Sore Throat In Children Research Articles

Comparação entre dois dispositivos supraglóticos de vias aéreas na dor de garganta pós‐operatória em crianças: estudo controlado prospectivo randomizado

Background and objectiveSore throat is well recognized complaint after receiving general anesthesia. This study is conducted to compare the severity and frequency of postoperative sore throat in children undergoing elective surgery – following the use of Ambu laryngeal mask airway) or I‐gel® – who are able to self‐report postoperative sore throat. MethodSeventy children, 6 to 16 years‐old, undergoing elective surgery randomly allocated to either Ambu laryngeal mask (Ambu Group) or I‐gel® (I‐gel Group). After the procedure, patients were interviewed in the recovery room immediately, after one hour, 6 and 24 hours postoperatively by an independent observer blinded to the device used intra‐operatively. ResultsOn arrival in the recovery room 17.1% (n=6) of children of the Ambu Group complained of postoperative sore throat, against 5.7% in I‐gel Group (n=2). After one hour, the results were similar. After 6 hours, postoperative sore throat was found in 8.6% (n=3) of the children in Ambu group vs. 2.9% (n=1) in I‐gel Group. After 24hours, 2.9% (n=1) of the kids in Ambu Group compared to none in I‐gel Group. There was no significant difference found in the incidence of postoperative sore throat in both devices on arrival (p=0.28); after 1 hour (p=0.28); after 6 hours (p=0.30); and after 24 hours (p=0.31). The duration of the insertion was shorter in Ambu Group and it was easier to insert the I‐gel® (p=0.029). Oropharyngeal seal pressure of I‐gel® was higher than that of Ambu laryngeal mask (p=0.001). ConclusionThe severity and frequency of postoperative sore throat in children is not statistically significant in the I‐gel Group compared to Ambu Group.

Group C beta hemolytic Streptococci as a potential pathogen in patients presenting with an uncomplicated acute sore throat – a systematic literature review and meta-analysis

Objective: The pathogenicity of beta-hemolytic Streptococcus group C (GCS) in patients attending for an uncomplicated acute sore throat is unknown and it was the objective to clarify this.Design: Systematic literature review with meta-analysis. Setting Medline and Scopus were searched from inception to February 2019, with searches of reference lists, Subjects case-control studies stating prevalence of GCS in patients as well as healthy controls presented for children and adults separately. Studies including patients already treated with antibiotics and studies focused on patients with HIV, malignancy or immunosuppression were not included. Main outcome measures Pooled prevalence of GCS was compared between patients and controls using chi-square and was further explored by calculating the positive etiologic predictive value (P-EPV) showing the post-test probability of a link between a sore throat and the bacterial finding. P-EPV for GCS was compared with that for group A Streptococci (GAS) using figures from the same publications and patients.Results: Eleven studies were included. The prevalence of GCS among patients versus controls was similar in children (3.15 versus 2.87%, p = .44) but for adults higher in patients (11%) than in controls (5.6%) (p < .0001). The P-EPV for finding GCS in children with a sore throat was 9.3% (0.0–41%). The corresponding P-EPV for GCS in adults with a sore throat was 53% (36–67%) while the corresponding P-EPV for GAS in adults was 94% (90–96%).Conclusions: GCS do not seem associated with the uncomplicated acute sore throat in children but there is support for an association in adults being weaker than for GAS. A possible consequence is to ignore GCS in otherwise healthy patients at their first visit for an uncomplicated sore throat. This would enable a stronger focus on the use of modern point of care tests (POCTs) to detect GAS.Key pointsThere is no current consensus on the pathogenicity of group C beta-hemolytic Streptococcus (GCS) in patients attending for an uncomplicated acute sore throat.This systematic literature review concludes it is unlikely that GCS is involved in the uncomplicated sore throat in otherwise healthy children.This meta-analysis found a moderate link between GCS and the uncomplicated sore throat in adults.The link in adults between GCS and the sore throat is much weaker than the corresponding link for group A beta-hemolytic Streptococcus.

