Approach to

Upper Respiratory Tract

Infections(URTI)

Dr. Othman Bani Yonis

1
URTIs : inflammation of the respiratory
mucosa from the nasal cavity down to the
bronchus. (above the level of the carina).
Includes : common colds , influenza ,
sinusitis , rhinitis , tonsillitis , otitis media ,
pharyngitis , laryngitis,epiglottitis,Tracheitis
and croup.
Epidemiology:
In average , children will have 5 URTIs/ year
and adults 2-3/year.
70-80 % of these infections are caused by
viruses ; rhinoviruses and adenoviruses are
the most common.

3
Management principles:
*Viral infections need ONLY symptomatic
treatment , NO need for antibiotics(Abs).
Viral URTIs :
1. Influenza

2. Common cold

3. Mild acute sinusitis

4. Mild acute otitis media

4
*Bacterial infections need ABs for treatment
in addition to the symptomatic treatment.
Bacterial URTIs :
1. GABHS pharyngitis

2. Moderately to severe acute sinusitis

3. Moderately to severe acute otitis media

4. Special cases ( pertussis , epiglottitis )

5
*Why not to use Abs for viral infections ?
1. Promotes Abs resistance.

2. Adverse reactions such as allergy and

anaphylaxis
3. Patients do not need Abs to feel satisfied

4. costly

6
Why to use Abs for bacterial infections?
1. To prevent suppurative complications

2. To prevent rheumatic fever

3. To speed up recovery

4. To reduce spread to others

7
Common cold( nasopharyngitis )

8
Common cold is a self-limiting , viral
infectious disease of the upper respiratory
system.
Incidence : most frequent infectious disease in
humans ; 2-4 infections / year in adults and 6-
12 in children.
Transmitted by droplets and close personal
contact / airborne.
usually occurs in the fall and winter months.

9
Causative agents :
Rhinovirus (50%) , coronavirus (10-20%),
adenovirus (5%) , others :RSV , parainfluenza virus.
Bacterial infections are unlikely:
Mycobacterium leprae, Klebsiella
rhinoscleromatis, Pseudomonas mallei
(glanders), Rhinosporidium seeberi
(rhinosporidiosis), Leishmania mexicana
(leishmaniasis)

10
Symptoms:
The first symptom is usually a sore or “scratchy
throat” , followed soon after by nasal stuffiness and
discharge ( rhinorrhea ) , sneezing and coughing.
The throat is usually sore for a brief time. The cough symptoms are
usually worse on the 4th or 5th day of illness , while the nasal
symptoms improve.
Symptoms generally last for 7 to 10 days.
Cough may continue up to 4 weeks.

11
If the nasal discharge becomes viscous and
green with time ; it doesn’t mean
superimposed bacterial infection . It’s a
normal course of common cold.

12
Complications:
1. Acute otitis media (most common in children)

2. Pharyngitis

3. Sinusitis

4. Bronchitis and pneumonia

5. Conjunctivitis

6. Adenitis

7. Aggravation of asthma

13
Management:
Symptomatic Treatment :
comfort is the goal of treatment which may
include:
*nasal suction for infants
*steam/mist inhalation
*nasal irrigation
*humidified air

14
*consume extra fluids (warm fluids may be
soothing for irritated throats
*consume nutritious diet as tolerated
*elevate head of bed
*salt water gargle for sore throat with
homemade salt water (1/4 teaspoon dissolved in
8 ounces warm water)
*get adequate rest

15
*VitaminC may reduce duration of
common cold in children.

*Zinc syrup associated with reduced

duration of cold symptoms in children

*Honey may reduce nocturnal cough and sleep disruption in children

with acute cough, and might be more effective than
dextromethorphan or diphenhydramine

16
Medication :
1. Antipyretics: no evidence that
fever or antipyretic treatment affects
illness course or neurologic
complications:
2. Ibuprofen appears more effective
than acetaminophen for reducing
fever in single-dose comparisons
and ibuprofen and acetaminophen
appear to17
have similar analgesic
effects .
*Combined or alternating
acetaminophen and ibuprofen
regimens may be more effective than
either monotherapy for reducing
fever in children.
*Ibuprofen approved for use( by FDA)
after 6 months of age.
*Paracetamol: may be used after 2-3
months of age.
18
Nasal Decongestants and Antihistamines:
*Nonprescription medicines (antihistamines
and antitussives) do not appear effective for
acute cough in children )
*FDA recommends against use of nonprescription cough and cold
products in children < 2 years old and supports not using them in
children < 4 years old.
*nonprescription cough and cold preparations may not be safe
in children

19
*Aspirin is contraindicated in children
with viral infections due to association
with increased risk for

Antibiotics :
*Abs do not appear to reduce symptoms of common
cold or acute purulent rhinitis.
* No role of antibiotics in common cold ( viral infection ).

