Acute Epiglottitis is fortunately a rarity since the regular use of the H. Influenze type B vaccination.  Other nomenclature for the disease include Supraglottitis, Oedema glottis, and Supraglottic Croup.

Epiglottitis

Angioedema (or Quincke’s edema) is inflammation of the deep dermis or submucosa. It is non pitting, non dependent, non tender, non erythematous, usually assymmetric.  The term angiioneurotic oedema was a misnomer as it was initially thought to be a nervous system disorder. It can be life threatening if it involves the airway. It can be congenital, idiopathic, or drug induced. Ace inhibitor blood pressure medications are common offenders causing this condition. NSAIDS and food allergies are the other big culprit. A thorough allergy history and testing are paramount. Exciting new drugs are on the horizon for this condition.

Angioedema

Most commonly seen in infants and young children, retropharyngeal abscess (RPA) is an abscess located in the tissues in the back of the throat behind the posterior pharyngeal wall (the retropharyngeal space). Because RPA’s typically occur in deep tissue, they are difficult to diagnose by physical examination alone. RPA is a relatively uncommon illness, and therefore may not receive early diagnosis in children presenting with stiff neck, malaise, difficulty swallowing, or other symptoms listed below. Early diagnosis is key, while a delay in diagnosis and treatment may lead to death. Parapharyngeal space communicates with retropharyngeal space and an infection of retropharyngeal space can pass down behind the oesophagus into mediastinum. [1] RPA’s can also occur in adults of any age.

Retropharyngeal Abscess

Ludwig’s angina, otherwise known as angina ludovici, is a serious, potentially life-threatening cellulitis[1][dead link], or connective tissue infection, of the floor of the mouth, usually occurring in adults with concomitant dental infections and if left untreated, may obstruct the airways, necessitating tracheotomy. It is named after the German physician, Wilhelm Friedrich von Ludwig who first described this condition in 1836.

Ludwig’s Angina

Diphtheria (Greek διφθέρα (diphthera) “pair of leather scrolls”) is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium.[1][2] It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.[3] A milder form of diphtheria can be restricted to the skin. Less common consequences include myocarditis (about 20% of cases) [4] and peripheral neuropathy (about 10% of cases).[5]

Diptheria

The Styloid Process is a pointed piece of bone that extends down from the skull, just below the ear. It serves as an anchor point for ligaments and muscles associated with the tongue and larynx.

The stylohyoid ligament, stylomandibular ligament, styloglossus muscle, stylohyoid muscle and stylopharyngeus muscle are attached to the styloid process.  (3 muscles innervated by 3 cranial nerves attach to the styloid process—–stylohyoid – C.N. VII, stylopharyngeus – C.N. IX, and styloglossus – C.N. XII)

A small percentage of the population suffers from a condition called Eagle Syndrome which causes an elongation of the styloid process and stylohyoid ligament calcification. When someone with Eagle Syndrome swallows, the tissue of the throat rubs against the styloid process, resulting in glossopharyngeal nerve pain. Eagle Syndrome was first described by Watt Weems Eagle, an otorhinolaryngologist, in 1937.

GABHS has a number of known problematic sequelae that are the primary reason we look for it.  Although rare, ARF (Acute Rhematic Fever) or Rheumatic Heart Disease is our primary concern.  It is a sterile Type II autoimmune attack on the heart valves, myocardium, and joints resulting from the protracted high anti strep circulating antibodies.  It is my understanding that if you treat Strep within 9 days you avoid this possibility.  Apparently you need to treat about 40,000 cases of strep throat to avoid one such case.  With the incidence of a severe allergic reaction to PCN being 1/12,000 so clinical judgement is paramount.  The most winning strategy is to just use the “rapid test” as the decision maker.  Using this strategy, in the US, we could prevent 85 cases of rheumatic heart disease annually at the cost of $727,000 per case prevented.  You are actually more likely to contract Lemeirre’s Syndrome from Fusobacterium with a GABHS infection than Rheumatic Heart Disease.

The changes in voice after rhinoplasty are more personal perception than reality

Patients who have undergone plastic surgery to change the appearance of their nose may also notice changes in the sound of their voice, reports a study in the February issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS).

Changes in voice after rhinoplasty are perceptible to patients as well as to experts, but generally don’t cause problems with speech function, according to the new research by Dr. Kamran Khazaeni and colleagues of Mashhad University of Medical Sciences, Iran. However, they believe that patients considering rhinoplasty – especially those who use their voice professionally – should be aware of “potential voice alterations.”

Shots and Vaccines

Getting an annual flu shot and getting the pneumococcal vaccine are always a good idea. Prevnar is a 7-valent vaccine, whereas Pneumovax is better with 23 stimulating antigens. The pneumococcal vaccine is slightly effective at lessening the incidence of otitis media and probably rhinosinusitis. It changes the infectious agent to non-typable hemophilis, which lessens the efficacy of the aminopenicillins.

Intradermal zovirax and flu vaccine

Vitamins and Supplements

Vitamin D

Zinc (zicam), vitamin C (up to 2,500 mg or 25,000 units per day), echinacea and other supplements remain unproven but certainly have no ill side effects. These can be administered either topically or systemically.

Papaya enzymes in a product called Clearease has been advocated by Dr. Grossan to be used in his Water Pik. Evidence is lacking and benefits seem subjective. A variety of herbal remedies have received attention. Echinacea is well known by many to help with URI’s. Some have advocated horseradish, bromelain, goldenseal, stinging nettle, ephedra and others. They seem harmless.

Adjunctive Thyroid Medicine

Bactroban Ointment

Yeast Reduction Protocol (Antifungals)Adjuntive

Probiotics

Gluten Free Diet

ASA Desensitization

SCIT or SLIT

Long Term Antibiotics (Derm Style)

Macorlides