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Pharyngitis is a type of inflammation, most commonly caused by an upper respiratory tract infection. It may be classified as acute or chronic. Acute pharyngitis may be catarrhal, purulent or ulcerative, depending on the causative agent and the immune capacity of the affected individual. Chronic pharyngitis may be catarrhal, hypertrophic or atrophic.
Tonsillitis is a sub type of pharyngitis. If the inflammation includes both the tonsils and other parts of the throat, it may be called pharyngotonsillitis. Another sub classification is nasopharyngitis (the common cold).
An integral symptom of acute otitis media is ear pain; other possible symptoms include fever, and irritability (in infants). Since an episode of otitis media is usually precipitated by an upper respiratory tract infection (URTI), there are often accompanying symptoms like a cough and nasal discharge.
Discharge from the ear can be caused by acute otitis media with perforation of the ear drum, chronic suppurative otitis media, tympanostomy tube otorrhea, or acute otitis externa. Trauma, such as a basilar skull fracture, can also lead to discharge from the ear due to cerebral spinal drainage from the brain and its covering (meninges).
Pharyngitis is inflammation of the back of the throat, known as the pharynx. It typically results in a sore throat and fever. Other symptoms may include a runny nose, cough, headache, a hoarse voice. Symptoms usually last three to five days. Complications can include sinusitis and acute otitis media. Pharyngitis is typically a type of respiratory tract infection.
Most cases are caused by a viral infection. Strep throat, a bacterial infection, is the cause in about 25% of children and 10% of adults. Uncommon causes include other bacteria such as gonorrhea, fungus, irritants such as smoke, allergies, and gastroesophageal reflux disease. Specific testing is not recommended in people who have clear symptoms of a viral infection such as a cold. Otherwise a rapid antigen detection test (RAPD) or throat swab is recommended. Other conditions that can produce similar symptoms include epiglottitis, thyroiditis, retropharyngeal abscess, and occasionally heart disease.
NSAIDs, such as ibuprofen, can be used to help with the pain. Topical lidocaine may also help. Strep throat is typically treated with antibiotics, such as either penicillin or amoxicillin. It is unclear if steroids are useful in acute pharyngitis, other than possibly in severe cases.
About 7.5% of people have a sore throat in any three-month period. Two to three episodes in a year is not uncommon. This resulted in 15 million physician visits in the United States in 2007. Pharyngitis is the most common cause of a sore throat. The word comes from the Greek word "pharynx" meaning "throat" and the suffix "-itis" meaning "inflammation".
The most common bacteria isolated from the middle ear in AOM are "Streptococcus pneumoniae, Haemophilus influenzae", "Moraxella catarrhalis," and "Staphylococcus aureus".
Acute adenoiditis is characterized by fever, runny nose, nasal airway obstruction resulting in predominantly oral breathing, snoring and sleep apnea, Rhinorrhea with serous secretion in viral forms and mucous-purulent secretion in bacterial forms. In cases due to viral infection symptoms usually recede spontaneously after 48 hours, symptoms of bacterial adenoiditis typically persist up to a week. Adenoiditis is sometimes accompanied by tonsillitis. Repeated adenoiditis may lead to enlarged adenoids.
Ear pain is the predominant complaint and the only symptom directly related to the severity of acute external otitis. Unlike other forms of ear infections, the pain of acute external otitis is worsened when the outer ear is touched or pulled gently. Pushing the tragus, the tablike portion of the auricle that projects out just in front of the ear canal opening, also typically causes pain in this condition as to be diagnostic of external otitis on physical examination. People may also experience ear discharge and itchiness. When enough swelling and discharge in the ear canal is present to block the opening, external otitis may cause temporary conductive hearing loss.
Because the symptoms of external otitis lead many people to attempt to clean out the ear canal (or scratch it) with slim implements, self-cleaning attempts generally lead to additional traumas of the injured skin, so rapid worsening of the condition often occurs.
Complications of acute adenoiditis can occur due to extension of inflammation to the neighboring organs.
Necrotizing external otitis (malignant otitis externa) is an uncommon form of external otitis that occurs mainly in elderly diabetics, being somewhat more likely and more severe when the diabetes is poorly controlled. Even less commonly, it can develop due to a severely compromised immune system. Beginning as infection of the external ear canal, there is an extension of the infection into the bony ear canal and the soft tissues deep to the bony canal. Unrecognized and untreated, it may result in death. The hallmark of malignant otitis externa (MOE) is unrelenting pain that interferes with sleep and persists even after swelling of the external ear canal may have resolved with topical antibiotic treatment. It can also cause skull base osteomyelitis (SBO), manifested by multiple cranial nerve palsies, described below under the "Treatment" heading.