20
Prevention:
*Wash hands after contact with common cold
patients.
*Do not touch any surfaces or objects that may
have been contaminated.
*Keep fingers out of eyes and nose.

21
Influenza:
*Influenza is a viral infection that affects
mainly the nose , throat , bronchi , and
occasionally lungs.

*Influenza causes annual epidemics that peak

during winter.

22
Seasonal influenza
*Acute viral infection caused by influenza type A , B and C.
*Type A and B are constantly changing due to mutations
( antigenic drift and shift ) , more serious than type C.
*Type C is stable , it’s cases occur much less frequently than
type A and B.
*Currently influenza A (H1N1) and A (H3N2) subtypes are
circulating among humans.
*Transmitted by droplets and close person contact /
airborne.

23
 Signs and symptoms
*Following an incubation period of 1-2 days, flu presents with abrupt
onset of fever (39 – 40 c) ,muscle aches , headache and fatigue. The
individual may have respiratory symptoms such as a dry cough , sore
throat , and occasionally a runny nose.

*Other symptoms related to systemic illness include chills and sweats ,

loss of appetite , diarrhea and vomiting.

24
Prognosis:
These symptoms generally improve over two to five days, though may
last one or more weeks.

*Some patients experience postinfluenzal asthenia (persistent weakness

or becoming tired easily) which may be present for several weeks
following the illness.

* A dry cough (post viral cough syndrome) may also persists for several
weeks.

25
Common cold Vs Influenza:

*Influenza is different from the common cold in that it

causes a more severe illness , with fever , headache ,
significant fatigue and muscle aches and systematic
manifestations.

*It’s less likely to cause sneezing or a blocked nose

with thick nasal discharge.

26
Complications
1. Bronchitis

2. Sinus infections

3. Ear infections

4. Pneumonia

5. Encephalitis

27
 Highest risk of complications occurs among :

1. Children < 2 years

2. Adults 65 years or older
3. Medical chronic illnesses
4. Immunocompromised patients

28
Treatment:
1. Bed rest

2. Antipyretic/Analgesics

3. Fluid intake

29
 4-Antiviral treatment:
 antiviral treatment recommended as soon as possible (and not
delayed while awaiting diagnostic confirmation) for patients with
confirmed or suspected influenza who:
 *have severe, complicated, or progressive illness
 *require hospitalization
 *are at higher risk for influenza complications
1. - children < 2 years,
2. -adults ≥ 65 years ,
3. -pregnant women ,
4. -chronic medical illnesses ,
5. -immunocompromised patients
 adults
 zanamivir 10 mg (2 inhalations) twice daily for 5 days;
not recommended in patients with airways disease
 oseltamivir 75 mg orally twice daily for 5 days
 peramivir 600 mg IV single dose
 children
 zanamivir 10 mg (2 inhalations) twice daily for 5 days
for children ≥ 7 years old
 amantadine 5 mg/kg/day (maximum 150 mg/day) in 2
divided doses for 5 days for children aged 1-9 years
 oseltamivir
Prevention:
1. Frequent hand washing.

2. Wear masks and gloves.

3. Isolation of patient until 24 hours of

afebrile period.
4. Vaccination ; most effective measure of

prevention .

32
Influenza vaccine
Annual vaccine
 Two types :
1. Injectable : killed vaccine
2. Nasal spray : live but weakened virus

 70% protection in 1 year.

 Reduces severe complications by 60% , and death by 80%.

33
Recommended for :
1. *all persons ≥ 50 years old
2. *Infants and children aged from 6 months to 4 years.
3. *women who are or will be pregnant during the influenza season.

*adults who have chronic pulmonary (including asthma) or cardiovascular

(except isolated hypertension), renal, hepatic, neurological, hematologic,
or metabolic disorders (including diabetes mellitus)

.)

34
*household contacts and caregivers of children < 5 years old.

*adults ≥ 50 years old.

*Immunocompromised patients and immunosuppressive treatment.

*Health care professionals.

