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PubMed1997

Optimum treatment of streptococcal pharyngitis.

Streptococcal pharyngitis is a common infection in children and adolescents. The great majority of these infections are caused by group A beta-haemolytic streptococci. Although the use of penicillins for group A beta-haemolytic streptococcal pharyngitis has reduced the incidence of rheumatic fever, in the past decade several studies of pharyngitis treatment have reported penicillin failure. It has also been suggested that in comparison with the penicillins the cephalosporins are associated with a lower rate of clinical failure. Cephalosporins have drawbacks in cost, administration frequency or adverse effect profile. Moreover, there is the theoretical risk of cross-antigenicity to cephalosporins in penicillin-allergic patients. Erythromycin is a traditional alternative to penicillins, especially in penicillin-allergic patients, for the treatment of tonsillopharyngitis. However, increased resistance as well as failure rates as high as 24.7% have been reported for erythromycin in the treatment of pharyngitis. Therefore oral penicillins, and alternatively oral cephalosporins, should be considered first-line agents for the treatment of culture-confirmed group A beta-haemolytic streptococcal tonsillopharyngitis. Cephalosporins are useful especially for the treatment of recurrent streptococcal tonsillopharyngitis.

Cephalosporins↗

PubMed2006

[Clinical experience with silicon pharyngeal tube for pharyngocutaneous fistula and cervical esophagus stenosis].

Total laryngectomy or laryngopharyngectomy are commonly performed for the treatment of laryngeal cancer or hypopharyngeal cancer. However pharyngocutaneous fistula and cervical esophageal stenosis have been reported as postoperative complications of these procedures. We used a silicon pharyngeal tube in cases that developed pharyngocutaneous fistula and cervical esophageal stenosis. The pharyngeal tube was useful for controlling aspiration pneumonia and for starting oral feeding in a case of pharyngocutaneous fistula after a total laryngectomy. It was also helpful for starting oral feeding in a case with cervical esophageal stenosis after total laryngopharyngectomy and free jejunum interposition. This patient was able to maintain a good quality of life until re-operation. Adverse effects from the insertion of the tube included a foreign body sensation and pharyngeal pain that was tolerable with the use of NSAIDs for a short time. Silicon pharyngeal tubes are useful for the treatment of pharyngocutaneous fistula and cervical esophageal stenosis.

Aged↗

PubMed2006

Population-based prevalence of repeated group A beta-hemolytic streptococcal pharyngitis episodes.

OBJECTIVE: To define the population-based 3-year period prevalence of repeated group A beta-hemolytic streptococcal (GABHS) pharyngitis episodes in children between 4 and 15 years of age. PATIENTS AND METHODS: Residents of Rochester, Minn (age, 4-15 years), who had 3 or more GABHS pharyngitis episodes In 1 year, at least 1 month apart, between January 1, 1996, and December 31, 1998, were Identified using the resources of the Rochester Epidemiology Project (N=536). Pharyngitis episodes (evidence of a sore throat with or without presence of fever) followed by either a positive rapid streptococcus test result or a positive plate culture test result were considered positive GABHS episodes. Age- and sex-specific prevalence rates were calculated, assuming that all residents 4 to 15 years of age in Rochester during 1996 to 1998 were at risk. RESULTS: A total of 208 children met our definition for repeated GABHS episodes between 1996 and 1998 and were included in this study. Approximately 1% of children between the ages of 4 and 15 years experienced repeated GABHS pharyngitis episodes between 1996 and 1998. This estimate increased to approximately 2% among children 4 to 6 years of age and decreased to 0.1% among children 13 to 15 years old. CONCLUSION: A relatively small proportion (1%) of children between 4 and 15 years of age experienced repeated GABHS episodes in a 3-year period; however, this proportion represents a substantial number of children who are affected at the population level. Given the increased costs associated with treating repeated GABHS episodes, further studies are necessary to determine how best to reduce episodes and treatment costs in this age group.

Adolescent↗

PubMed1996

Streptococcal pharyngitis in a paediatric emergency department.

