Last reviewed: 28 Sep 2021
Last updated: 05 Aug 2021

Summary

Definition

History and exam

Key diagnostic factors

  • hoarseness
  • dysphagia
  • sore throat
  • odynophagia
  • cough
  • hyperemia of the oropharynx
  • history of heavy vocal use
  • gastroesophageal reflux
  • oropharyngeal white-gray exudates

Other diagnostic factors

  • rhinitis
  • fatigue and malaise
  • fever
  • enlarged tonsils
  • enlarged, tender anterior cervical lymph nodes
  • postnasal drip
  • dyspnea
  • weight loss
  • tonsillopharyngeal exudate
  • acute respiratory distress
  • toxic appearance
  • drooling
  • stridor

Risk factors

  • recent history of upper respiratory infection
  • incomplete or absent Haemophilus influenzae type B (Hib) vaccination
  • incomplete or absent diphtheria vaccination
  • contact with infected individual
  • travel to area where diphtheria or tuberculosis are endemic
  • HIV or other immunocompromise
  • residence in a nursing home
  • inhaled corticosteroids or prolonged courses of antibiotics
  • heavy vocal use
  • tobacco use

Diagnostic investigations

Investigations to consider

  • biopsy during laryngoscopy
  • oropharyngeal cultures
  • nasal swab for culture
  • serum immunoprecipitation, polymerase chain reaction, or immunochromatography for diphtheria
  • complete blood count
  • rapid antigen detection test
  • chest x-ray
  • sputum cultures
  • purified protein derivative skin test (PPD)
  • videostroboscopy

Treatment algorithm

Contributors

Authors

Chad W. Whited, MD

Clinical Faculty

Laryngeal surgeon and general otolaryngologist

Austin ENT Clinic

Austin

Texas

Disclosures

CWW declares that he has no competing interests.

Seth H. Dailey, MD

Chief

Section of Laryngology and Voice Surgery

Professor

Division of Otolaryngology - Head and Neck Surgery

University of Wisconsin School of Medicine and Public Health

Madison

WI

Disclosures

SHD declares that he has no competing interests.

Acknowledgements

Dr Chad W. Whited and Dr Seth H. Dailey would like to gratefully acknowledge Dr Ozlem E. Tulunay-Ugur, a previous contributor to this topic. OETU declares that she has no competing interests.

Peer reviewers

Michael Johns, MD

Director

Assistant Professor

Emory University

Atlanta

GA

Disclosures

MJ declares that he has no competing interests.

James Suen, MD

Chair; Professor

University of Arkansas for Medical Sciences

Department of Otolaryngology - Head and Neck Surgery

Little Rock

AR

Disclosures

JS declares that he has no competing interests.

Remco de Bree, MD, PhD

Otolaryngologist

Head and Neck Surgeon

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

RdB declares that he has no competing interests.

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