Monday, December 17, 2018

Dumaguing: Sore throat season

DOMENG and Ester were unwelcome visitors. While it’s true they did not make significant landfall, they drew a lot of monsoon rains that brought unprecedented rainfall volume not normally seen in the month of June, with swollen rivers as well as flooded streets which caused traffic jams, and to think that children going back to school added to the usual pedestrian as well as motor vehicle gridlock, bottle-neck traffic miseries.

If the rains come, can sore throats be far behind? Indeed, the first few days of classes saw many children absent from class because of sore throats. Acute tonsillitis is the inflammation of the pharynx (pharyngitis) usually caused by microbes, mostly virus but also commonly caused by bacteria.

Allow your columnist to go into details.

The pharynx has three parts- nasopharynx, just behind the posterior nares of our nose, oropharynx – opening shared both by digestive and respiratory system and the laryngopharynx where are vocal cords are.

Adenoids are inflamed nasopharyngeal tonsils and the tonsils in sore throat are the fauces or faucial tonsils in the oropharynx. Also called palatine tonsils, they are the ones removed in tonsillectomies.

Pharyngitis can be caused by viruses that cause common colds, influenza infectious mononucleosis. Bacteria includes streptococcus (strep throat) and in sexually transmitted diseases, notably Neiserria gonorrhea.

Dysphagia or painful swallowing is the most common complaint because of the inflammation of the mucous membranes that line the pharynx, which may be covered by a whitish membrane or a pus discharge. There is fever and usually there are enlarged lymph nodes in the anterior triangle of the neck just below the chin.

Often times, there is also pain in the ears because the throat and the ears share common nerve fibers. Parents, remember that your very young child may not verbalize the pain but he/she simply refuses to eat, then you would know they have sore throat. Headaches and even vomiting are also common accompanying symptoms with that sick-feeling or generalized malaise- weakness with joint, nerve and muscle pain.

The tonsils are swollen, big and angry red- some doctors, especially pediatricians like to describe them as ripe strawberries topped with condensed milk, referring to the creamy-white pus that covers the tonsils. Rhinorrhea or copious nasal discharge, also called coryza is common, and since the throat is inflamed, there is also coughing which all the more add to the irritation of the lining of the pharynx.

Diagnosis is established by a detailed history- exposure to drizzle or sudden downpour, contact with a lot of people in a crowded room or with a sick person; physical examination is very useful, with a tongue depressor pressed down gently on the tongue, with the proverbial big Ahhh, angry-red huge tonsils are staring at you.

A throat swab is done for gram staining and probably culture to determine microbial etiology and antimicrobial therapy. Complete blood count would reveal elevated white blood cells, mostly neutrophils.

Next Week: Complications, Management and Treatment of Sore Throat


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