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Pharyngeal bursitis — Clinical Guidelines

Overview

Pharyngeal bursitis is a rare inflammatory condition involving bursae located in the pharyngeal region, often secondary to trauma, infection, or systemic inflammatory processes. 6 11

Diagnosis

Clinical presentation includes localized pain, swelling, and tenderness over the affected bursa.

Bursal aspiration may reveal characteristic fluid analysis: high leukocyte count, low glucose-to-serum ratio, and positive Gram stain in septic cases. 12

Imaging (ultrasound) can help identify bursal inflammation and rule out other pathologies. 1

Culture of aspirated fluid is crucial for identifying infectious etiologies, such as Neisseria sicca or Prototheca zopfii. 5 7

Management

First-line treatments:

- Aspiration: For both septic and aseptic bursitis to relieve symptoms and manage infection. 10 12 - Antibiotics: If septic bursitis is confirmed, targeted antibiotic therapy based on culture and sensitivity results. 5 7

Adjunctive treatments:

- Rest and immobilization: To reduce inflammation and promote healing. - NSAIDs: For pain and inflammation management. 12 - Surgical intervention: Arthroscopic or open bursectomy for chronic or recurrent cases. 3 4

Special Populations

Maintenance hemodialysis patients: Higher incidence of olecranon bursitis, often related to sustained pressure on the bursa during dialysis access. 9

Pediatrics: Limited specific data; POCUS training can aid in accurate assessment of bursal effusions remotely. 1

Comorbidities: Rheumatoid arthritis and gout may predispose to nonseptic bursitis. 12

Key Recommendations

Perform bursal aspiration for both diagnostic and therapeutic purposes in suspected bursitis cases to differentiate between septic and nonseptic conditions. (Evidence: Moderate) 12

Initiate targeted antibiotic therapy based on culture results for septic bursitis. (Evidence: Moderate) 5 7

Consider arthroscopic bursectomy for chronic or recurrent bursitis to avoid complications associated with open excision. (Evidence: Weak) 3 4

References

1 Riera A, Leviter JI, Iqbal A, Soma G, Malik RN, Chen L. Agreement With Pediatric Suprapatellar Bursa Effusion Assessments by Point-of-Care Ultrasound After Remote Training. Pediatric emergency care 2022. link 2 Kegels L, Van Oyen J, Siemons W, Verdonk R. Bicipitoradial bursitis. A case report. Acta orthopaedica Belgica 2006. link 3 Kaalund S, Breddam M, Kristensen G. Endoscopic resection of the septic prepatellar bursa. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 1998. link70105-7) 4 Kerr DR. Prepatellar and olecranon arthroscopic bursectomy. Clinics in sports medicine 1993. link 5 Halla JT. Septic olecranon bursitis caused by Neisseria sicca. The Journal of rheumatology 1990. link 6 Taylor PW. Inflammation of the deep infrapatellar bursa of the knee. Arthritis and rheumatism 1989. link 7 Naryshkin S, Frank I, Nachamkin I. Prototheca zopfii isolated from a patient with olecranon bursitis. Diagnostic microbiology and infectious disease 1987. link90103-9) 8 Schreiber S, Dupont P. Apatite-induced acute bursitides triggered by parathyroidectomy. Clinical rheumatology 1983. link 9 Jain VK, Cestero RV, Baum J. Septic and aseptic olecranon bursitis in patients on maintenance hemodialysis. Clinical and experimental dialysis and apheresis 1981. link 10 Vilbar RM, Daugirdas JT, Ing TS, Gandhi VC, Popli S, Chen WT. Treatment of dialysis elbow by simple aspiration. Journal of dialysis 1979. link 11 Canoso JJ, Yood RA. Reaction of superficial bursae in response to specific disease stimuli. Arthritis and rheumatism 1979. link 12 Ho G, Tice AD. Comparison of nonseptic and septic bursitis. Further observations on the treatment of septic bursitis. Archives of internal medicine 1979. link 13 Ger R. The skin incision in the excision of the prepatellar bursa. The Journal of dermatologic surgery and oncology 1978. link

Pharyngeal bursitis