*residents of nursing homes and other long-term care facilities.

*persons who are morbidly obese (body mass index ≥ 40 kg/m2

Pharyngitis/Tonsillitis

36
Pharyngitis/Tonsillitis:

 It is an inflammation of the pharynx, w/o tonsilles.most commonly

caused by viral or bacterial infection.
 Causative agents :

1. Viral : adenovirus (80% most common ) , enterovirus , EBV , herpes

simplex virus.
2. Bacterial : GABHS (5-15%), mycoplasma.

 GAS uncommon in children younger than 2-3 years, and the

peak is between 5-11 years.
 Peak Winter to early Spring.
 37
Spread by direct contact.
Clinical presentation:
*The main symptom is a sore throat.

*Other symptoms may include:

- Fever
- Headache
- Joint pain and muscle aches
- Skin rashes
- Swollen lymph nodes in the neck

38
Bacterial Vs. Viral
*Viral Infection:
-Clinically: Gradual, more likely to have rhinorrhea, cough, diarrhea,
hoarseness of voice.

 Adenovirus: conjunctivitis, most common cause in

children < 3 years of age.

 - Coxsackieviruses: ulcer on posterior pharynx,

herpangina (mouth blisters).

 - EBV: prominent tonsils with white exudates,

posterior cervical
39 LN enlargement, Palatal rash,
Hepatosplenomegaly, high fever and fatigue.
Bacterial Infection:
*Clinically: Rapid onset fever, prominent throat pain, headache,
abdominal pain, vomiting, dysphagia and malaise.

*On exam: Pharynx are erythematous, tonsils enlarged with yellow-

blood tinged exudate, petichia may be present on soft palate, anterior
cervical lymph nodes enlarged and tender.

40
41
 Age-modified Centor score (McIsaac
score):
 1 point for each of
 tonsillar exudate
 swollen tender anterior cervical nodes
 absence of cough
 history of fever or measured temperature > 38 degrees C
(100.4 degrees F)
 age modification
 1 point if age < 15 years
 -1 point if age > 45 years
43
Why we treat GAS pharyngitis
*decrease risk of Rheumatic fever, but not of PSGN.

*shorten duration of illness.

*decrease risk of complication (mainly abscess).

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Diagnosis of Sore Throat:
Rapid Antigen Test (RAT)
 Sensitivity of RAT against culture varies between 61-95%.
 Specificity of RAT 88-100%

 Takes 10 min to be performed

 -ve results should be confirmed by culture.

Throat Culture
 20-40% of those with negative throat culture will be labeled as
having GABHS.
 +ve culture makes the Dx of GABHS,

but –ve culture does not rule out.

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1. Differential diagnosis -
2. Infectious mononucleosis, when a membranous exudate is
present.

3. - Diphtheria, especially in the underimmunized.

4. - Herpangina, with many vesiculoulcerative lesions in the

anterior pillars & soft palate.

5. - Agranulocytosis, yellowish dirty white exudates covering the

tonsils & post pharyngeal wall.

6. - Kawasaki disease.

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Complication of GAS pharyngitis:
1- otitis media
 2- Glomerulonephritis and Rheumatic Fever may follow
streptococcal infection.
 3- Monoarthritis.
 4- Mesenteric adenitis (viral or bacterial) abdominal pain
with or without vomiting.
 5- In debilitated children, large chronic ulcers in the
pharynx (viral or bacterial).

47
 According to revised Jones criteria, the
Rheumatic Fever diagnosis of rheumatic fever can be
Major Criteria: made when:
- Polyarithritis 2 major criteria, or 1 major criterion
- Carditis plus 2 minor criteria, are present along
with evidence of streptococcal
- Sydenham Chorea infection: (elevated or rising ASO titre or
- Subcutaneous nodules DNAase).

- Erythema Marginatum Exceptions are chorea and indolent

Minor Criteria: carditis, each of which by itself can
indicate rheumatic fever.
 Fever of 38.2–38.9 °C (101–102 °F)
 Arthralgia: Joint pain without swelling (Cannot be included
if polyarthritis is present as a major symptom)
 Raised ESR or CRP
 Leukocytosis
 ECG showing features of heart block, such as a prolonged PR
interval (Cannot
48 be included if carditis is present as a major
symptom)

Treatment of Sore Throat:
Viral Pharyngitis:
Rest
Oral fluid
salt-water gargling (for soothing effect)
Humidified air and irritants avoidance
Analgesics and antipyretics may be used for relief of pain or pyrexia.
Paracetamol is the drug of choice.

