No abstract available.
Diagnosis* ; Pharyngitis*

Background: Acute tonsillopharyngitis is a common reason for consult in the primary care setting. Although most cases are viral in etiology, more than half of patients with acute tonsillopharyngitis still receive antibiotic therapy for group A beta-hemolytic streptococcal infection. Streptococcal throat infection may lead uncommonly to suppurative complications like peritonsillar abscess and non-suppurative complications like acute rheumatic fever. It is with this consideration that streptococcal throat infection must be distinguished from viral infections. Clinical practice guidelines have focused their efforts on how it can be accurately diagnosed to prevent complications while reducing unnecessary antibiotic prescribing. Objective: This clinical pathway was developed to serve as guidance for family and community medicine practitioners in making clinical decisions regarding the diagnosis and management of acute tonsillophrayngitis. Methods: After defining the scope of the pathway, the PAFP Clinical Pathways Group first identified the key issues in managing patient with acute tonsillopharyngitis. These key issues were then translated to review question. The group then reviewed the published medical literature to identify, summarize, and operationalize the evidence in clinical publication. Databases were first searched for existing clinical practice guidelines from reputable medical organizations. Further search for evidence was also conducted using the terms “tonsillopharyngitis” or “tonsillitis”, “diagnosis” and “treatment”. Evidence was then summarized and its quality assessed using the modified GRADE approach. From the evidence-based summaries, the CPDG then developed general guideline and pathway recommendations which are stated as time-bound tasks of patient-care processes in the management of acute tonsillopharyngitis in family and community practice. The recommendations were then presented to a panel of family and community practitioners in both urban and rural settings, for a consensus agreement on the applicability of the recommendations to family and community practice. Lastly, the final clinical pathway was written and developed to include the recommendations, the clinical pathway tables, and an algorithm. The clinical pathway can be used as a checklist or standards of care. The algorithm can be used to explain the process of care to the patient. Recommendations: This clinical pathway contains updates on recommendations in the 2010 clinical practice guidelines on acute tonsillopharyngitis. Recommendations on the utilization of clinical scoring and rapid antigen tests as basis for deciding on need for antibiotic therapy comprise the major changes from the previously published guidelines. Penicillin remains as the first-line antibiotic therapy for streptococcal throat infection. Implementation Implementation of the clinical pathway will be at the practice and the organizational levels. The pathway may be used as a checklist to guide family medicine specialists or general practitioners in individual clinic and community medicine practice. It may also be used as reference for exams by the training programs and the specialty board. In the commitment to achieve the goal of improving the effectiveness, efficiency and quality of patient care in family and community practice, the clinical pathway may also be implemented through quality improvement activities in the form of patient record reviews, audit and feedback. Audit standards will be the assessment and intervention recommendations in the clinical pathway. Organizational outcomes can be activities of the PAFP devoted to the promotion, development, dissemination and implementation of clinical pathways.
Pharyngitis ; Family Practice

Introduction: During a thyroidectomy, the neck is hyperextended. This position may inverse the tracheal axis to the endotracheal tube (ET), can cause damage to the vocal cords and tracheal wall. We propose a simple turn of the ET corresponding with the laryngo-tracheal axis to reduce of post-operative sore throat (PST) and hoarseness (H) in thyroidectomy patients. Methods: 122 patients undergoing general anesthesia were prospectively randomized divided into 4 groups. Gp1 (n=31): normal ET tube placement. Gp2 (n=30): normal ET tube rotated 180o following insertion. Gp3 (n=30): armoured tube. Gp4 (control, n=31): Normal ET tube in operations other than thyroidectomy, that require hyperextension. Cuff pressure (CP) and inspiratory peak pressure (IPP) were monitored during anesthesia. PST and H were evaluated by a VAS (0-10mm). Results: The 4 groups were similar in age, gender and intubation duration. IPP remained stable in all 4 groups. However, CP increased significantly in Gp1 and Gp4 after hyperextension. GP1 had the most PST and H (p<0.05). Tube rotation achieved the same results as the Armoured tube. Discussion: Rotating ET tube 180o reduced PST and H as much as intubation with a armoured tube. This rotation did not interfere with ventilation during anesthesia.
Thyroidectomy, Hoarseness, Pharyngitis, Intubation, Intratracheal

INTRODUCTION: Sore throat and hoarseness often follow general anesthesia administered via a single-lumen endotracheal tube (SLT). Numerous studies have investigated the role of factors as contributing causes, but the influence of double-lumen endobronchial tube (DLT) has not been examined systemically. The goal of this study was to examine the incidence of sore throat and hoarseness after DLT insertion. METHODS: 70 patients who were intubated with SLT or DLT were studied. Sore throat and hoarseness were evaluated after 24~48 hr from extubation of each tubes. RESULTS: In SLT and DLT group, the incidence of sore throat and hoarseness was 14 patients (40%) vs 16 patients (45.7%) and 8 patients (22.8%) vs 10 patients (28.5%), respectively. CONCLUSIONS: There are no statistical differences in incidence of sore throat and hoarseness between SLT and DLT.
Anesthesia, General ; Hoarseness* ; Humans ; Incidence* ; Intubation* ; Pharyngitis*