Качество распыления – предиктор эффективности лекарственных препаратов в форме спреев для купирования боли в горле у детей

Качество распыления – предиктор эффективности лекарственных препаратов в форме спреев для купирования боли в горле у детей

A prospective observational cohort study on the incidence of postoperative sore throat in the pediatric population.

Postoperative sore throat is common after general anesthesia. The incidence in pediatric anesthesia is variable, and the etiology unclear. Establishing risk factors would enable prevention and could improve quality of care. We performed a prospective single-center cohort study aiming to establish the incidence of postoperative sore throat in children undergoing GA with an endotracheal tube or laryngeal mask airway. Secondary aims were to identify independent risk factors for sore throat and the incidence of other postoperative complications including stridor, laryngospasm, nausea and vomiting, and delayed oral intake. Between November 2017 and April 2018, perioperative data were collected from children aged 5-16years undergoing general, plastic, urology, renal, and orthopedic surgery. Patients completed a postoperative questionnaire within 24hours of surgery. We screened 334 children for inclusion at a tertiary pediatric hospital in the United Kingdom. One hundred and ninety-seven patients were included in the final analysis. The frequency of postoperative sore throat was 36.5%. Stridor occurred in 1.5%, laryngospasm 1.0%, postoperative nausea 59.4%, vomiting in recovery 4.6%, and delayed oral intake due to postoperative sore throat 30%. Nausea, vomiting, thirst, and pain were associated with a sore throat. Univariate analysis showed anesthesia longer than 2hours, and use of an endotracheal tube was statistically associated with higher risk of sore throat. Over 50% of children with an endotracheal tube cuff pressure <20cmH2 O had a postoperative sore throat. Postoperative sore throat is common in children. Endotracheal intubation is associated with a greater incidence than laryngeal mask airway use. A high rate of postoperative sore throat in children with endotracheal tube cuff pressures within the recommended range suggests multifactorial etiology. To confirm validity of the identified risk factors, we would recommend a larger prospective multi-center study.

Acute Otitis Media and Group A Streptococcal Pharyngitis: A Review for the General Pediatric Practitioner.

For pediatric practitioners, acute otitis media (AOM) and group A streptococcal pharyngitis are two of the most common infections seen in ambulatory practices. The purpose of this article is to review these conditions with the focus of highlighting evidence-based guidelines. AOM in children is a visual diagnosis and not one that can be made on history alone. The American Academy of Pediatrics (AAP) guidelines have clear criteria to aid clinicians in how to diagnose AOM. The pneumatic otoscope is the standard tool used to diagnose otitis media, and the AAP guidelines stress developing proficiency in distinguishing a normal tympanic membrane from otitis media with effusion or AOM. There are several components to appropriate management (treatment) of AOM including analgesia, education, antibiotics, and the option (for some) for observation. Group A streptococcal pharyngitis is the most common bacterial cause of sore throat in children but still only accounts for a minority of cases. History and physical examination help determine who should be tested. Testing is required to determine who to treat. Up to 15% of children in the United States are carriers, so indiscriminate testing can lead to inappropriate antibiotic use. If a patient's test is positive, treatment is recommended and penicillin or amoxicillin are appropriate for most cases. [Pediatr Ann. 2019;48(9):e343-e348.].

Вопросы выбора медикаментозной терапии при боли в горле у детей

Вопросы выбора медикаментозной терапии при боли в горле у детей

A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses.

