View source for Uvulitis

==Background==
[[File:Gray1014.png|thumb|Anatomy of the posterior pharynx.]]
[[File:Human anatomy, including structure and development and practical considerations (1911) (14594049867).jpg|thumb|Midline neck anatomy on lateral view.]]
*Uvulitis is characterized by inflammation and edema of uvula
*Isolated uvular inflammation is rare
*More commonly manifests with other inflammatory diseases of oropharynx:
**[[Epiglottitis]]
**[[Pharyngitis]]
*Rarely causes life threatening [[respiratory distress]]

===Etiologies===
*Major division: infectious vs. noninfectious etiology
*'''Infections''': 
**Most commonly [[H. Influenzae]] Type B & [[Group A Streptococcus]]
***[[H. Influenzae]]
****Frequently with [[Epiglottitis]]
***[[Group A Streptococcus]]
****Frequently with [[Pharyngitis]]
**Less common
***[[S. Pneumoniae]]
****Adults
***[[Anaerobic bacteria]]
***[[Candida Albicans]]
*'''Noninfectious'''
**Trauma
**[[Angioedema]]
**Inhalant irritation
***Inhaled [[cannabinoids]]
***Smoking
**[[Acute allergic reaction|Allergy]]

==Clinical Features==
[[File:Swollen Uvula.jpg|thumb|Uvulitis with edematous uvula on exam.]]
[[File:Swollenuvula.jpg|thumb|Pediatric uvulitis with edematous uvula on exam.]]
===History===
*[[sore throat|Throat pain]]
*[[Dysphagia]], sensation of something in their throat, gagging sensation
*Low-grade [[fever]]
*Signs/symptoms of concomitant [[epiglottitis]]
**Sudden onset
***High [[fever]]
***[[Dysphagia]]
***[[SOB]]
***Drooling
*+/- Features indicative of etiology:
**Sick contacts
**Allergen exposure
**Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc) 
**Recent inhalation of cannabis
**Incomplete [[Vaccination schedule|vaccination]] status
***[[H. Influenzae]] - epiglottis 
***First H. Influenzae vaccine at 2 months, last booster 12-15 months
**Hereditary [[angioedema]]

===Physical Exam===
*General
**Range from well appearing to toxic
*Uvula
**Markedly erythematous and edematous
**Pinpoint hemorrhage is possible
**Vesicular lesions possible if viral etiology
**Nonerythematous, pale, swollen (uvular hydrops) may indicate angioedema
*Tonsils
**Edematous vs. nonedematous
**Exudative vs. nonexudative 
*Erythematous posterior pharynx
*Respiratory
**Range non-labored breathing to (rarely) [[respiratory distress]]
**[[Stridor]]
**"Hot Potato Voice"
**Typically clear lungs

==Differential Diagnosis==
*Uvulitis
**Infectious
***Group A [[Streptococcus]]
***[[H. Influenza]]
***[[Strep. Pneumoniae]]
***[[Candida Albicans]]
**Noninfectious
***[[Trauma]]
***[[Angioedema]]
***Inhalant irritation
***[[allergic reaction|Allergy]]
*[[Epiglottitis]]
*[[Streptococcal Pharyngitis]]
*[[Peritonsillar Abscess]]
*[[Retropharyngeal Abscess]]
*[[Herpes gingivostomatitis]]

==Evaluation==
*Rapid strep throat swab
*Heterophile antibody (monospot) test
*'''If patient is ill appearing consider:'''
**CBC
**CMP
**Blood culture
*'''Imaging'''
**If concern for epiglottitis
***Lateral neck x-ray
**If concern for retropharyngeal abscess
***CT neck with contrast

==Management==
*ABC’s and Resuscitation if necessary
*Management guided by association with [[Epiglottitis]] or [[Streptococcal Pharyngitis]]
===Infectious===
====[[Epiglottitis]]====
*General Treatment
**Airway protection with fiberoptic intubation or tracheostomy
**[[Dexamethasone]] 0.15mg/kg 
**Nebulized [[epinephrine]]
*Antibiotic treatment
**Pediatric:
***([[Cefotaxime]] 50mg/kg IV q8h and [[Ceftriaxone]] 50mg/kg IV q24hr) plus [[Vancomycin]] 15mg/kg IV q12h
**Adult:
***([[Cefotaxime]] 2gm IV q4-8h or [[Ceftriaxone]] 2gm IV q24h) plus [[Vancomycin]]
====[[Streptococcal Pharyngitis]]====
*Pediatrics
**Penicillin V 250mg PO BID x 10 days
**Amoxicillin 50mg/kg PO once daily x 10 days
*Adults
**[[Penicillin V]] 500mg PO BID x 10 days
**If compliance is unlikely
***Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose
**If allergic to PCN
***[[Clindamycin]] 300mg PO q8h x 10days
====C. Albicans====
*Topical [[nystatin]]
===Noninfectious===
====Trauma====
*[[Acetaminophen]]
*Local anesthetic lozenges
====[[Allergic Reaction]]====
*Treatment determined by severity of illness
**[[Epinephrine]] 0.3mg 1:1,000 IM 
**[[Diphenhydramine]] 50mg IV
**[[Ranitidine]] 150mg
**[[Methylprednisolone]] 125mg IV
====[[Angioedema]]====
*Cover for allergic reaction with medications above
**If true angioedema, will not resolve symptoms
*Stop [[ACE inhibitor]]
*See [[Angioedema#Management|angioedema management]]
====Inhalant irritation====
*[[Antihistamines]] IV
*[[Hydrocortisone]] or [[dexamethasone]] IV

==Disposition==
*Determined by severity, complications, etc.

==See Also==
*[[Epiglottitis]] 
*[[Retropharyngeal abscess]]

==External Links==

==References==
<references/>

[[Category:ENT]]