OBJECTIVE: To determine the prevalence and clinical features of beta-haemolytic streptococcal infection in children with acute pharyngitis and thereby to define those requiring antibiotic therapy. DESIGN: Prospective 2:1 case--control study. SETTING: Emergency Medicine Department of the Royal Children's Hospital, Melbourne, between May 1994 and May 1995. PARTICIPANTS: Cases (n = 271) were the first 10 self-referred children in each week with pharyngitis and no antibiotic use in the previous week. Controls (n = 135) were age-matched children without infection. MAIN OUTCOME MEASURES: Presence of groups A, C or G beta-haemolytic streptococci in oropharyngeal cultures; demographic and clinical characteristics. RESULTS: Group A beta-haemolytic streptococci (GABHS) were isolated from significantly more case than control children (cases, 57/271 [21%]; controls, 9/135 [7%]; odds ratio [OR], 3.7; P < 0.001). Groups C and G beta-haemolytic streptococci were isolated from 10 (4%) and 5 (2%) case children, respectively, but not from controls. Age > or = 4 years, tender cervical lymph nodes, pharyngotonsillitis, absent coryza and scarlatiniform rash were significantly associated with GABHS (P < 0.02). GABHS was uncommon in children aged < 4 years (4%), but was present in 12 of 14 children > or = 4 years with a rash (86%). However, most cases lacked a rash, and for children > or = 4 years likelihood of GABHS varied from 10%-65%, depending on other clinical features. CONCLUSIONS: In children aged < 4 years, GABHS is an unlikely cause of acute pharyngitis and symptomatic treatment alone should be considered. In children > or = 4 years, the likelihood of GABHS being the cause of acute pharyngitis increases with presence of scarlatiniform rash, pharyngotonsillitis and tender cervical nodes.

Acute Disease↗

PubMed1986

Corynebacterium hemolyticum as a cause of pharyngitis and scarlatiniform rash in young adults.

Over an 8-year period from 1973 through 1980, Corynebacterium hemolyticum was isolated from 103 of 24,695 throat cultures done at our hospital. Medical records were available for review from 33 of the 80 patients with a positive culture. Pharyngitis was present in all but 1, and 20 of the 32 symptomatic patients had a diffuse, erythematous, macular skin rash, often with a fine papular component, on the extremities and trunk. Screening of household contacts of 9 patients showed the presence of C. hemolyticum in the pharynges of 6 of 17 siblings but in 0 of 10 parents. Therapy with benzathine penicillin G or erythromycin resulted in rapid clinical improvement in most patients. In contrast to streptococcal pharyngitis, which is predominantly a disease of childhood, C. hemolyticum infection affects mostly teenagers and young adults: 30 of the 33 patients in this study were between the ages of 11 and 22. Within this age group, infection with C. hemolyticum is an important cause of pharyngitis associated with a scarlatiniform skin rash.

Adolescent↗

PubMed1999

[Pharyngeal muscles and sleep obstructive apnea syndrome].

An analysis of the way the pharyngeal musculature modulates the caliber of the pharynx is important to better understand and treat obstructive sleep apnea syndromes. The caliber of the pharynx at the soft palate depends on the action of the tensor veli, the palatoglossus, the palatopharyngeus and the uvula muscles. At the ligual level, the action of the genioglossus and the geniohyoideus predominate. These different muscle groups contract in co-ordination before the diaphragm contracts. Their activity is diminished and disorganized during sleep. These muscles appears to have a histological composition adapted to short-duration intense contractions making them vulnerable to fatigue. In apneic patients, these muscles are solicited constantly. Muscular lesions related to overwork have been suggested. The histological composition of these muscles is modified in apneic patients compared with non-apneic subjects (increased number of type IIa fibres), the expression of an adaptive process. The degree of adaptation varies depending of the pharyngeal level considered. Similar to their reflex stimulation, the response of these pharyngeal muscles to increased resistance is probably greater at the soft palate level. Greater solicitation of palatine muscles associated with their greater vulnerability to fatigue could explain why obstruction is particularly important at this level. A study of the mechanical and histological properties of the pharyngeal musculature is required for a better understanding of the occlusive mechanisms of the upper airways and must be undertaken before initiating therapeutic stimulation of these muscles.

Humans↗

PubMed2000

[A case of Fisher syndrome showing pharyngeal-cervical-brachial weakness with an elevation of anti-GQ 1 b and anti-GT 1 a antibodies].

A 15-year-old boy developed ataxic gait, diplopia and hoarseness. Within 3 days after the onset, he had additional symptoms of dysphagia and dysarthria. He was admitted to our hospital 7 days after the onset of the disease. On admission, he had total ophthalmoplegia, ataxia, areflexia, facial diplegia, bulbar palsy and weakness of the neck and upper arms. Serum anti-GQ 1 b and anti-GT 1 a antibodies were significantly elevated. A diagnosis of Fisher syndrome associated with pharyngeal-cervical-brachial weakness was made. He was placed on a high dose of intravenous immunoglobins (12.5 g/day x 2 days) and had steroid pulse therapy (methylprednisolone 1 g x 3 days), which resulted in an almost complete recovery. There have been no reports of Fisher syndrome associated with brachio-pharyngeal-palsy. As in the case of the pharyngeal-cervical-brachial variant of Guillain Barré syndrome, anti-GT 1 a antibodies may be associated with Fisher syndrome with pharyngeal-cervical-brachial weakness.

