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Patients present to the emergency department with a number of eye, ear, nose, and throat (ENT) problems. This article updates some very common problems; identifies a few pearls on nasal foreign body removal, ophthalmologic medication, and epistaxis; and reviews a few pitfalls in identifying malignancies and sore throats.
Deep throat swabs are usually cultured for potential respiratory pathogens in patients with cystic fibrosis (CF) who do not produce sputum. Using alginate swabs, three methods were examined in the present study: (i) semiquantitative processing (direct plating); (ii) mere elution of swabs in Ringer's lactate followed by plating of the eluate; and (iii) complete quantitative processing (elution plus two-step dilution series). Throat swabs from 56 CF patients yielded 122 isolates of potential respiratory pathogens. Semiquantitative processing (n = 101 isolates) was not significantly inferior to elution (n = 104) and quantitative processing (n = 113; p > 0.05). Since semiquantitative processing is the simplest method, it is to be preferred, provided that alginate swabs are used.
Acute rheumatic fever (ARF) remains a major problem in tropical regions, resource-poor countries, and minority indigenous communities. It has long been thought that group A streptococcal (GAS) pharyngitis alone was responsible for acute rheumatic fever; this belief has been supported by laboratory and epidemiological evidence gathered over more than 60 years, mainly in temperate climates where GAS skin infection is uncommon. GAS strains have been characterised as either rheumatogenic or nephritogenic based on phenotypic and genotypic properties. Primary prevention strategies and vaccine development have long been based on these concepts. The epidemiology of ARF in Aboriginal communities of central and northern Australia challenges this view with reported rates of ARF and rheumatic heart disease (RHD) that are among the highest in the world. GAS throat colonisation is uncommon, however, and symptomatic GAS pharyngitis is rare; pyoderma is the major manifestation of GAS infection. Typical rheumatogenic strains do not occur. Moreover, group C and G streptococci have been shown to exchange key virulence determinants with GAS and are more commonly isolated from the throats of Aboriginal children. We suggest that GAS pyoderma and/or non-GAS infections are driving forces behind ARF in these communities and other high-incidence settings. The question needs to be resolved as a matter of urgency because current approaches to controlling ARF/RHD in Aboriginal communities have clearly been ineffective. New understanding of the pathogenesis of ARF would have an immediate effect on primary prevention strategies and vaccine development.
An outbreak of streptococcal throat infection which took place in a preparatory school for boys (some of whom were choristers) over three terms from November 1983 to June 1984 is described. Typing of the organism revealed that four successive outbreaks, each due to a different type, had occurred. Thirty-nine per cent of the boys were affected, the incidence of infection being higher among boarders than day boys. Infection seemed to spread via the forms, dormitories and choir. Recurrent attacks occurred in 32% of infected boys. The complication rate was 8%. Treatment with penicillin was always effective but did not prevent reinfection. Suggestions for the management of an outbreak of sore throat in a school are given.
The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles.
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent. We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms. Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
The incidence of beta-haemolytic non-Group A streptococci (BHNAS) in the throats of a paediatric population was examined over a 1-year period. There was minimal seasonal fluctuation of Lancefield groups including species and biotypes within Groups C and G streptococci. A trend of increasing incidence with age of Streptococcus anginosus ('Streptococcus milleri') (possessing Groups C and G Lancefield antigens) was evident. A clinical impression of streptococcal pharyngitis was more common in patients with large-colony Groups C or G streptococci isolated from their throats compared with those patients where other BHNAS were isolated. This study is requisite to the planning of case control studies which are required to test the association of BHNAS (especially Groups C and G subgroups) and pharyngitis.
A high-performance liquid chromatography (HPLC) method was developed to quantitatively analyze oleocanthal in extra virgin olive oils. Oleocanthal, a deacetoxy ligstroside aglycone, is known to be responsible for the back of the throat irritation of olive oils and to have probated antiinflamatory activity. Oleocanthal was isolated from small amounts of olive oil sample (1 g) by liquid-liquid extraction. Hexane-acetonitrile was found to be the best solvent system to extract oleocanthal from the oil matrix. The solvent extract was analyzed by reversed-phase HPLC with UV detection at 278 nm. Chromatogaphic separation of oleocanthal from other extracted compounds and of the two geometric isomers of oleocanthal was achieved by an elution gradient with acetonitrile and water. Both the external standard calibration curve and the internal standard calibration curve were established, and quantitation using both calibration curves gave essentially the same result. The reproducibility (RSD = 4.7%), recovery (> 95%), and limit of quantitation (< 1 microg/g) were also determined. Concentrations of oleacanthal in 10 selected throat-burning extra virgin olive oils were determined using the method (ranged from 22 to 190 microg/g) with external standard calibration.