1. Risa E. Bochner, MD* 2. Mona Gangar, MD*,† 3. Peter F. Belamarich, MD* 1. *Department of Pediatrics, Children’s Hospital at Montefiore, Bronx, NY 2. †Department of Otorhinolaryngology/Head and Neck Surgery, Division of Pediatric Otorhinolaryngology, Albert Einstein College of Medicine, Bronx, NY * Abbreviations: ALPS: : Autoimmune lymphoproliferative syndrome ARF: : Acute rheumatic fever CMV: : Cytomegalovirus CT: : Computed tomography EBV: : Epstein-Barr virus GAS: : Group A Streptococcus HIV: : Human immunodeficiency virus NSAIDs: : Nonsteroidal anti-inflammatory drugs OSA: : Obstructive sleep apnea PFAPA: : Periodic fever, apthous stomatitis, pharyngitis, and adenitis PSGN: : Poststreptococcal glomerulonephritis PTA: : Peritonsillar abscess RADT: : Rapid antigen detection test SDB: : Sleep-disordered breathing T&A: : Tonsillectomy and adenoidectomy Despite established guidelines for group A Streptococcus pharyngitis diagnosis and treatment, pediatricians are overtreating and mistreating sore throat in children. (1) This results in unnecessary antibiotic use and contributes to antimicrobial resistance, increased health care costs, and risk for adverse drug reactions. In addition, controversy exists among pediatricians regarding the indications for tonsillectomy and adenoidectomy in children. After completing this article, readers should be able to: 1. Describe the clinical presentation, differential diagnosis, diagnostic evaluation, and management of tonsillitis/pharyngitis in pediatric patients. 2. Describe the clinical presentation, diagnostic evaluation, and management of peritonsillar abscess in pediatric patients. 3. Describe the clinical presentation, diagnostic evaluation, and management of retropharyngeal abscess in pediatric patients. 4. Describe the indications for tonsillectomy and adenoidectomy in pediatric patients and associated complications. ### Epidemiology Sore throat is a common complaint in children and adolescents. Most cases of pharyngitis are viral and self-limited. Group A Streptococcus (GAS) pharyngitis is the only commonly occurring infectious pharyngitis in which antimicrobial treatment is indicated. Treatment of GAS decreases the risk of acute rheumatic fever (ARF), suppurative complications and transmission of disease, and provides symptomatic relief. GAS pharyngitis accounts for 20%-30% of office visits for sore throats in children. (2) Infection typically occurs in school-age children and adolescents, and is uncommon in children younger than 3 years. GAS pharyngitis occurs most commonly in the winter and early spring months …

Pediatrician’s approaches to the treatment of acute tonsillopharyngitis in children

Sore throat is one of the most common complaints with which patients seek the aid of pediatricians. Acute tonsillopharyngitis is a frequent cause of sore throat in children. In a majority of cases, the disease has viral etiology, and less frequently bacterial. Acute tonsillopharyngitis in children is often associated with irrational prescribing of antibacterial agents. Antibiotics are only indicated for tonsillopharyngitis caused by group A beta-hemolytic streptococcal infection. In order to choose rational therapy for acute tonsillopharyngitis, pediatrician should perform differential diagnosis, guess the etiology of the disease based on the clinical pattern using the McIsaac score, and, if possible, quick tests for identification of group A beta-hemolytic streptococcus. In the treatment of acute tonsillopharyngitis in children, regardless of the etiology, the doctor should be guided by a compre???hensive approach including the use of drugs with a local antimicrobial effect.

The effectiveness of the McIsaac clinical decision rule in the management of sore throat: an evaluation from a pediatrics ward.

Sore throats may be due to either viral or group A beta hemolytic streptococcus (GABHS) infections; but diagnosis of the etiology of a sore throat is difficult, often leading to unnecessary antibiotic prescriptions and consequent increases in bacterial resistance. Scoring symptoms using the McIsaac clinical decision rule can help physicians to diagnose and manage streptococcal infections leading to sore throat and have been recommended by the Ministry of Health, Malaysia. In this paper, we offer the first assessment of the effectiveness of the McIsaac rule in a clinical setting in Malaysia. This study is a retrospective review of 116 pediatric patients presenting with sore throat. Group A comprised patients before the implementation of the McIsaac rule and Group B comprised patients after the implementation. Unnecessary throat swab cultures were reduced by 40% (P = 0.003). Redundant antibiotic prescriptions were reduced by 26.5% (P = 0.003) and the overall use of antibiotics was reduced by 22.1% (P = 0.003). The pediatricians' compliance rate to McIsaac rule criteria was 45% before implementation of the McIsaac rule, but improved to 67.9% (P = 0.0005) after implementation. The McIsaac rule is an effective tool for the management of sore throat in children in Malaysia.