Adolescent↗

PubMed2000

[Pharyngeal musculature and obstructive sleep apnea syndromes].

An analysis of the way the pharyngeal musculature modulates the caliber of the pharynx is important to better understand and treat obstructive sleep apnea syndromes. The caliber of the pharynx at the soft palate depends on the action of the tensor veli, the palatoglossus, the palatopharyngeus and the uvula muscles. At the ligual level, the action of the genioglossus and the geniohyoideus predominate. These different muscle groups contract in co-ordination before the diaphragm contracts. Their activity is diminished and disorganized during sleep. These muscles appears to have a histological composition adapted to short-duration intense contractions making them vulnerable to fatigue. In apneic patients, these muscles are solicited constantly. Muscular lesions related to overwork have been suggested. The histological composition of these muscles is modified in apneic patients compared with non-apneic subjects (increased number of type IIa fibres), the expression of an adaptive process. The degree of adaptation varies depending of the pharyngeal level considered. Similar to their reflex stimulation, the response of these pharyngeal muscles to increased resistance is probably greatest at the soft palate level. Greater solicitation of palatine muscles associated with their greater vulnerability to fatigue could explain why obstruction is particularly important at this level. A study of the mechanical and histological properties of the pharyngeal musculature is required for a better understanding of the occlusive mechanisms of the upper airways and must be undertaken before initiating therapeutic stimulation of these muscles.

Airway Resistance↗

PubMed2001

[A case of Miller Fisher syndrome with pharyngeal palsy as an initial symptom].

We report herein a rare case of Miller Fisher syndrome with pharyngeal palsy as an initial symptom. A 68-year-old man admitted to our hospital with pharyngeal palsy two weeks after a respiratory infection. He subsequently developed ataxic gait, paresthesia in the upper limbs and ophthalmoplegia. Double-filtrated-plasmapheresis had been performed four times and all the symptoms subsided within two months. In the acute phase of the disease, the titers of anti-GQ1b and GT1a antibodies were elevated. The titer of anti-GT1a antibody was higher than that of anti-GQ1b antibody. Recently, the activity of serum anti-GT1a antibody has been supposed to be associated with pharyngeal palsy. In the present case, higher titer of anti-GT1a antibody compared with that of anti-GQ1b antibody could possibly cause pharyngeal palsy as an initial symptom of Miller Fisher syndrome.

Aged↗

PubMedDate not supplied

Acute and chronic pharyngitis across the lifespan.

Although most instances of sore throat are caused by relatively benign infectious or noninfectious processes, pharyngitis may herald serious or even fatal illnesses. Viral pharyngitis is the diagnosis in most cases, but because GABHS is the most common bacterial organism requiring antimicrobial treatment, an office visit is often necessary. There is no exact constellation of signs and symptoms that is pathognomonic for GABHS; nevertheless, sudden onset of sore throat with fever and cervical lymph node tenderness, in the absence of cough and nasal symptoms, is at least suggestive in adults, and possibly in children. Physical examination and prudent use of laboratory testing will assist in the diagnosis of both acute and chronic pharyngitis. The primary care provider who promptly identifies and properly treats patients infected with S. pyogenes has reduced the number of missed school or work days, the risk of developing ARF, the likelihood of transmission to others, and inappropriate use of antibiotics for those with other causes of sore throat. Further education of patient, family, and other clinicians will reduce medical expenses, avoid unnecessary antibiotic exposure, and inform the public regarding judicious management of pharyngitis.

Acute Disease↗

PubMed2000

[Pharyngeal plexus neurectomy for voice restoration of alaryngeal].

OBJECTIVE: To release the spasm of pharyngeal constrictor and raise the successful rate of voice rehabilitation in total laryngectomized patients wearing Blom-Singer prosthesis. METHODS: The main branch of the pharyngeal plexus nerves within the inferior contractor can be found at the posterior side of hyoid greater cornu, which is about 6.5 mm from the back of constrictor. The spasm of the inferior constrictor can be resolved by cut off the nerve. RESULTS: Voice restoration was achieved in 15 cases after pharyngeal plexus neurectomy, the successful rate was 93.75%. CONCLUSION: It is feasible to replace pharyngeal myotomy by nerve plexus neurectomy and raise the voice rehabilitation rate.

