What is the treatment for throat burns?

Treatment of Throat Burns

Immediate cooling with clean running water is the primary first-line treatment for thermal burns of the throat, followed by appropriate airway management and referral to a burn center for severe cases. 1

Initial Assessment and Management

• Assess for signs of airway obstruction including voice changes, stridor, and laryngeal dyspnea, which require immediate medical attention 1
• Monitor closely for respiratory distress, especially in patients with face/neck burns who were exposed to vapors or inhaled smoke due to risk of glottic edema 1
• Remove all jewelry near the burn site before swelling occurs to prevent constriction and vascular compromise 1, 2
• For thermal burns, apply cool running water to the affected area for at least 20 minutes to limit tissue damage 1

Airway Management

• Patients with severe burns involving the whole face should be intubated if they have any of the following:

  • Deep circular neck burn 1
  • Symptoms of airway obstruction (voice modification, stridor, laryngeal dyspnea) 1
  • Very extensive burns (total burned body surface area ≥40%) 1

• Intubation should be performed without delay in patients with severe respiratory distress, severe hypoxia/hypercapnia, or coma 1

• Consider fiberoptic intubation techniques for difficult airways in patients with burns to the head and neck 3

• In patients without immediate indication for intubation, re-evaluate the clinical situation regularly during transport and after hospital admission 1

Specialized Care

• Respiratory symptoms and hypoxemia on admission should prompt early discussion with an intensivist and rapid transfer to an ICU or burn center 1

• If smoke inhalation is suspected, bronchial fibroscopy should not be performed outside burn centers to avoid transfer delays 1

• Referral to a burn specialist should be sought to determine whether the patient should be admitted to a burn center 1

• Burns involving the face, hands, feet, or genitals require specialized burn center treatment 1, 2

Wound Care

• After cooling, apply petrolatum, petrolatum-based antibiotic ointment, honey, or aloe vera and a clean nonadherent dressing to open burn wounds 1

• For oral involvement:

  • Apply white soft paraffin ointment to the lips every 2 hours through the acute illness 1
  • Clean the mouth daily with warm saline mouthwashes or an oral sponge 1
  • Use an anti-inflammatory oral rinse or spray containing benzydamine hydrochloride every 3 hours, particularly before eating 1
  • Use an antiseptic oral rinse containing chlorhexidine twice daily 1
  • Use a potent topical corticosteroid mouthwash (e.g., betamethasone sodium phosphate) four times daily 1

Pain Management

• Administer over-the-counter pain medications such as acetaminophen or NSAIDs for burn pain 1

Monitoring and Follow-up

• Daily oral review is necessary during the acute illness for patients with oral involvement 1

• Monitor for signs of infection including increasing pain, redness, swelling, purulent discharge, or systemic symptoms 2

• For patients with inhalation injury, consider targeted medical therapy aimed at components of mucosal airway inflammation (local corticosteroids and systemic azithromycin) 4

Common Pitfalls and Caveats

• Unnecessary intubation in the prehospital setting can lead to increased complications; follow strict criteria for intubation 1

• Tracheal intubation is not recommended in children who have been burned by hot fluid in the absence of respiratory distress, even if the burns involve the face, skull, or neck 1

• Some throat burning sensations may be due to hyperacidity and reflux rather than thermal burns, requiring different treatment approaches 5

• Avoid applying ice directly to burns as it can worsen tissue damage 1