49
 Bacterial Pharyngitis:
 Antibiotics:
 Penicillin: 10 days oral or once IM.
safe , cheap , narrow spectrum , no resistance

 Amoxicillin ,Erythromycin: 10 days/

 Azithromycin: higher dose, 5 days.

 Symptomatic:
 Antipyretics/ Analgesia: paracetamol.

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  Surgery (tonsillectomy )
Surgery to remove tonsils (tonsillectomy) may be used to treat
frequently recurring tonsillitis, chronic tonsillitis, or bacterial
tonsillitis that doesn't respond to antibiotic treatment.

Frequent tonsillitis is generally defined as:

More than 6 episodes in one year
More than 4 episodes a year over two years
More than 3 episodes a year over three years

A tonsillectomy may also be performed if tonsillitis results in

difficult to manage
51 complications, such as:
1. Obstructed sleep apnea
2. Breathing difficulty
 Sinusitis

52
Sinusitis:
Inflammation of mucosa of
paranasal sinuses.

Most commonly it is viral, especially post common cold,:

Rihnovirus, Influenza virus, parainfluenza virus.
 Could be bacterial: Strep. Pneumoniae, H. Influenzae, M.

Catarrhalis, Staph. Aureus.

53
Sinusitis:
Risk Factors:
 Allergic rhinitis or hay fever
 Cystic fibrosis.
 Day care, Weakened immune system from HIV or chemotherapy
 Changes in altitude (flying or scuba diving)
 Large adenoids, Nasal polyps
 Smoking
 Nasogastric and nasotracheal intubation

54
*Clinical presentation
*The symptoms of acute sinusitis in adults usually
follow a cold that does not improve, or one that
gets worse after 5 - 7 days of symptoms.
*Symptoms:
 Mucopurulent Rhinorrea
 Nasal congestion
 Facial pain, pressure and fullness
 Decrease sense of smell
 Exam:
 Looking in the nose for signs of polyps
 Shining a light against the sinus (transillumination) for
signs of inflammation
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 Tapping over a sinus area to find infection (tenderness),
very painful
Diagnosis of Sinusitis:
 Clinically
 We use radiological evaluation if there is warning signs:

-Severe swelling and redness of the tissues around the

eye
-Limitations of eye movement
-Swelling of the forehead
-High fever
-Altered consciousness
 Radiological evaluation:
 Regular x-rays of the sinuses are not very accurate for diagnosing
sinusitis.
 A CT scan of the sinuses to help diagnose sinusitis or view the
bones and tissues
56 of the sinuses more closely.
 way.
Complications of Sinusitis:
Periorbital cellulites
 Meningitis

 Brain abscesses

 Cavernous sinus thrombosis

 Osteomylitis of frontal bane.

57
Treatment of Sinusitis:
*Analgesics and antipyretics as needed
*Intranasal corticosteroids.
*Consider intranasal saline with either
physiologic or hypertonic saline.
*Decongestants and antihistamines: lack evidence
for effectiveness unless evidence of allergic
component.

58
*antibiotics for acute bacterial sinusitis:
-most cases resolve without antibiotic treatment.
-only consider treatment with antibiotics if patient meets criteria for
acute bacterial sinusitis.
consider watchful waiting without antibiotics in patients with
uncomplicated mild illness (mild pain and temperature < 101 degrees F
[38.3 degrees C]) with assurance of follow-up .
*if decision made to treat with antibiotics, amoxicillin is first-line therapy
for most patients

59
Criteria for acute bacterial sinusitis:

*persistent symptoms or signs lasting ≥ 10 days without evidence of clinical

improvement (IDSA Strong recommendation, Low-moderate-quality evidence)
*severe symptoms or signs of high fever (≥ 39 degrees C and purulent nasal
discharge or facial pain lasting for ≥ 3-4 consecutive days at beginning of illness (
IDSA Strong recommendation, Low-moderate-quality evidence)

*worsening symptoms or signs characterized by new onset of fever, headache, or

increase in nasal discharge following typical viral upper respiratory infection
that lasted 5-6 days and were initially improving ("double-sickening") (
IDSA Strong recommendation, Low-moderate-quality evidence)

