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UPPER RESPIRATORY TRACT DISEASE

Pooja Mehta

Family Physician, Vakola, Mumbai 400 055.

Commonest presentations in family practice - cough, cold, fever, dysphagia, dyspnoea etc - are generally grouped under URTI. Even though treatment is almost the same, we have to be sure of the exact diagnosis to foresee complications and prevent spread to adjoining tissue. For example a cold turning to otitis media. A ready reckoner is provided and reader is welcome to add his/ her own observations.

1. Acute allergic rhinitis

2. Acute infective rhinitis

3. Acute pharyngitis

4. Acute tonsillitis

5. Chronic tonsillitis

6. Follicular tonsillitis

7. Sinusitis

8. Adenoids

Acute Allergic Rhinitis

- Sneezing, watery coryza, redness of eyes

- Past and/ or family h/o allergies

- Precipitation from change of weather, food items like chocolate, mint, preservative,   essence etc

- Clinical course recurrent /short lasting

- May become infective course later on

- Examination - generally NAD

Acute Infective Rhinitis

- Recurrent cold /cough

- Coryza thick white/yellow/green

- May have febrile episodes also

- Examination - generally NAD

Acute Pharyngitis

- Presentation may be just refusal to eat, dysphagia or only fever and URTI symptoms.

- It is mandatory to properly examine the throat of the child, may be by tongue depressor if the child is uncooperative or very small.

- O/E : Throat - congested

Acute Tonsillitis

- Over diagnosed in paediatric practice. Commonest diagnosis offered

- Incidences - In busy paediatric practice of 50 -70 patients /day 1 case of tonsillitis/year.

- Presentation similar as acute pharyngitis

- O/E - throat - cherry red tonsils

Chronic Tonsillitis

- H/O recurrent acute episodes

- Symptoms : difficulty in swallowing/breathing if tonsillar size has increased where virtually both tonsils touch each other - KISSING TONSILS

- O/E Tonsils - enlarged (normally also in children tonsillar size is enlarged which regress after puberty

- Jugulo digastric lymph nodes - enlarged, tender

Follicular Tonsillitis

more severe

- O/E - Tonsils - Follicles seen

- cervical lymph nodes - enlarged tender

- Here before coming to diagnosis, DD of "Infectious Mononucleosis" should be borne in mind

                          

 Follicular tonsillitis   
  Neck glands
                          
Infectious Mononucleosis
   Heptatomegaly 
   Splenomegaly
Skin rash
                                              

Sinusitis

- Sinus development

Frontal - 7 yrs

Maxillary - 18 mths

Ethmoid - At birth

Sinusitis should be suspected if

a) "cold" seems more severe than usual (high fever, periorbital oedema, facial pain)

b) "cold" lingers for more than 10 days

- Headaches, facial pain, tenderness, oedema are common

- Cough is the main presentation

- Postnasal discharge is diagnostic and result in a sore throat or pertussoid cough    especially at night or early morning.

- Chronic sinusitis (due to polyp, nasal deformities, infected and hypertrophied    adenoids) may lead to a picture of bronchitis known as "sinobronchitis"

- Course of lingering sinusitis 2-3 weeks

Adenoids

- Breathing through mouth, drooling and backward scholastic performance are usual presentations

- Less common in routine practice

- "ADENOID FACIES" is diagnostic

- Protruding teeth

- Drooling

- Pointed small underdeveloped nose

- Open mouth

- And other features



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