Uvulitis

Background

Anatomy of the posterior pharynx.

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
  • Allergy

Clinical Features

Uvulitis with edematous uvula on exam.

Pediatric uvulitis with edematous uvula on exam.

History

• 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 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
    • 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

Inhalant irritation

• Antihistamines IV
• Hydrocortisone or dexamethasone IV

Disposition

• Determined by severity, complications, etc.

See Also

• Epiglottitis
• Retropharyngeal abscess