Aged↗

PubMed2000

[The clinical study of tongue flaps repairing after resecting pharyngeal neoplasm and laryngeal neoplasm].

OBJECTIVE: To study the repair methods of the defect after resecting pharyngeal neoplasm and laryngeal neoplasm. METHODS: Four kinds of tongue flap, such as 1/3 tongue flap, 1/2 tongue base flap, tongue base flap and transverse tongue flap were devised and applied in 15 patients with pharyngeal neoplasm and laryngeal neoplasm. RESULTS: These tongue flaps were alive in all patients. The wound of 13 patients healed in I stage. Two patients dehiscenced because of infection and healed after treatment. All the patients deglutited well. One-year, 3-year, disease-free survive rate were 92.9% (13/14), 72.7% (8/11) respectively. CONCLUSION: Tongue flaps are obtained easily, with enough blood flow, adapted to pharyngeal environment, easily alive and low complication in repairing the pharyngeal defect. We think that these tongue flaps should be applied in clinic.

Adult↗

PubMed1992

[Pharyngeal obstruction and the functional adaptation of the natural posture of the head and the hyoid bone in sleep apnea syndrome].

Variations in natural head posture (NHP) and hyoid bone (HB) positioning impart changes in the size and shape of the pharyngeal airways. In SAS, which was shown to be correlated with detrimental craniofacial anatomical conditions, control of pharyngeal permeability is lost during sleep. The aim of this study was determine if functional adaptation of NHP and HB position to these detrimental conditions could be observed, using Bonferonni probabilities, in a cephalometric comparison of 38 SAS adults in the wakeful state and a control group of 38 healthy adults. Since HB relationships with craniofacial anatomical structures vary with the positioning of the head, the cephalograms were taken according to the preliminarily tested NHP, thus making the method reproducible. In SAS craniovertical angulation was unchanged, but the head was maintained in a forward position (increased cervico-vertical angulation, P < 0.001). Maintenance of an acceptable pharyngeal permeability was associated with a more distant positioning of HB from the cervical column (P < 0.01) and from craniofacial references (P < 0.001). In spite of these facts lower pharynx opening was still reduced (P < 0.05). Soft palate and facial divergence were expectedly increased in the apneic group. All the individuals but one control could be correctly reclassified with the help of soft palate length, facial divergence, and two HB related variables. Prevention of pharyngeal collapsibility in SAS seems to be commonly associated with functional adaptation of NHP and HP position. The precise control mechanisms of this adaptation remains to be elucidated. Skeletal predispositions to SAS do probably develop already during infancy.

Adaptation, Physiological↗

PubMed2003

Acute streptococcal pharyngitis in pediatric medicine: current issues in diagnosis and management.

Group A beta-hemolytic streptococcus (GABHS) is the most common bacterial cause of acute pharyngitis. Although children infected with GABHS will recover clinically without antibiotics, treatment is recommended in order to prevent acute rheumatic fever and probably suppurative complications, hasten resolution of clinical signs and symptoms, and prevent transmission to close contacts. Streptococcal pharyngitis usually cannot be reliably distinguished from other etiologies on the basis of epidemiologic or physical findings, and therefore a throat culture or a rapid antigen detection test is generally necessary to confirm the diagnosis. All isolates of GABHS are sensitive to penicillins and cephalosporins, whereas resistance to macrolides has been identified in some geographic regions. The recommended first-line therapy for streptococcal pharyngitis is a 10-day course of penicillin V, usually given 2 or 3 times per day. A number of alternatives to penicillin V are available, including other penicillins, macrolides, and cephalosporins. As a class, the cephalosporins are noteworthy because they may provide somewhat higher bacteriologic eradication rates than penicillin V. Many cephalosporins can be administered twice daily, but they also must be given for 10 days. Two third-generation cephalosporins, cefdinir and cefpodoxime proxetil, are approved for use in a more convenient 5-day dosing schedule, thus possibly increasing the likelihood of adherence to the full course of therapy. Palatability is also an important consideration when prescribing antibiotics to children. In a series of studies, children preferred the pleasant strawberry-cream taste of cefdinir to that of amoxicillin/clavulanate, cefprozil, and azithromycin. Cefdinir may offer an alternative to penicillin V for children with streptococcal pharyngitis, particularly when compliance is a clinical concern.

Acute Disease↗

PubMed1992

Management of children with acute pharyngitis: a decision analysis.

