I.

Tonsilo-pharyngeal infections/inflammations A. ABSCESSES 1. Definition: Infections in the fascial spaces. Peritonsillar abscess: Forms iin the space between the tonsil and the fascia that covers the superior strictor muscle. Retropharyngeal abscess: Forms between the posterior pharyngeal wall and prevertebral fascia. Pharyngomaxillary abscess: Forms in the deep space between the fascia of the parotid gland and the superior constrictor muscle.

2. Pathophysiology: Peritonsillar abscess: 1)Usually forms after a patient has tonsillitis for a few days and appears to improve. 2)Usually caused by group A beta hemolytic streptococci, Staphylococcus aureus, or anaerobic organism. Retropharyngeal abscess: Usually found as complications of infections that have spread from the pharynx. Pharyngomaxillary abscess: Usually occur in direct needle contamination or by the spread of adjacent infection.

3. Diagnostic Studies 3.1. ICT or MRI scan: Larynx appears pushed forward; mass found in posterior pharynx with retropharyngeal abscess. 3.2. 3.3. Throat Culture: To identify causative organism. Visual Examination: Tonsil appears pushed toward midline and downward; uvula may rest against tonsil or palate. 4. Surgical Management 4.1. Incision and Drainage of abscess with or without local anesthesia if needed. 4.2. Tonsillectomy about one month after peritonsillar abscess has healed to prevent recurrence. 5. Medical Management 5.1. Antiinfective Agents: Clindamycin, 300mg, IV, IM, or PO q6 for 10-14 days. Ampicillin- sulbactam, 1.5-3mg, Im, IV q6 for 7-10 days. Amoxicillin-Clavunalate, 500mg, PO q8 for 10-14 days. 6. Nursing Management Pain related to swelling from abscess.

Ineffective breathing pattern related to pressure on airway from abscess. B. LUDWIGS ANGINA 1. Definition: A virulent, rapidly spreading infection of the floor of the mouth that occurs in the submental, sublingual, and submaxillary spaces. 2. Pathophysiology: Usually cause by S. viridians and E. coli and spreads rapidly to the sublingual space causes the floor of the mouth to become very swollen. 3. Diagnostic Studies 3.1. 3.2. Identification of causative organism: Culture exudates. CT Scan: Indicates presence and pinpoints location of abscess.

4. Surgical Management 4.1. 4.2. Incision and Drainage: To relieve pressure Tracheotomy: if airway is impaired.

5. Medical Management 5.1. Antiinfective Agents Penicillin G aqueous, 1-2 million U q4 Iv Cefuroxime, 1-2g, q6-8, IM, or IV 6. Nursing Management Ineffective airway clearance related to swelling. Pain related to swelling.

C. LARYNGITIS 1. Definition: Inflammation of the larynx. Acute Laryngitis: May be found as a part of viral or bacterial infection of the upper respiratory tract, or maybe an isolated infection limited to the vocal cords. Chronic Laryngitis: Implies inflammatory changes in the laryngeal mucosa. It can be progressive and may lead to a serious voice disability. 2. Pathophysiology: 1)Usually found in combination with viral or bacterial infections. 2)excessive use of voice 3)inhalation of toxic fumes. 3. Diagnostic Studies 3.1. Laryngoscopy: Shows abnormalities in true cords, reddened mucosa, and secretions on vocal cords.

4. Surgical Management 4.1. Tracheotomy (if indicated): Due to severe laryngeal edema.

5. Medical Management 5.1. Antiinfective Agents Penicillin G, 250mg, PO, q6, for 10-12 days. 5.2. Analgesics/Antipyretics Acetaminophen, 650 mg, PO, q4-6 PRN 5.3. Antitusives Guaifenessin, 100-400mg, q4, for cough 6. Nursing Management Pain related to sore throat, laryngeal edema. Impaired verbal communication related to poor voice quality.

D. PHARYNGITIS 1. Definition: Acute or chronic inflammation of the pharynx. 2. Pathophysiology: Frequenly precedes or accompanied common colds. 3. Diagnostic Studies 3.1. 3.2. Throat Culture: To determine causative organism. Heterophil Agglutination Antibody (monospot): To rule out mononucleiosis. 4. Medical Management 4.1. Antiinfective Agents Penicillin G or V, 250mg, PO q6, for 10 days. Fluconazole, 100-200mg, PO, qD, for 1-5 days. Nystatin, 100,000U/ml 400,000-600,000 U PO, qid for 10-14 days. Clortrimazole, 10mg, qid for 14 days. 4.2. Analgesics/Antipyretics Aspirin, 300-600mg PO q4-6. 5. Nursing Management Pain related to infectious process in throat.

E. TONSILITTIS 1. Definition: Inflammation of the palatine tonsil(s). 2. Pathophysiology: Begins as a sore throat accompanied by fever, chills, headache, myalgia, joint pain and anorexia. 3. Diagnostic Studies

3.1.

Throat Culture: To identify causative organism.

4. Surgical Management 4.1. Tonsillectmy (if indicated)

5. Medical Management 5.1. Antiinfective Agents Penicillin G 600,00-1,200,000 U IM Penicillin V 125-250 mg PO q6. 5.2. Analgesics Acetaminophen, 650mg, Po q4-6. 6. Nursing Management Pain related to severe sore throat. II. Degenerative/Structural Disorders A. VOCAL CORD PARALYSIS 1. Definition Loss of nerve and motor supply to the vocal cords resulting in fixation and abnormal position of one or both cords. 2. Pathophysiology Result of either disease or injury to the superior laryngeal nerve or the recurrent laryngeal nerve, which is the branch of vagus nerve that provides entire motor supply to the larynx. 3. Diagnostic Studies 3.1. 3.2. Laryngoscopy: Shows paralyze condition of cords. Bronchoscopy and Esophagoscopy: Done as part of malignancy workup. 3.3. 3.4. Videotroboscopy; Records vocal cord movements. Electromyography: Determines vocal cord innervations.

4. Surgical Management 4.1. For Unilateral Paralysis a. Thyroplasty: Involves an external incision in the neck with insertion of a stent to move the paralyzed vocal cords toward the midline. 4.2. For Bilateral Paralysis a. Tracheotomy: may be needed due inadequate airway. b. Kings Procedure: Suture is passed around arytenoids cartilage and through adjacent cricoids cartilage. c. Medialization Laryngoplasty: Involves creation of window into the larynx.

5. Nursing Management Ineffective breathing pattern. Prepared by: ALBA, Arnaldo Jr. A.