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E.N. T .

This resource covers common throat conditions such as sore throats, foreign bodies, bleeding post-tonsillectomy, and hoarseness. Learn how to manage and refer these conditions.

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E.N. T .

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  1. E.N.T. Dr Katie Bleksley GPST1

  2. Aims • Coverage of the common conditions affecting the throat presenting to General practice.

  3. Objectives Recognise the following conditions and know how to manage / refer to secondary care • Sore throats • Foreign bodies • Bleeding post-tonsillectomy • Hoarseness

  4. Sore throat • 70% Viral vs. 30% Bacterial – usually clinically indistinguishable • DDx: • Viral • Bacterial tonsillitis +/- quinsy • EBV

  5. Sore throat: Ix • Ix usually not done • Swabs not felt to be useful (can’t distinguish commensals from infecting organisms, expensive, delayed in getting result)

  6. Sore Throat: Rx • Analgesics, inc fluids intake, gargle salt water • Antibiotics?? • Benefits of ABx: sl dec risk of some complications (quinsy, OM) but not RhF or acute GN • Risks of ABx: S/Es, resistant organisms, encourages re-attendence for sore throats

  7. Sore throat – when to give ABx CENTOR criteria (3/4 of … suggests give ABx) • h/o fever • Absence of cough • Cervical LNs • Tonsillar exudate Or if significant comorbidities Or if Gp A haem strep isolated

  8. Tonsillitis

  9. Tonsillitis • Management • Analgesia – aspirin gargles • Penicillin V 500mg qds +/- metronidazole (erythro/clarith if pen allergy), treat for 10days • Maintain hydration Dysphagia ?retropharyngeal abcess Quinsy (peritonsillar abcess) Systemic upset / Dehydration

  10. Quinsy

  11. When to refer for tonsillectomy • Recurrent tonsillitis (>5 per yr for 2y) • Recurrent quinsy • Obstructive Sxs • Chr tonsillitis >3 mo with hallitosis • Unilat tonsillar enlargement ? malig

  12. Glandular Fever

  13. Glandular Fever Infectious Mononucleosis • Suspect in teenagers and young adults with sore throat lasting >1 wk • Malaise • LNs/spleen • Palatal petechiae and rash • Exudative pharyngitis (+/- white membrane)

  14. Glandular Fever Rx Ix: FBC (atypical lymph) and monospot (maybe neg). Rx: rest, fluids, paracetamol, aspirin gargles (if >14y). Treat secondary infection with ABx. Counsel pt about ongoing Sxs (several months), avoiding contact sports. Don’t give ampicillin / amoxil for sore throat

  15. Foreign Bodies in the Throat

  16. Foreign bodies in the Throat • Various types • fish / chicken bones • dental plates • Features • Pain on swallowing • Tender neck • Respiratory problems • Fever

  17. Foreign bodies in the Throat • Management • ABC’s • Assess swallowing • Look • Close inspection • Good light • Good tongue depression • ? Attempt removal ? • Refer all, except those with mildest symptoms • Advise to return if not settling in 24 hours Animal bone –urgent removal

  18. Bleeding post tonsillectomy

  19. Bleeding post tonsillectomy • Usually recurs 3-10 d post-op. • Management • Refer all immediately • Augmentin IV

  20. Hoarseness • DDx: • Neurol /Local causes Local causes: • Acute: laryngitis, shouting • Chronic: vocal cord nodules, functional, reflux malig Hoarseness >3wks refer to ENT to r/o malig

  21. Summary • We have covered: • Sore throats: when to give ABx, when to consider EBV, what complications to look out for • Foreign bodies: very low threshold for referral, and urgent referral if animal bone. • Bleeding post-tonsillectomy: refer to ENT • Hoarseness: refer if >3wks

  22. Questions ?

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