Core Curriculum Syllabus: Emergencies in Otolaryngology-Head and Neck Surgery
Sore Throat or Difficulty Swallowing

Many patients go to an emergency room complaining of a sore throat or difficulty swallowing and not all have major problems such as an obstructed airway or an inspired or ingested foreign body; however, each patient should be examined carefully.

History

Sore throat

  • Duration
  • Associated complaints
    • Fever
    • Neck nodes
    • Oral lesions
    • Hoarseness
  • Systemic infection, immunodeficiency
  • History of smoking or chewing tobacco

Difficulty Swallowing - above questions plus the following:

  • Type
    • Large bolus to liquids - intrinsic or extrinsic obstruction
    • Liquids only - neurologic involvement
  • Aspiration or nasal regurgitation
  • Odynophagia
  • Referred otalgia
  • Vomiting
  • History of foreign body or caustic ingestion
  • Weight loss
  • Reflux
  • History of neck or chest surgery

Physical examination

A. Good light source important
B. Anesthetize palate, pharynx and base of tongue if necessary
C. Bimanual palpation of floor of mouth, base of tongue
D. Indirect mirror exam and/or flexible nasopharyngoscopy
E. Assess

  • Dental hygiene
  • Tongue mobility
  • Palatal competence

F. Look for
  • Drooling
  • Presence of lip or oral lesions
  • Pooling of secretions in pyriform sinuses
  • Hidden neoplasms on palate, tonsillar fossa, base of tongue, epiglottis, pyriform sinus and postcricoid region

Ancillary Studies

A. Barium swallow with cine-esophagram
B. Chest x-ray
C. CT scan
D. Endoscopy and biopsy

Treatment

A. Correct dehydration, especially important in children
B. Caustic ingestion

  • Do not induce vomiting
  • Do not perform a gastric lavage
  • Do not order a barium swallow
  • Early, aggressive endoscopy and resection of nonviable tissue

 

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Bobby R. Alford Department of Otolaryngology-Head and Neck Surgery
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Last modified: Jan. 23, 2006