Airway and ENT emergencies

Sore throat emergencies

Overview and approach

Severe sore throat can reflect peritonsillar or deep-neck abscess, epiglottitis or rapidly progressing infection.

  • Your framework: sore throat, fever, dysphagia and dysphonia plus stridor, increased work of breathing, drooling, tripod positioning or a sick patient = emergency. Emergencies: peritonsillar abscess (quinsy), retropharyngeal abscess, epiglottitis, bacterial tracheitis, diphtheria, Ludwig angina (deep soft-tissue infection of the floor of mouth), respiratory burn. Non-emergencies: tonsillitis (GAS)/pharyngitis, infectious mononucleosis (1)(2)(3).
Assessment and clinical features

Look for trismus, muffled voice, drooling, neck swelling, stridor, sepsis and dehydration; maintain a calm approach.

  • Quinsy: age 20-40; sore throat progressing to quinsy with or without tonsillitis; locked jaw (trismus), fever, dysphonia, dysphagia, cervical adenopathy, stridor if severe (1).
  • Tonsillitis (GAS)/pharyngitis: fever, viraemic features, dysphonia, dysphagia.
Differentials and investigations

Senior ENT/anaesthetic assessment; blood tests and imaging only when safe and not delaying airway control.

  • See each emergency's own page: Peritonsillar abscess, Deep neck space infections. Imaging (CT with contrast) only with advanced airway capability available (4).
  • Infectious mononucleosis: consider EBV serology if the diagnosis is uncertain (5).
Management and follow-up

Analgesia, IV support and antibiotics under local guidance; drainage and airway decisions belong with the specialist team.

  • Quinsy: antibiotics, steroids to reduce inflammation (not routine in some sources), aspiration or incision and drainage (resus bed) (1)(2).
  • Epiglottitis: keep upright, avoid agitation or oral examination, involve airway specialists, secure the airway in a controlled setting, IV broad-spectrum antibiotics (2)(3). Bacterial tracheitis: controlled airway, IV antibiotics, debridement. Diphtheria: isolation, airway planning, antitoxin and antibiotics.
  • Tonsillitis/pharyngitis: pain relief (paracetamol and ibuprofen), antibiotics only if confirmed or suspected GAS or high rheumatic-fever risk (Therapeutic Guidelines summary: phenoxymethylpenicillin 500 mg twice daily for 10 days, or benzathine benzylpenicillin once) (5)(6); consider steroids and IV hydration for severe cases. Infectious mononucleosis: supportive; avoid contact sports while splenomegaly persists (5).
Red flags and clinical pearls

Do not force examination or lie a distressed patient flat when airway compromise is suspected.

  • Post-streptococcal complications: glomerulonephritis and acute rheumatic fever (6).
  • Trismus, drooling and a muffled 'hot potato' voice suggest abscess.
References
  1. Cochrane: Needle aspiration vs incision and drainage for peritonsillar abscess
  2. StatPearls: Peritonsillar abscess
  3. BMJ Best Practice: Epiglottitis - treatment algorithm
  4. RCH: Sore throat
  5. RACGP: Infectious mononucleosis
  6. Therapeutic Guidelines: Antibiotic prescribing in primary care summary table 2024

Last updated from Sen’s notes on 9 October 2026.