Emergency Medicine

NON-TRAUMATIC CONDITIONS OF THE THROAT

ENT emergencies 405

3 Send blood for FBC, electrolyte and liver function tests (ELFTs) and Epstein–
Barr virus (EBV) serology including IgM and IgG.
(i) IgM positive result indicates acute infection; IgG only positive
indicates past infection.
(ii) LFTs may be mildly deranged in EBV infection.

4 Give an antipyretic analgesic, and consider penicillin V 500 mg orally b.d.
for 10 days, particularly when the patient is systemically unwell or has
peritonsillar cellulitis, or is immunosuppressed or underprivileged.
(i) Add prednisone 50 mg orally daily for 2–3 days if pain or
swelling are marked.

5 Return the patient to the care of his or her GP.

Quinsy (peritonsillar abscess)

DIAGNOSIS AND MANAGEMENT

1 This may follow tonsillitis and is more common in adults.

2 There is a worsening of the illness, with high temperature, muff led voice,
dysphagia, referred earache and trismus.

3 Examination shows unilateral swelling of the soft palate, with displacement
of the tonsil downwards and medially, and deviation of the uvula to the
unaffected side.

4 Give benzylpenicillin 1.2 g i.v. q.d.s. and metronidazole 500 mg i.v. t.d.s.
(i) Add prednisone 50 mg orally daily for 2–3 days particularly for
any peritonsillar cellulitis.

5 Refer the patient immediately to the ENT team for operative drainage.

Foreign body in the pharynx

DIAGNOSIS

1 Fish or meat bones are the most common objects to cause symptoms.

2 Usually, a fish bone will impact in the tonsil, base of the tongue or posterior
pharyngeal wall.
(i) Depress the tongue to look at the tonsil, or use a laryngeal mirror
to visualize the back of the tongue and posterior pharynx.

3 Request a lateral soft-tissue X-ray of the neck if no bone is seen despite
symptoms.
(i) Calcification of superimposed hyoid, thyroid, cricoid and
laryngeal cartilages often cause confusion in the diagnosis.

MANAGEMENT

1 Refer the patient immediately to the ENT team for oesophagoscopy if
oesophageal impaction is suspected from dysphagia, excessive salivation,
local tenderness or pain.