Humans ; Myocardial Infarction ; diagnosis ; Pharyngitis ; complications

BACKGROUND: Sore throat is a common complaint after endotracheal intubation and affected by several factors. The most important causes that affect the incidence and severity of postoperative sore throat is cuff overexpansion. We evaluate the incidence and severity of postoperative sore throat when foam-filled cuff endotracheal tubes and air-filled cuff endotracheal tubes are used. METHOD: Forty patients undergoing general endotracheal anesthesia were allocated randomly to two groups to receive either foam-filled cuff tubes or air-filled cuff tubes. All patients were interviewed 24 hours postoperatively whether they had experienced a sore throat or not by individuals who did not know which tube was used. RESULTS: Incidence of sore throat was 20% in foam-filled cuff group and 50% in air-filled cuff group. In foam-filled cuff group, sore throat was less severe than air-filled cuff group. In air- filled cuff group, sore throat was more severe as intracuff pressure was increased. CONCLUSION: The incidence and severity of postoperative sore throat could be significantly reduced using the foam-filled cuff tubes.
Anesthesia ; Humans ; Incidence ; Intubation ; Intubation, Intratracheal ; Pharyngitis*

This 1-year prospective open trial was conducted on 777 children aged from 3 to 16 years old, who visited for acute sore throat and had at least one sign of pharyngitis. Data of demographic information, history of illness and use of antibiotics within recent days was documented. Clinical findings, included temperature and 2 pharyngeal swabbing samples (for microbial isolation and for detecting group A Streptococcal -specified antigen by rapid test), was computerized and analysed. Results: Group A Streptococcus was detected in 30.8% of children with acute pharyngitis. There wasn't any factor, including sex, age, and body temperature on admission or illness duration, related to the infection rate. It was found that, however, the infection rate was highest during winter and spring, when it is wet and cold. The mean of infection rate during these seasons was 36.6% and with the peak was 44.2% in March 1998. The rapid test produced the sensitivity of 88.7% and the specificity of 95.7% in this trial.
Streptococcus pyogenes ; Pharyngitis ; infection ; child ; Diagnosis

OBJECTIVE: To observe the clinical therapeutic effect of acupuncture at Qianlianquan (Extra) and eight confluent points on chronic pharyngitis. METHODS: A total of 42 patients with chronic pharyngitis were randomized into an observation group and a control group, 21 cases in each one. In the observation group, acupuncture was applied at Qianlianquan (Extra) and eight confluent points [Neiguan (PC 6), Waiguan (TE 5), Lieque (LU 7), Houxi (SI 3), Gongsun (SP 4), Shenmai (BL 62), Zhaohai (KI 6) and Zulinqi (GB 41)], once a day, 6 days as one course, with an interval of 1 day between the courses, 4-course treatment was required. In the control group, granules were taken orally 5 g each time, 3 times a day, 7 days as one course and 4 courses were required. Before and after treatment, symptoms and signs scores of chronic pharyngitis and the contents of IL-2 and TNF-a in serum were compared in the two groups. RESULTS: Compared before treatment, symptoms and signs scores of chronic pharyngitis and the contents of IL-2 and TNF-a in serum were improved in both groups (all <0.05), and the changes in the observation group were superior to the control group (all <0.05). The total effective rate was 90.5% (19/21) in the observation group, which was superior to 81.0% (17/21) in the control group (<0.05). CONCLUSION The therapeutic effect of acupuncture at Qianlianquan (Extra) and eight confluent points on chronic pharyngitis is superior to conventional Chinese patent medication treatment by granules.
Acupuncture Therapy ; Humans ; Pharyngitis ; therapy ; Treatment Outcome

BACKGROUND: The cuff pressure (CP) of the laryngeal tube airway (LTA) increases during general anesthesia using nitrous oxide. However, there have been few studies on the relationship between CP and postoperative sore throat (POST). This study evaluated the efficacy of the CP on a POST on the recovery time and postoperative day. METHODS: Forty patients were divided into two groups, group M (n = 20) and group I (n = 20). In all patients, the CP was set to 65 cmH2O at the induction of anesthesia. In group M, the CP was maintained at 60-70 cmH2O during general anesthesia using N2O. However, in group I, the CP was allowed to increase. The CP was measured every 10 minutes during surgery in the two groups. The frequency and intensity (numerical rating scale of 0-100, NRS-101) of the sore throat was measured at recovery room (RR) and on postoperative day 1 (POD1). RESULTS: There was a significant increase in the CP in group I during general anesthesia and the CP was higher in group I than in group M (P < 0.05). The frequency of POST was higher in group I at RR (10% vs 70%) and POD1 (0% vs 35%) than in group M. In addition, the NRS-101 was higher in group I at RR and POD1 than in group M (P < 0.05). CONCLUSIONS: The CP of the LTA needs to be monitored and controlled during surgery in order to reduce POST.
Anesthesia ; Anesthesia, General* ; Humans ; Nitrous Oxide ; Pharyngitis* ; Recovery Room

BACKGROUND: Cough reflex in response to extubation of the endotracheal tube is common; however, the effect of remifentanil on cough reflex is uncertain. Therefore, we evaluated the effect of lidocaine and remifentanil on cough reflex following extubation. METHODS: Forty adult patients scheduled to undergo elective surgery in two hours were enrolled in this study. All patients received a standard anesthetic protocol. Following surgery, the patients were randomly divided into two groups, Group L (n = 20), which received 1.5 mg/kg of 2% lidocaine intravenously, and Group R (n = 20), which received 0.5 microgram/kg remifentanil intravenously. Treatment was administered immediately after the patients opened their eyes, after which extubation was performed. We then evaluated breath holding and recorded the number of coughs at 5 minutes, 15 minutes and 30 minutes after extubation. In addition, we checked for sore throat 30 minutes after extubation. RESULTS: The number of coughs was significantly lower in Group R than in Group L at 5 minutes after extubation. However, there was no significant difference in the number of coughs in Group R and Group L at any other times evaluated. CONCLUSIONS: There are no significant differences in suppression of the cough reflex in response to treatment with lidocaine and remifentanil.
Adult ; Breath Holding ; Cough ; Eye ; Humans ; Lidocaine ; Pharyngitis ; Piperidines ; Reflex