60
Preventing Sinusitis;
 gently blowing your nose, blocking one nostril while blowing
through the other
 drinking plenty of fluids to keep nasal discharge thin
 avoiding air travel. If you must fly, use a nasal spray
decongestant before take-off to prevent blockage of the
sinuses allowing mucus to drain
 If you have allergies, try to avoid contact with things that
trigger attacks. If you cannot, use over-the-counter or
prescription antihistamines and/or a prescription nasal spray

61
Otitis Media

62
 Suppuratice or acute otitis media (AOM):
 Mainly caused by Strep. Pneumoniae, non typeable H. influenza,
M. catarrhalis.
 Virusis: mainly Rhinovirus and RVS (30%)
 Non-suppurative or secretory otitis media or otitis media with
effusion (OME)
 Usually non infective
 Cultures are sterile, but in 30% same organisms
 Recurrent otitis media
 3 times in 6 months or more than 4 times in a year
 Chronic otitis media
 Foul-smelling otorrhea.

63
 Risk factors:
 Age: 6-20 months- decrease with age
 Male gender
 Low socioeconomic status
 Exposure to smoking and day care attendance
 More in cold weather
 Bottle feeding while sleeping, breast feeding (protective)
 Congenital anomalies: Down syndrom, cleft palate.

64
Clinical Presentation:
 In infants, are nonspecific and include fever, irritability,
excessive crying and poor feeding.
 In older children and adolescents, fever, otalgia (acute ear

pain), otorrhea (ear drainage); after spontaneous rupture of

the tympanic membrane. Signs of a common cold are
often present.
 Nausea, Vomiting, dizziness, fever.

 TM exam: red, bulge, loss of land marks, decrease

mobility (by pneumatic otoscopy), apparent light reflex,

perforation.

65
 Acute Otitis Media:
Acute symptoms and signs or Middle Ear
inflammation with Middle Ear Effusion.
 Middle Ear Effusion:
 Bulging of the tympanic membrane.

 Limitation or absent motility of TM

 Air fluid level behind TM

 Otorrhea

 Symptoms and signs of Middle Ear

inflammation:
 Distinct erythemia of TM

 Distinct otalgia

 66 with perferation: History suggestive or

AOM
AOM and ear canal full of purulent exudate
•
Normal tympanic
membrane:

1. Shiny
2. Translucent.
3. +ve light reflux
4. No air fluid border
5. No bulge.

67
 Red bulging TM
 Red, bulge, distortion of
normal landmarks, loss of the
cone of light.

68
 Acute otitis media

Redness
69
Bulging
Complication of Otitis Media :
Chronic suppurative otitis media
Acute mastoiditis
Facial paralysis
Cholesteatoma (cyst like lesion in middle ear, tend to expand and
cause bone resorption)
Intracranial complications: meningitis, abscess, lateral sinus
thrombosis
Conductive hearing loss and possible developmental sequelae

70
How to manage it?
Natural history of OME is spontaneous resolution … days-
months.
• Prompt surgical referral for structural damage to TM or ME
(e.g. cholesteatoma).
• Surgical referral for children with OME with hearing loss
independent on OME, speech or language disorder,
developmental delay and uncorrectable visual impairment.
• Antihistamines, decongestants, or steroids are not used in
the management of OME in children.
71
 Treatment of Otitis Media:
 Give drugs to decrease pain (oral-topical analgesics)
 Antibiotics :Indications:
 moderate or severe otalgia
 otalgia for ≥ 48 hours

 temperature ≥ 39 degrees C (102.2 degrees F)

 age < 24 months and bilateral AOM

either antibiotic therapy or observation with close follow-up

recommended for (AAP Recommendation, Grade B)
children aged 6-23 months with unilateral AOM without severe
signs or symptoms
children ≥ 24 months old with unilateral or bilateral AOM without
severe signs or symptoms

72
Choice:
Amoxicillin 90mg/kg/days
Amoxicillin 45mg+amoxiclav 45mg

Clarithromycin 15 mg/kg twice per day

Alternatives: Cefuroxime, Cefdinir, Cefpodoxime
The patient or the parents are instructed to contact the general
practitioner if there is an abnormal clinical course:
 Increasing illness or earache/ decreased drinking.
 No improvement within 3 days.

73
 If the patient fails to respond to the initial management
option within 48-72 hours, clinician must reassess to confirm
AOM and exclude other causes of illness. If AOM is confirmed
in:
 Patient initially managed with observation, begin

antibacterial therapy.
 Patient initially managed with antibacterial agent, change

the agent.
 If treatment failed: tympanocentesis and culture may be

needed
 Clinician should encourage the prevention of otitis media

through decrease the risk factors.

