Uvulitis

General

• Uvulitis is characterized by inflammation and edema of uvula
• Isolated uvular inflammation is rare
• More commonly manifests with other inflammatory diseases of oropharynx:
  • Epiglottitis
  • Pharyngitis
• Rarely causes life threatening respiratory distress

Etiologies

• Major division: infectious vs. noninfectious etiology
• Infections:
  • Most commonly H. Influenzae Type B & Group A Streptococcus
    • H. Influenzae
      • Frequently with Epiglottitis
    • Group A Streptococcus
      • Frequently with Pharyngitis
  • Less common
    • S. Pneumoniae
      • Adults
    • Anaerobic bacteria
    • Candida Albicans
• Noninfectious
  • Trauma
  • Angioedema
  • Inhalant irritation
    • Inhaled cannabinoids
  • Allergy

Clinical Features

History

• Throat pain
• Dysphagia, sensation of something in their throat, gagging sensation
• Low-grade fever
• Signs of Epiglottis
  • Sudden onset
    • High fever
    • Dysphagia
    • Dyspepsia/SOB
    • Drooling
• History of sick contacts
• Allergen exposure
• Recent surgical procedure with site of entry via mouth (EGD, laryngoscopy, OGT, etc)
• Recent inhalation of cannabis

PMH

• Vaccination status
  • H. Influenzae - epiglottis
  • First H. Influenzae vaccine at 2 months, last booster 12-15 months
• Hereditary angioedema

Physical Exam

• General
  • Range from well appearing to toxic
• HEENT
  • Oropharynx
    • Uvula
      • Markedly erythematous and edematous
      • Pinpoint hemorrhage is possible
      • Vesicular lesions possible if viral etiology
      • Nonerythematous, pale, swollen (uvular hydrops) may indicates angioedema
    • Tonsils
      • Edematous vs. nonedematous
      • Exudative vs. nonexudative
    • Erythematous posterior pharynx
• Respiratory
  • Range non-labored breathing to respiratory distress
  • Stridor
  • "Hot Potato Voice"
  • Clear lungs bilaterally

Differential Diagnosis

• Uvulitis
  • Infectious
    • Group A Streptococcus
      • Streptococcal Pharyngitis
    • H. Influenza
      • Epiglottitis
    • Strep. Pneumoniae
    • Candida Albicans
  • Noninfectious
    • Trauma
    • Angioedema
    • Inhalant irritation
    • Allergy
• Epiglottitis
• Streptococcal Pharyngitis
• Peritonsillar Abscess
• Retropharyngeal Abscess
• Herpes Gingivostomatitis

Evaluation

• Labs
  • Rapid strep throat swab
  • Heterophile antibody (monospot) test
• If patient is ill appearing consider:
  • CBC
  • CMP
  • Blood culture
• Imaging
  • If concern for epiglottitis
    • Lateral neck x-ray
  • If concern for retropharyngeal abscess
    • CT neck with contrast

Management

• ABC’s and Resuscitation if necessary
• Management guided by association with Epiglottitis or Streptococcal Pharyngitis

Infectious

Epiglottitis

• General Treatment
  • Airway protection with fiberoptic intubation or tracheostomy
  • Dexamethasone 0.15mg/kg
  • Nebulized epinephrine
• Antibiotic treatment
  • Pediatric:
    • (Cefotaxime 50mg/kg IV q8h and Ceftriaxone 50mg/kg IV q24hr) plus Vancomycin 15mg/kg IV q12h
  • Adult:
    • (Cefotaxime 2gm IV q4-8h or Ceftriaxone 2gm IV q24h) plus Vancomycin

Streptococcal Pharyngitis

• Pediatrics
  • Penicillin V 250mg PO BID x 10 days
  • Amoxicillin 50mg/kg PO once daily x 10 days
• Adults
  • Penicillin V 500mg PO BID x 10 days
  • If compliance is unlikely
    • Benzathine Penicillin 25,000Units/kg IM (to a maximum of 1.2 million units) x 1 dose
  • If allergic to PCN
    • Clindamycin 300mg PO q8h x 10days

C. Albicans

• Topical nystatin

Noninfectious

Trauma

• Acetaminophen
• Local anesthetic lozenges

Allergic Reaction

• Treatment determined by severity of illness
  • Epinephrine 0.3mg 1:1,000 IM
  • Diphenhydramine 50mg IV
  • Ranitidine 150mg
  • Methylprednisolone 125mg IV

Angioedema

• Cover for allergic reaction with medications above
  • If true angioedema, will not resolve symptoms
• Stop ACE inhibitor
• See angioedema management

Inhalant irritation

• Antihistamines IV
• Hydrocortisone or dexamethasone IV

Disposition

• Determined by severity, complications, etc.

Also See

• Epiglottitis
• Retropharyngeal Abscess

References

• Yellon R, Chi D. Atlas of pediatric physical diagnosis. 6th Ed. 2012; 23: Philadelphia, PA: Saunders/Elsevier; 2012: 913-960
• Wald Ellen. Feigin and Cherry’s Textbook of Pediatric Infectious Disease, 7th ed. Philadelphia, PA : Elsevier/Saunders; 2014: 165-167
• Guarisco J, Cheney M, Lejeune F, Reed H. Isolated uvulitis secondary to marijuana use. Laryngoscope. 1988; 98:1309-131
• Boyce S, Quigley M. Uvulitis and partial upper airway obstruction following cannabis inhalation. Emergency medicine. 2002; 14:106-108
• Westerman E, Hutton J. Acute uvulitis associated with epiglotitis. Arch Otolaryngol Head Neck Surg. 1986; 12:448-449
• Peghlnl P, Salcedo J, Al-Kawas F. Traumatic uvulitis: a rare complication of upper GI endoscopy. Gastrointestinal Endoscopy. 2001; 53:818-820
• Lee S, Schwatz R, Babadori R. Retropharyngeal abscess: epiglottitis of the new mellennium. The Journal of Pediatrics. 2001; 138:435-437

Authors

Garrett Blumberg, Ross Donaldson, Claire, Daniel Ostermayer