Some common symptoms and signs of mastoiditis include pain, tenderness, and swelling in the mastoid region. There may be ear pain (otalgia), and the ear or mastoid region may be red (erythematous). Fever or headaches may also be present. Infants usually show nonspecific symptoms, including anorexia, diarrhea, or irritability. Drainage from the ear occurs in more serious cases, often manifest as brown discharge on the pillowcase upon waking.
In uncomplicated colds, cough and nasal discharge may persist for 14 days or more even after other symptoms have resolved.
Acute upper respiratory tract infections include rhinitis, pharyngitis/tonsillitis and laryngitis often referred to as a common cold, and their complications: sinusitis, ear infection and sometimes bronchitis (though bronchi are generally classified as part of the lower respiratory tract.) Symptoms of URTIs commonly include cough, sore throat, runny nose, nasal congestion, headache, low-grade fever, facial pressure and sneezing.
Symptoms of rhinovirus in children usually begin 1–3 days after exposure. The illness usually lasts 7–10 more days.
Color or consistency changes in mucous discharge to yellow, thick, or green are the natural course of viral upper respiratory tract infection and not an indication for antibiotics.
Group A beta hemolytic streptococcal pharyngitis/tonsillitis (strep throat) typically presents with a sudden onset of sore throat, pain with swallowing and fever. Strep throat does not usually cause runny nose, voice changes, or cough.
Pain and pressure of the ear caused by a middle ear infection (otitis media) and the reddening of the eye caused by viral conjunctivitis are often associated with upper respiratory infections.
A URI may be classified by the area inflamed.
Rhinitis affects the nasal mucosa, while rhinosinusitis or sinusitis affects the nose and paranasal sinuses, including frontal, ethmoid, maxillary, and sphenoid sinuses. Nasopharyngitis (rhinopharyngitis or the common cold) affects the nares, pharynx, hypopharynx, uvula, and tonsils generally. Without involving the nose, pharyngitis inflames the pharynx, hypopharynx, uvula, and tonsils. Similarly, epiglottitis (supraglottitis) inflames the superior portion of the larynx and supraglottic area; laryngitis is in the larynx; laryngotracheitis is in the larynx, trachea, and subglottic area; and tracheitis is in the trachea and subglottic area.
Otitis is a general term for inflammation or infection of the ear, in both humans and other animals.
It is subdivided into the following:
- "Otitis externa", external otitis, or "swimmer's ear" involves the outer ear and ear canal. In external otitis, the ear hurts when touched or pulled.
- "Otitis media" or middle ear infection involves the middle ear. In otitis media, the ear is infected or clogged with fluid behind the ear drum, in the normally air-filled middle-ear space. This very common childhood infection sometimes requires a surgical procedure called "myringotomy" and tube insertion.
- "Otitis interna" or labyrinthitis involves the inner ear. The inner ear includes sensory organs for balance and hearing. When the inner ear is inflamed, "vertigo" is a common symptom.
Mastoiditis is the result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside the mastoid process. The mastoid process is the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces. Mastoiditis is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries where surgical treatment is now much less frequent and more conservative, unlike former times. Additionally, there is no evidence that the drop in antibiotic prescribing for otitis media has increased the incidence of mastoiditis, raising the possibility that the drop in reported cases is due to a confounding factor such as childhood immunizations against Haemophilus and Streptococci. Untreated, the infection can spread to surrounding structures, including the brain, causing serious complications.
Post-streptococcal glomerulonephritis (PSGN) is an uncommon complication of either a strep throat or a streptococcal skin infection. It is classified as a type III hypersensitivity reaction. Symptoms of PSGN develop within 10 days following a strep throat or 3 weeks following a GAS skin infection. PSGN involves inflammation of the kidney. Symptoms include pale skin, lethargy, loss of appetite, headache, and dull back pain. Clinical findings may include dark-colored urine, swelling of different parts of the body (edema), and high blood pressure. Treatment of PSGN consists of supportive care.
A subset of children with acute, rapid-onset of tic disorders and obsessive compulsive disorder (OCD) are hypothesized to be due to an autoimmune response to group A beta-hemolytic streptococcal infection (PANDAS).
The typical symptoms of a cold include a cough, a runny nose, nasal congestion and a sore throat, sometimes accompanied by muscle ache, fatigue, headache, and loss of appetite. A sore throat is present in about 40% of cases and a cough in about 50%, while muscle ache occurs in about half. In adults, a fever is generally not present but it is common in infants and young children. The cough is usually mild compared to that accompanying influenza. While a cough and a fever indicate a higher likelihood of influenza in adults, a great deal of similarity exists between these two conditions. A number of the viruses that cause the common cold may also result in asymptomatic infections.
The color of the sputum or nasal secretion may vary from clear to yellow to green and does not indicate the class of agent causing the infection.