74
 Croup

75
Croup:
 LaryngoTracheoBronchitis
 Caused by ParaInfluenza virus
 Age: 3 months – 5 years, peak 2 year
 More in male
 More in Winter

76
Clinical presentation:
 Some Rhinorrhea, mild cough, low grade fever,
 1-3 days then characteristic barking cough, hoarseness and
inspiratory stridor (70% obstruction)
 Worse at night, usually resolve in 1 week.

 Exam: hoarseness of the voice, mild tachypnea, child prefer

to sit upright, more symptoms with crying and agitation.
 ( seal-like )Barking cough is the hallmark of croup among
infants and young children, whereas hoarseness
predominates in older children and adults.

77
Diagnosis of Croup:
diagnosis is usually based on history, physical, and response
to treatment.
sudden onset of barking cough, hoarseness, and inspiratory
stridor in a child (especially if aged 6-36 months)
absence of atypical findings (for example, wheezing, drooling,
or toxic appearance)

improved respiratory symptoms after treatment with

corticosteroids, with or without nebulized epinephrine

78
Treatment of Croup:
Airway management is the priority:
 Use cool mist

 Steroids: IM dexamethasone or oral.

 or prednison oral for 3 days
 Epinephrine nebulizer- for children with severe croup

79
 Complications:
 respiratory distress
 Epiglottitis
 Bacterial trachetitis
 Prevention:
 Immunication for influenza and parainfluenza
virus.

80
 Epiglottitis

81
Epiglottitis:
Epiglottitis is inflammation of the tissue that covers the trachea
(windpipe). It is a life-threatening disease.
 Caused by H. Influenzae, S. pneumoniae, S. aureus

 Epiglottitis is now very uncommon, because the H. influenzae

type B vaccine is a routine childhood immunization.

82
Clinical Presentation:
Epiglottitis begins with a high fever and sore throat.
 Dyspnea, progressive upper airway obstruction in hours.

 On Exam: Toxic,ill looking, difficulty

swallowing, drooling, hyper extended neck
(tripod sign)
 Stridor is a late sign

• Complications: the airway may become

totally obstructed which could result in
death, empyema or epiglottic abscess

83
Diagnosis:
Clinical
 Large cherry red swollen epiglottis by

laryngoscope
 Lateral neck x-ray: thumb sign

(swollen epiglottis)

84
Treatment of Epiglottitis:
It is a Medical Emergency : establish airway by
intubation, rarely tracheotomy regardless of the
degree of obstruction.
 Antibiotics: broad-spectrum second- or third-

generation cephalosporins recommended, cefotaxime

most commonly used
 Corticosteroids to decrease the sweling of the
throat.
 Chemoprophylaxis of the family (Rifampicin).

85
 Laryngitis

86
 Is one of the most common conditions
identified in the larynx.
 An inflammation of the larynx, manifests in
both acute and chronic forms.
Acute : less than 3 weeks
Chronic : last more than 3 weeks
 Acute laryngitis has an abrupt onset and is
usually self-limited. If a patient has
symptoms of laryngitis for more than 3
weeks, the condition is classified as chronic
laryngitis. The etiology of acute laryngitis
includes vocal misuse, exposure to noxious
agents, or infectious agents leading to upper
respiratory tract infections. The infectious
agents are most often viral but sometimes
bacterial
87
Causes:
 Infection (usually viral upper respiratory tract
infection) Rhinoviruses
 Parainfluenza viruses
 Respiratory syncytial virus
 Adenoviruses
 Influenza viruses
 Measles virus
 Mumps virus
 Bordetella pertussis
 Varicella-zoster virus
 Gastroesophageal reflux disease
 Environmental insults (pollution)
 Vocal trauma88
 Use of asthma inhalers
 Generally associated with hoarseness or loss of voice.
 Symptoms: hoarseness of the voice
Fever
Swollen lymph nodes
 Patients with laryngitis may also experience odynophonia,
dysphagia, odynophagia, dyspnea, rhinorrhea, postnasal
discharge, sore throat, congestion, fatigue, and malaise.
 Complications: rarely respiratory distress
 Treatment: no role of antibiotics, symptomatic
treatment (pain killer, decongestant)

89
90