck x-ray or CT w/ IV contrast, may get needle
aspiration to culture
rapid strep (+ culture)
peritonsillar abscess managment
, • Protect airway
• Incision and drainage (ENT/specialist)
• Fluids, antipyretics
• Antibiotics: amox-clav or clindamycin
Deep space infection in neck
• Behind posterior pharyngeal wall
• Most common ages 2-4 y/o
Dental infection
retropharyngeal abscess
describe the presentation of retropharyngeal abscess
• Fever, agitation
• Retropharyngeal bulge
• Neck pain/stiffness
• Torticollis-> difficulty moving neck due to pain
• Dysphagia/odynophagia/drooling
• Poor oral intake, lethargy, respiratory distress
retropharyngeal abscess mangament
CT neck with IV contrast
ER/hospital
Abx
oxygen, fluids, monitoring
