The patient with sore throat

Abstract

Sore throat is a common medical complaint seen by the emergency practitioner, internist, pediatrician, and otolaryngologist. The differential for sore throat is vast. However, with a directed history this can often be narrowed down to 2 to 3 possible diagnoses. By paying particular attention to the associated symptoms and duration of symptoms, common self-limited etiologies like viral pharyngitis and nonstreptococcal tonsillitis can be distinguished from those that require more investigation, such as supraglottitis and tonsillar cancer. A sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor.

Fig. 1

Fiberoptic view of laryngeal anatomy. A, arytenoid; BOT, base of tongue; E, esophageal inlet; EP, epiglottis; FVC, false vocal cord; IA, interarytenoid mucosa; PC, postcricoid mucosa; PP, posterior pharyngeal wall; PS, pyriform sinus; TVC, true vocal cord.

Fig. 2

Retropharyngeal and prevertebral spaces and their relationship to the spinal column and mediastinum.

Fig. 3

Retropharyngeal abscess. (A) lateral neck radiograph shows widening of the soft tissues anterior to the vertebral bodies. (From Flint PW. Cummings otolaryngology: head & neck surgery, 5th edition. St. Louis (MO): Mosby Elsevier; 2010. Chapter 196, Fig. 196-7A and B; with permission.) (B) CT scan with contrast of neck shows rim-enhancing collection consistent with a left retropharyngeal abscess.

Fig. 4

Right parapharyngeal abscess with impingement on the airway.

Fig. 5

Epiglottitis. Widened epiglottis (asterisk) and aryepiglottic folds (arrowheads).

Fig. 6

Laryngeal changes from chronic reflux. Edema of the interarytenoid mucosa (asterisk). Irregular, edematous, and erythematous true vocal cord mucosa (arrowheads).