Ear pain can be caused by disease in the external or middle ear(because of infection), or inner ear, but the three are indistinguishable in terms of the pain experienced.
External ear pain may be:
- Mechanical: trauma, foreign bodies such as hairs, insects or cotton buds.
- Infective (otitis externa): "Staphylococcus", "Pseudomonas", "Candida", herpes zoster, or viral Myringitis. (See Otitis externa)
Middle ear pain may be:
- Mechanical: barotrauma (often iatrogenic), Eustachian tube obstruction leading to acute otitis media.
- Inflammatory / infective: acute otitis media, mastoiditis.
The common cold, also known simply as a cold, is a viral infectious disease of the upper respiratory tract that primarily affects the nose. The throat, sinuses, and larynx may also be affected. Signs and symptoms may begin less than two days following exposure. They include coughing, sore throat, runny nose, sneezing, headache, and fever. People usually recover in seven to ten days. Some symptoms may last up to three weeks. In those with other health problems, pneumonia may occasionally develop.
Well over 200 virus strains are implicated in the cause of the common cold; the rhinoviruses are the most common. They spread through the air during close contact with infected people and indirectly through contact with objects in the environment followed by transfer to the mouth or nose. Risk factors include going to daycare, not sleeping well, and psychological stress. Symptoms are mostly due to the body's immune response to the infection rather than to tissue destruction by the viruses themselves. People with influenza often show similar symptoms as people with a cold, though symptoms are usually more severe in the former. Influenza is less likely to result in a runny nose.
There is no vaccine for the common cold. The primary methods of prevention are hand washing; not touching the eyes, nose or mouth with unwashed hands; and staying away from other sick people. Some evidence supports the use of face masks. No cure for the common cold exists, but the symptoms can be treated. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may help with pain. Antibiotics should not be used. Evidence does not support a benefit from cough medicines.
The common cold is the most frequent infectious disease in humans. The average adult gets two to four colds a year, while the average child may get six to eight. They occur more commonly during the winter. These infections have been with humanity throughout history.
Ear pain, also known as otalgia , is pain in the ear. Primary ear pain is pain that originates inside the ear. Referred ear pain is pain that originates from outside the ear.
Ear pain is not always associated with ear disease. It may be caused by several other conditions, such as impacted teeth, sinus disease, inflamed tonsils, infections in the nose and pharynx, throat cancer, and occasionally as a sensory aura that precedes a migraine.
Granular myringitis (GM) is a long term condition in which there is inflammation of the tympanic membrane in the ear and formation of granulation tissue within the tympanic membrane. It is a type of otitis externa.
Without treatment it can lead to narrowing of the ear canal. A number of treatment options exist including putting vinegar in the ear, using antibiotic drops, and surgery.
Other symptoms of the syndrome include:
- retroorbital pain due to pain in the area supplied by the ophthalmic branch of the trigeminal nerve (fifth cranial nerve),
- abducens nerve palsy (sixth cranial nerve), and
- otitis media.
Other symptoms can include photophobia, excessive lacrimation, fever, and reduced corneal sensitivity.
The syndrome is usually caused by the spread of an infection into the petrous apex of the temporal bone.
Although some disagreement exists on the exact boundary between the upper and lower respiratory tracts, the upper respiratory tract is generally considered to be the airway above the glottis or vocal cords. This includes the nose, sinuses, pharynx, and larynx.
Typical infections of the upper respiratory tract include tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, certain types of influenza, and the common cold. Symptoms of URIs can include cough, sore throat, runny nose, nasal congestion, headache, low grade fever, facial pressure and sneezing.
The typical signs and symptoms of cellulitis is an area which is red, hot, and painful. The photos shown here of are of mild to moderate cases, and are not representative of earlier stages of the condition.
Gradenigo's syndrome, also called Gradenigo-Lannois syndrome and petrous apicitis, is a complication of otitis media and mastoiditis involving the apex of the petrous temporal bone. It was first described by Giuseppe Gradenigo in 1904 when he reported a triad of symptoms consisting of: (1)"unilateral periorbital pain" related to trigeminal nerve involvement, (2)"diplopia" due to sixth nerve palsy and (3)persistent "otorrhea", associated with bacterial otitis media with apex involvement of the petrous part of the temporal bone (petrositis). The classical syndrome related to otitis media has become very rare after the antibiotic era.
The lower respiratory tract consists of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs.
Lower respiratory tract infections are generally more serious than upper respiratory infections. LRIs are the leading cause of death among all infectious diseases. The two most common LRIs are bronchitis and pneumonia. Influenza affects both the upper and lower respiratory tracts, but more dangerous strains such as the highly pernicious H5N1 tend to bind to receptors deep in the lungs.