Postoperative sore throat: a systematic review.

Postoperative sore throat has a reported incidence of up to 62% following general anaesthesia. In adults undergoing tracheal intubation, female sex, younger age, pre-existing lung disease, prolonged duration of anaesthesia and the presence of a blood-stained tracheal tube on extubation are associated with the greatest risk. Tracheal intubation without neuromuscular blockade, use of double-lumen tubes, as well as high tracheal tube cuff pressures may also increase the risk of postoperative sore throat. The expertise of the anaesthetist performing tracheal intubation appears to have no influence on the incidence in adults, although it may in children. In adults, the i-gel(™) supraglottic airway device results in a lower incidence of postoperative sore throat. Cuffed supraglottic airway devices should be inflated sufficiently to obtain an adequate seal and intracuff pressure should be monitored. Children with respiratory tract disease are at increased risk. The use of supraglottic airway devices, oral, rather than nasal, tracheal intubation and cuffed, rather than uncuffed, tracheal tubes have benefit in reducing the incidence of postoperative sore throat in children. Limiting both tracheal tube and supraglottic airway device cuff pressure may also reduce the incidence.

Acute sore throat in children at the emergency department: best medical practice?

Belgian antibiotic (AB) policy guidelines discourage the use of ABs in sore throat in otherwise healthy individuals; yet, 35% of all children with sore throat in our pediatric emergency department receive a prescription for ABs. To identify factors influencing our physician's prescription behavior. Using a retrospective study, we analyzed all medical records of children younger than 16 years of age diagnosed with sore throat (in 2009 and 2010). We included 1345 files. Children younger than 5 years of age received an AB prescription more easily (37.8 vs. 27.7%; P=0.0007). Children of White origin received less frequent ABs compared with non-Whites (31.6 vs. 37.8%; P=0.02). More ABs were prescribed during night shifts (38.7 vs. 31.8%; P=0.008). Physicians with a Belgian degree prescribed less frequently compared with those with a Dutch degree (23.4 vs. 46.4%; P<0.0001). We find several 'practical' factors to have an influence on the AB prescription rate.

Tonsillectomy or adenotonsillectomy reduces the number of sore throats in children; however, insufficient information is available on the effectiveness in adults

Tonsillectomy or adenotonsillectomy reduces the number of sore throats in children; however, insufficient information is available on the effectiveness in adults

Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.

