Oropharyngeal Lesions/Pain

Oral Lesions

Ulceration

  • Common

    • Trauma (incidental)

    • Aphthous stomatitis

    • Contact stomatitis

    • Lichen planus

      • Presents with reticular, erythematous, and/or erosive lesions

      • Symptomatic (painful) lesions: Topical clobetasol propionate 0.05%

  • Uncommon: Vitamin deficiencies (e.g. iron, folate)

Vesicles

  • Coxsackie virus

  • Herpes zoster oticus (Ramsay-Hunt syndrome)

  • Herpes simplex virus

Leukoplakia

  • Candidiasis

  • Mononucleosis (EBV)

  • Oral squamous cell cancer

Acute Pharyngitis

Common

  • Upper respiratory infection (acute laryngitis)

  • Streptococcal pharyngitis

  • Mononucleosis

    • Epstein-Barr virus infection most common in adolescents/young adults

    • Presents with fever, fatigue, palatal petechiae, pharyngitis, posterior cervical lymphadenopathy, splenomegaly (less common)

    • Labs

      • WBC > 12,000/microL and > 50% lymphocytes on CBC with differential, positive heterophile antibody (Monospot) test, negative streptococcal rapid antigen detection test

      • High clinical suspicion with negative heterophile antibody test during first week of illness: Obtain EBV-specific IgM and IgG antibody levels

      • History of high risk sexual activity: Obtain 4th generation HIV antibody/antigen (ELISA) test

    • Treatment

      • Symptomatic treatment with rest, fluids, acetaminophen 500 mg q6h, Naproxen 500 mg BID

      • Concern for airway compromise: Start dexamethasone 0.25 mg/kg q6h (MDD 40 mg/day) and refer to otolaryngology or emergency department

    • Patient counseled to avoid strenuous activity and contact sports for 6 weeks due to risk of splenic rupture

Emergent

  • Epiglottitis

  • Peritonsillar abscess

Chronic Pharyngitis

Chronic Irritation (More Common)

  • Chronic cough due to upper airway cough syndrome (post-nasal drip), asthma, GERD, and/or ACE-inhibitor use

  • Laryngeal strain, e.g. professional vocalists

  • Chemical including smoking and occupational exposures

Esophagitis (Less Common)

  • Iatrogenic

  • Infectious

    • More common: Candida esophagitis, HSV esophagitis

    • Less common: Esophagitis due to Cytomegalovirus (CMV), Epstein-Barr (EBV) and varicella-zoster (VZV)