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
- CBC
- rapid antigen detection test
- CXR
- sputum cultures
- purified protein derivative skin test (PPD)
- videostroboscopy
Treatment algorithm
Contributors
Authors
Clinical Faculty
Laryngeal surgeon and general otolaryngologist
Austin ENT Clinic
Austin
Texas
Disclosures
CWW declares that he has no competing interests.
Chief
Section of Laryngology and Voice Surgery
Associate 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.
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
Director
Assistant Professor
Emory University
Atlanta
GA
Disclosures
MJ declares that he has no competing interests.
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.
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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