Surgical removal of the tonsils, with or without adenoidectomy (adeno-/tonsillectomy), is a common ENT operation but the indications for surgery are controversial.To determine the effects of tonsillectomy, with and without adenoidectomy, in patients with chronic/recurrent acute tonsillitis.The Cochrane Ear, Nose and Throat Disorders Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2008, issue 2), MEDLINE (1966 to 2008), EMBASE (1974 to 2008), bibliographies, and additional sources were searched for published and unpublished trials. The date of the last search was 11 April 2008.Randomised controlled trials comparing tonsillectomy, with or without adenoidectomy, with non-surgical treatment in adults and children with chronic/recurrent acute tonsillitis. We included trials which used reduction in the number and severity of tonsillitis and sore throat as main outcome measures.Two authors applied the inclusion/exclusion criteria independently.This review includes five studies: four undertaken in children (719 participants) and one in adults (70 participants). Good information about the effects of tonsillectomy is only available for children and for effects in the first year following surgery.Children were divided into two subgroups: those who are severely affected (based on specific criteria which are often referred to as the 'Paradise criteria') and those less severely affected.For more severely affected children adeno-/tonsillectomy will avoid three unpredictable episodes of any type of sore throat, including one episode of moderate or severe sore throat in the next year. The cost of this is a predictable episode of pain in the immediate postoperative period.Less severely affected children may never have had another severe sore throat anyway and the chance of them so doing is modestly reduced by adeno-/tonsillectomy. For them, surgery will mean having an average of two rather than three unpredictable episodes of any type of sore throat. The cost of this reduction is one inevitable and predictable episode of postoperative pain. The 'average' patient will have 17 rather than 22 sore throat days but some of these 17 days (between five and seven) will be in the immediate postoperative period. Whilst the concept of the 'average' patient is attractive, in practice, wide variability is likely.One reason why the impact of surgery is so modest, is that many untreated patients get better spontaneously. There is a trade-off for the physician and patient who must weigh up a number of different uncertainties: what proportion of my throat symptoms are attributable to my tonsils, and will I get better without any treatment? Similarly, the potential 'benefit' of surgery must be weighed against the risks of the procedure.Adeno-/tonsillectomy is effective in reducing the number of episodes of sore throat and days with sore throats in children, the gain being more marked in those most severely affected. The size of the effect is modest, but there may be a benefit to knowing the precise timing of one episode of pain lasting several days - it occurs immediately after surgery as a direct consequence of it.It is clear that some children get better without any surgery, and that whilst removing the tonsils will always prevent 'tonsillitis', the impact of the procedure on 'sore throats' due to pharyngitis is much less predictable.

The role of tonsillectomy for recurrent sore throats in children: A qualitative study

IntroductionDecisions regarding tonsillectomy for children with recurrent sore throats are mainly based on guidelines that take the number of sore throat episodes into consideration. Anecdotally, parents report a number of additional factors that change after the operation. With this in mind, the first follow up tonsillectomy qualitative study was undertaken to identify what the operation truly offers this group of children. Materials and methodsTen families were interviewed between 3 and 14 months after their child's operation. A narrative method was utilised. Interviews with families were transcribed and analysed to identify key themes that had changed due to the operation. ResultsThemes identified included an improvement in general and specific symptoms. Psychosocial aspects such as education, socialising, family consequences and psychological consequences were also important factors that families noticed. ConclusionTonsillectomy has much more to offer families and children than an improvement in the numbers of episodes of sore throats and this study could form the basis of a specific quality of life assessment tool.

Дифференцированный подход к антибактериальной терапии острых тонзиллофарингитов у детей

Рассмотрен дифференцированный этиотропный подход к назначению антибиотиков при ангине у детей: при остром тонзиллофарингите стрептококковой этиологии препаратами выбора являются аминопенициллины, при аллергии или резистентности к ним, а также в случаях определения внутриклеточных патогенов — Chlamydophila pneumoniae или Mycoplasma pneumoniae показано назначение макролидов.

Tonsillectomy for Recurrent Sore Throats in Children: Indications, Outcomes, and Efficacy

To perform a comprehensive narrative review of the literature to provide a better understanding of the indications, outcomes, and efficacy of tonsillectomy for recurrent sore throats in children. This article explores the reasons why there is a lack of robust clinical evidence for its efficacy despite good evidence of positive reported outcomes from parents of children who undergo the procedure. Articles published between 1960 and July 2013 were searched in PubMed and Cochrane databases. A narrative review method was adopted to provide a comprehensive overview of articles. Only individual, interventional studies on children (0-16 years old) undergoing tonsillectomy or adenotonsillectomy for recurrent sore throats with greater than 1 month of follow-up were included. The inclusion criteria and outcome measures in the studies were varied, but most investigated changes in symptoms related to sore throats or illness episodes. Quality-of-life tools validated for measuring pediatric outcomes were used in a number of more recent studies. None of the outcome measures were specific for recurrent sore throats in children. No qualitative method designed studies were identified. The disparity between parental satisfaction rates and published clinical efficacy can be explained by a lack of parent/child outcome measures specific to tonsillectomy for recurrent sore throats. A more parent/child-centered approach may establish what tonsillectomy could offer this group of children.