BACKGROUND: Although the incidence of acute rheumatic fever has declined in the last decades, a few outbreaks have recently been reported. A rapid latex agglutination test for group A streptococci seems reasonably accurate, and early treatment of acute pharyngitis seems to influence the pharyngitis itself. These factors have promoted uncertainty concerning the current best management of patients with sore throat. METHODS: Clinical decision analysis is used to compare the risks and benefits of symptomatic treatment, and oral and intramuscular penicillin as therapeutic options, and the throat culture and the rapid latex agglutination test as diagnostic strategies. Best estimates of the risk of streptococcal pharyngitis, its complications, the carrier rate, the accuracy of diagnostic tests, the efficacy of antibiotic treatment, allergic reactions, medication compliance, and health outcomes are combined into a management advisory. All results are subjected to a sensitivity analysis in order to check their strength against plausible changes in assumptions. Quality adjusted life days (QALD) lost are used as an outcome measure. RESULTS: The agglutination test combined with oral penicillin yielded the lowest expected loss (.50) of QALD for a typical child with a risk of harboring streptococci of .60. The other strategies, however, yielded losses that were only several hundredths of QALD higher. CONCLUSIONS: For children with at least a 40% chance of harboring streptococci and a duration of complaints of less than 2 days before starting treatment, diagnostic testing and prescription of oral penicillin appear to be the best choice of initial management. The rapid latex agglutination test is more effective than the throat culture, because prompt penicillin treatment after a positive test result may shorten the duration of pharyngitis in infected children. High rates of acute rheumatic fever (over 5 X 10(-4] and low medication compliance change the best strategy to agglutination test with intramuscular administration of penicillin.

Acute Disease↗

PubMed1992

[Acute pharyngitis: value of the bacteriological diagnosis].

The aetiological diagnosis of acute pharyngitis relies upon laboratory examinations, but these are difficult to obtain in routine general practice. While taking throat swabs is mandatory in some clinical situations (membranous or ulcerous pharyngitis, special investigations in some patients) where it provides essential diagnostic data, it is in fact seldom performed in patients with common acute pharyngitis. Penicillin is systematically administered for fear of the severe sequelae of group A streptococci pharyngitis, but this type of infection occurs in only 10 to 20% of the cases so that on statistical grounds routine antibiotic therapy is not fully justified. For this reason, rapid diagnostic tests without cultures and feasible at the patient's bedside have been devised. These tests have excellent specificity, but their sensitivity is not so good. In addition, their use by general practitioners raises a problem of medical responsibility, and they are not reimbursed by the french Sécurité sociale. The future of these fast methods will depend on the solution of these two problems.

Acute Disease↗

PubMed1992

[Treatment of acute pharyngitis].

The treatment of acute pharyngitis is mainly aimed at the prevention of complications, particularly rheumatic fever. To reach this objective group A beta-haemolytic streptococci must be eradicated. To be effective, antibiotics must penetrate into the pharyngeal and tonsillar tissues and be active against streptococci. Penicillin is effective if administered by intramuscular injection or administered orally for not less than 10 days. In practice, however, compliance with this treatment is insufficient, resulting in numerous bacteriological failures. A possible improvement in the effectiveness of treatment consists in the use of a first-generation cephalosporin with a prolonged half-life, taken daily for 10 days. Acute pharyngitis is an excellent indication for macrolides. In order to improve compliance, short treatments are being tested with promising results, but until studies on new therapeutic approaches have been completed, and in the present absence of rheumatic fever epidemics in France, acute pharyngitis must be treated systematically.

Humans↗

PubMed2005

Adjuvant prednisone therapy in pharyngitis: a randomised controlled trial from general practice.

BACKGROUND: Acute pharyngitis is a frequent and well-documented complaint in general practice but the associated suffering has remained largely unaddressed in the literature. Evidence, however, from five randomised controlled trials suggests that corticosteroids may be useful in relieving pain and discomfort arising from the condition. AIM: To determine if short-acting oral therapy with prednisone was more effective than placebo in alleviating the suffering from acute pharyngitis in adults in a general practice setting. DESIGN OF STUDY: Randomised placebo-controlled trial. SETTING: General practice in Israel. METHOD: Patients with acute pharyngitis were randomised to receive 60 mg prednisone orally for 1 or 2 days, or identical placebo treatment. The main outcome measures were throat pain, measured by a visual analogue scale at 12, 24, 48 and 72 hours after presentation, time off work, fever, dysphagia, recurrence of symptoms and bacterial recurrence. RESULTS: Patients treated with prednisone experienced more rapid throat pain resolution than those in the placebo group. No adverse effects were reported nor any differences between the two groups regarding either symptom or positive bacterial culture recurrence. CONCLUSION: Short-acting oral steroid therapy is effective for shortening throat pain duration in acute pharyngitis.

Adolescent↗