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RCentor has an interesting article on Sore Throats and Pharyngitis over at MedRants.  He writes:

“There is a new trend in pharyngitis that has taken hold amongst emergency physicians – the use of steroids to provide symptom relief.”

I too have noticed this, and I completely agree with Dr. Centor that while this is a highly effective treatment, it needs to be used with some caution. For our practice, this has been pushed by the ENTs. It has been our experience that when we see someone with a really bad sore throat or even with a peritonsillar abscess, 100% of the time the instruction from the ENTs has been to administer steroids. While the data is underwhelming (pain relief on average six hours quicker with steroids), the truth is that for a really bad case of tonsillitis, steroids work. I'm not meaning the average case of strep, mind you, but rather the muffled-voice cases where the patient is so bad that they can't take any fluids and you are worried about the integrity of their airway. You give these cases a whopping dose of whatever steroid you like and BAM, like magic the tonsils shrink down and the patient feels a million times better.

How can we ER docs—suckers for immediate gratification—possibly be expected to resist such a magical therapy?

Dr. Centor worries about masking complications of pharyngitis (specifically his pet disease Lemierre's); I worry more about masking the more common complications -- like the peritonsillar abscess.  Let me recount a cautionary tale.

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