BACKGROUND: Haemophilus influenzae is the major cause of otitis media and lower respiratory tract infection in childhood. In the presence of human milk, which contains numerous host defense factors, Haemophilus influenzae may be inhibited in attaching to and colonizing pharyngeal cells. We investigated the incidence of H. influenzae in the throats of 162 healthy infants with different feeding methods: 70 breast-fed, 49 mixed-fed and 43 formula-fed infants. METHODS AND RESULTS: Haemophilus influenzae was identified using standard microbiological procedures and the API NH system. The incidence of H. influenzae in breast-fed infants, mixed-fed infants and formula-fed infants was 0, 0 and 7.0% respectively. CONCLUSION: The results suggest that the colonization of H. influenzae in the throat was inhibited by the presence of breast milk.
OBJECTIVE: To study the emergence of macrolide resistance in throat flora following treatment with clarithromycin or azithromycin. METHODS: Throat samples were collected before and after treatment and plated as a lawn on Columbia blood agar with an erythromycin E test strip. Minimum inhibitory concentrations (MICs) of erythromycin, clarithromycin and azithromycin were determined against isolates of distinct morphology with erythromycin E test MIC results equal to or greater than 2 mg/L. Polymerase chain reaction techniques were used to determine the genetic mechanisms of resistance. RESULTS: There were 749 resistant isolates of which 474 (63%) were streptococci. Only a quarter of the patients had no resistant streptococci before treatment started. There were increases in the numbers of resistant isolates and in the number of patients carrying a resistant flora during and after treatment. The most common genes identified were mefA/E in isolates with low-level resistance and ermA/M in isolates with high-level resistance. CONCLUSIONS: There is a pool of streptococci carrying genes associated with macrolide resistance in the normal respiratory flora of generally healthy adults. Differences between the patients treated with clarithromycin and those treated with azithromycin were difficult to assess because of the large number of patients in each group with macrolide-resistant streptococci before treatment. Although there were some differences these were not statistically significant.
BACKGROUND: Icelandic Moss (Cetraria islandica) has been used to treat inflammation and dryness of the pharyngeal mucosa in the naturopathy for many years. It contains substances with protective and antiinflammatory effects for the oral mucosa. The necessary concentration of Icelandic Moss and its therapeutic effectiveness were analysed in this clinical study. METHODS: Sixty-one patients who recently underwent surgery of nasal septum were evaluated for this randomized study. These patients suffer especially from dryness and inflammation of the oral cavity due to breathing only through the mouth while the nose is permanently closed by a nasal package. Three groups of patients treated with three different concentrations of the active substance were compared, Coating, dryness, and inflammation of the mucosa, lymph nodes, tongue, the tolerance of the drug, and symptoms like hoarseness and sore throat were documented. The oral application was performed from the first to the fifth day after the operation. RESULTS: The treatment with Icelandic Moss caused a direct reduction of the observed pathological changes. There were no significant differences between the three test groups. A dose of 0.48 g per day (10 Isla-Moos lozenges per day) is a sufficient treatment. CONCLUSIONS: Icelandic Moss is an advisable therapeutic opportunity without interactions and side effects for the treatment of inflammation of the oral mucosa occurring after nasal surgery, after intubation, and for simple infections of the throat.
A few minutes after sucking a lozenge for a sore throat a 68-year-old man developed an anaphylactic shock. At a heart rate of 110/min there was no palpable blood pressure. A red confluent exanthem, predominantly of the trunk, was noted. After brief intensive-care treatment the patient was completely well again and diagnostic tests for allergy were performed. The prick test for the 14 individual ingredients of the throat lozenge produced massive reddening and urticaria on the test arm with carbowax, a polyethylene glycol which serves as a vehicle in the remedy and does not have to be listed. Later there were an urge to cough and urticaria all over the trunk. There was no systemic reaction. Neither specific IgE antibodies nor any complement-consuming reaction could be demonstrated. Thus the precipitating mechanism remains unexplained.
We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.