Association of CYP2C19 Polymorphisms and Lansoprazole-Associated Respiratory Adverse Effects in Children

To determine whether cytochrome P450 (CYP)2C19 haplotype associates with lansoprazole-associated adverse event frequency. Respiratory adverse events from a clinical trial of lansoprazole in children with asthma were analyzed for associations with extensive or poor metabolizer (PM) phenotype based on CYP2C19 haplotypes. Carriers of CYP2C19*2, *3, *8, or *9 alleles were PMs; carriers of 2 wild-type alleles were extensive metabolizers (EMs). Plasma concentrations of lansoprazole were determined in PM and EM phenotypes. The frequency of upper respiratory infection among PMs (n = 45) was higher than that among EMs (n = 91), which in turn was higher than that in placebo subjects (n = 135; P = .0039). The frequency of sore throat (ST) was similarly distributed among EMs and PMs (P = .0015). The OR (95% CI) for upper respiratory infections in PMs was 2.46 (1.02-5.96) (P = .046); for EMs, the OR (95% CI) was 1.55 (0.86-2.79). The OR (95% CI) for ST in EMs and PMs was 2.94 (1.23-7.05, P = .016) vs 1.97 (1.09-3.55, P = .024), respectively. Mean ± SD plasma concentrations of lansoprazole were higher in PMs than in EMs: 207 ± 179 ng/mL vs 132 ± 141 ng/mL (P = .04). Lansoprazole-associated upper respiratory infections and ST in children are related in part to CYP2C19 haplotype. Our data suggest that lansoprazole-associated adverse events in children may be mitigated by adjusting the conventional dose in PMs. Additional studies are required to replicate our findings.

MODERN ASPECTS OF ACUTE RESPIRATORY DISEASES TREATMENT IN CHILDREN: TOPICAL DRUGS IN RHINOPHARYNGITIS

The issues of acute respiratory diseases treatment in children, including the most common mistakes in management of such patients, unreasonable from the etiopathogenic point of view treatment with systemic antibacterial drugs and advantages of the topical therapy in arresting of the inflammatory process (in particular, of certain medical agents with topical effect) are discussed in this article. The authors review the most common otorhinolaryngological lesions in acute respiratory diseases. The problems of appropriate anaesthetic therapy and differentiated approach to the evaluation of sore throat in children of different age groups are emphasized.

CHOOSING OF THE OPTIMAL LOCAL MEDICINE FOR THE TREATMENT OF PHARYNGITIS IN CHILDREN

The cause of the sore throat in children is acute pharyngitis. The etiology and pathogenesis of this disease is discussed in the article. The authors explain the optimization of treatment with such topic drugs with anaesthetic and antibacterial actions as Strepsils in children with diseases associated with sore throat.

Caring for a Difficult Patient with Sore Throat

AbstractThis Dr Cochrane clinical vignette is based on upon an Overview of Cochrane Reviews that was published in a previous issue of Evidence‐Based Child Health: Foisy M, Martin B, Domino F, Becker, L A. The Cochrane Library and the Treatment of Sore Throat in Children and Adolescents: An Overview of Reviews. Evid‐Based Child Health 2011, 6: 6(3): 810–823; and inspired by: Marcy SM. When a parent insists on antibiotics for a virus. Am Fam Physician 1999; 59(3): 687–688.Dr Cochrane is a unique self‐learning experience—the integration of Cochrane evidence with a quirky fictional story and multiple‐choice questions provides readers with the opportunity to explore and understand the applicability of a Cochrane Review or Overview in a new way.In this series of fictional clinical vignettes, Dr Cochrane travels across time from the past century to the present day, to solve clinical problems using evidence from Cochrane Reviews. Read the associated article and then test your knowledge with five multiple‐choice questions. You can find the answers to the questions on page 1316. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley &amp; Sons, Ltd. The Cochrane Collaboration