OBJECTIVE: To evaluate the preventive effect of buttermilk, Yakult Light fermented milk drink and N-acetylcysteine on biofilm formation on voice prostheses in vitro. MATERIAL AND METHODS: Groningen button and Provox 2 voice prostheses were inoculated with a mixture of bacteria and yeasts isolated from previously explanted Groningen button voice prostheses. After 5 h, separate throats were flushed with buttermilk, Yakult Light fermented milk drink, N-acetylcysteine or phosphate-buffered saline, which served as a control. After 7 days, the microflora on each voice prosthesis was determined. RESULTS: On Groningen button voice prostheses, buttermilk, Yakult Light fermented milk drink and N-acetylcysteine all reduced the amount of both bacteria and yeasts. On Provox 2 voice prostheses, buttermilk, Yakult Light fermented milk drink and N-acetylcysteine reduced the amount of bacteria but, conversely, increased the amount of yeasts. CONCLUSION: These in vitro experiments demonstrate that biofilm formation on voice prostheses is reduced in an artificial throat by the use of buttermilk, Yakult Light fermented milk drink and N-acetylcysteine. However, the structural differences between the type of voice prostheses may influence the ultimate effects.
PURPOSE: The causes of the feeling of a lump in the throat (globus pharyngeus) are disputed. The symptoms are persistent and may lead clients to change their diet and suffer a reduced quality of life. Coexisting swallowing difficulties are often reported but no neurological or structural abnormality can be found. Psychological factors are likely to play a part in the condition and an eclectic approach to therapy appears to be warranted. This paper reports on a treatment programme that includes education, reassurance and the use of exercises. METHOD: Fourteen clients participated. Their progress was assessed using the Glasgow and Edinburgh Throat Scale (GETS). A baseline period was used to assess the stability of their symptoms prior to therapy. This was followed by a group therapy session, use of the exercises and a further reassessment. Videofluoroscopy was conducted before and after therapy. RESULTS: Clients score on the GETS improved. However, change was seen both during the baseline and the treatment making it unclear which aspects of the treatment were effective. Improvement during the baseline suggests that clients benefit from attention and reassurance. It is unclear, therefore, whether the therapy session and the exercises provide a specific benefit or a general benefit due to continued attention. The clients' videofluoroscopies were unchanged after therapy. The presence of residue after the swallow in the valleculae and the pyriform sinuses may contribute to the symptoms of globus. CONCLUSION: The treatment is economical and appears to benefit clients. However, further research is needed to distinguish whether it has a specific effect or whether clients benefit from general attention and reassurance.
'Open throat' is a term regularly used in the singing studio, but agreement across pedagogues as to its definition and function has not yet been assessed. Fifteen expert singing pedagogues participated in a qualitative study involving a semi-structured interview to explore current thinking regarding terminology, pedagogy, sound quality and the perceived physiology to achieve open throat, as used in the singing studio. Most teachers included the use of the technique as a fundamental in singing training, and were positive about the sound quality it achieved, especially in classical singing. The purpose of the technique was described as a way of maximizing pharyngeal space and/or achieving abduction of the ventricular folds.
Previous reports have indicated a wide variation in observed sensitivity of antigen-detection kits for group A streptococci. Before undertaking an evaluation of these new kits, the sensitivity of the throat culture technic routinely used by this laboratory was reexamined. Each throat swab was directly inoculated to sheep blood agar containing trimethoprim-sulfamethoxazole (SXT X BA) and drug-free sheep blood agar (SBA) plates. Swabs were then washed in saline and the saline used to inoculate one more of each type of medium. SXT X BA cultures were incubated aerobically (5 to 10% CO2), and SBA cultures were incubated anaerobically, both for two days at 35 degrees C. From 726 patients, 164 (22.6%) of the specimens contained group A streptococci, 99% detected on directly inoculated cultures and 100% on cultures inoculated with the saline wash. Either an aerobically (CO2) incubated SXT X BA or an anaerobically incubated SBA, directly inoculated and held for two days, appears to offer a satisfactory reference culture method for the recovery of group A streptococci.
A latex agglutination test (Marion Laboratories) was compared with standard culture methods for the detection of Group A streptococci in two studies of 500 throat swabs each. Swabs were first inoculated to sheep blood agar and then tested for Group A streptococcal antigen. The direct test performed with nearly identical sensitivity and specificity in the two phases of the study. Overall, Group A streptococci were isolated from 91 specimens, and 81 (89%) of these were detected by the direct latex test. The predictive value positive for the latex test was 90%, and the accuracy was 98%. The sensitivity of the latex test for detection of specimens having ten or more colonies of Group A streptococci was 95%. Non-Group A beta-hemolytic streptococci were isolated from 65 specimens, and all of these specimens had negative latex tests. The authors' findings suggest that this direct latex agglutination test is a reliable screening method for rapid detection of Group A streptococci in outpatient throat specimens.