PHARYNGITISPHARYNGITIS

DEPT OF DEPT OF OTORHINOLARYNGOLOGYOTORHINOLARYNGOLOGY

J J M M CJ J M M CDAVANAGEREDAVANAGERE

PharyngitisPharyngitisACUTE:ACUTE:•very common condition encountered in medicine.very common condition encountered in medicine.•One of the poorly understood condition.One of the poorly understood condition.•Many have no scientific basis.Many have no scientific basis.•Several questions remain unansweredSeveral questions remain unanswered Do viral infections predispose to bacterial Do viral infections predispose to bacterial infection?infection?Do viral infections involve pharyngeal lymphoid Do viral infections involve pharyngeal lymphoid tissue without involving tonsils?tissue without involving tonsils?

PharyngitisPharyngitis

Is there a condition like chronic tonsillitis?Is there a condition like chronic tonsillitis? Is there a infective condition like chronic Is there a infective condition like chronic

pharyngitis?pharyngitis? Why are some patients susceptible to acute Why are some patients susceptible to acute

pharyngitis/tonsillitis?pharyngitis/tonsillitis? Does the tonsil become irreversibly diseased Does the tonsil become irreversibly diseased

after many episodes of acute tonsillitis?after many episodes of acute tonsillitis? Does removal of tonsils predispose for more Does removal of tonsils predispose for more

frequent episodes of pharyngitis?frequent episodes of pharyngitis?

PharyngitisPharyngitis There is poor co-relation between surface culture swabs There is poor co-relation between surface culture swabs

from core culture.from core culture. Presence of organisms in throat culture does not mean that it Presence of organisms in throat culture does not mean that it

is pathogenic or vice versa is also true for streptococci, is pathogenic or vice versa is also true for streptococci, haemophilus influenza (aerobic) therefore suggested that haemophilus influenza (aerobic) therefore suggested that may be caused by anaerobes.may be caused by anaerobes.

Size of the tonsil is not directly related to their infective Size of the tonsil is not directly related to their infective state,infact sunken tonsils are immunologically state,infact sunken tonsils are immunologically incompetent.incompetent.

Parenchymatous tonsillitis, chronic tonsillitis, streptococcal Parenchymatous tonsillitis, chronic tonsillitis, streptococcal pharyngitis and chronic hypertrophic pharyngitis are non pharyngitis and chronic hypertrophic pharyngitis are non proven category. proven category.

Pharyngitis-aetiologyPharyngitis-aetiology ViralViral (42%)- (42%)- a) Adenovirus (most common 31%) a) Adenovirus (most common 31%)

b) Epstein –Barr virus(6%)b) Epstein –Barr virus(6%)

c) Influenza virus(5%)c) Influenza virus(5%) BacterialBacterial –Mixed infection common(48%) –Mixed infection common(48%)

-beta-hemolytic streptococci(38%)-beta-hemolytic streptococci(38%)

-H. influenza -H. influenza

-staphylococcus aureus-staphylococcus aureus

-diphtheria-diphtheria

-gonococcus-gonococcus

-anaerobes remain uncertain.-anaerobes remain uncertain. Fungal Fungal –Candida albicans. –Candida albicans.

Pharyngitis-clinical featuresPharyngitis-clinical features Mild infection-discomfort ,malaise ,low grade Mild infection-discomfort ,malaise ,low grade

fever ,congested ,no lymphadenopathy.fever ,congested ,no lymphadenopathy. Moderate-pain, dysphagia, headache, high fever.Moderate-pain, dysphagia, headache, high fever.

-congested, oedematous, exudates.-congested, oedematous, exudates.

-enlarged tonsils, lymphoid follicles of -enlarged tonsils, lymphoid follicles of posterior pharyngeal wall.posterior pharyngeal wall.

-lymph nodes palpable and tender.-lymph nodes palpable and tender. viral infection mild-associated with rhinorrhoea.viral infection mild-associated with rhinorrhoea. Voice change-severe bacterial infection.Voice change-severe bacterial infection. Gonococcal pharyngitis-mild or even symptomless.Gonococcal pharyngitis-mild or even symptomless.

Pharyngitis-diagnosis &treatmentPharyngitis-diagnosis &treatment Diagnosis-culture & sensitivity-may be helpful.Diagnosis-culture & sensitivity-may be helpful. Treatment –general measures-bed rest ,fluids ,warm Treatment –general measures-bed rest ,fluids ,warm

saline gargle, analgesics. saline gargle, analgesics.

-specific-penicillin g-oral or injection.-specific-penicillin g-oral or injection.

-if sensitive- macrolides.-if sensitive- macrolides.

Chronic PharyngitisChronic Pharyngitis

Characterized by hypertrophy of mucosal Characterized by hypertrophy of mucosal seromucinous glands, sub epithelial lymphoid seromucinous glands, sub epithelial lymphoid tissue, even muscular coat.tissue, even muscular coat.

Two types-a) catarrhal (mucosal)Two types-a) catarrhal (mucosal)

-b) hypertrophic-b) hypertrophic

Chronic Pharyngitis- aetiologyChronic Pharyngitis- aetiology Persistent infections- chronic rhinosinusitis with Persistent infections- chronic rhinosinusitis with

post nasal drip, chronic tonsillitis, dental sepsispost nasal drip, chronic tonsillitis, dental sepsis Mouth breathing-nasal polyp, DNS with Hit's, Mouth breathing-nasal polyp, DNS with Hit's,

allergic/vasomotor rhinitis, nasopharyngeal allergic/vasomotor rhinitis, nasopharyngeal adenoids, tumours.adenoids, tumours.

-with mouth breathing air is not filtered, -with mouth breathing air is not filtered, humidified and temperature conditioned.humidified and temperature conditioned.

Chronic irritants-smoking, tobacco chewing, Chronic irritants-smoking, tobacco chewing, alcohol, highly spicy food.alcohol, highly spicy food.

Chronic Pharyngitis- aetiologyChronic Pharyngitis- aetiology

Environmental-smoke, dust, chemicals, Environmental-smoke, dust, chemicals, occupational fumes.occupational fumes.

Faulty voice production- misuse/over useFaulty voice production- misuse/over use

Chronic Pharyngitis- symptomsChronic Pharyngitis- symptoms

1)1) Discomfort, pain-more during morning.Discomfort, pain-more during morning.

2)2) Foreign body sensation-constant desire to Foreign body sensation-constant desire to swallow or clear throat.swallow or clear throat.

3)3) Voice tiredness.Voice tiredness.

4)4) coughcough

Chronic Pharyngitis- signsChronic Pharyngitis- signs Catarrhal- congestion, vascular engogement, Catarrhal- congestion, vascular engogement,

increased secretions.increased secretions. Hypertrophic-pharyngeal wall thick, Hypertrophic-pharyngeal wall thick,

edematous, congested mucosa and dilated edematous, congested mucosa and dilated vessels.vessels.

-posterior pharyngeal wall studded with reddish -posterior pharyngeal wall studded with reddish nodules-(nodules-(granular pharyngitisgranular pharyngitis) due to sub epithelial ) due to sub epithelial lymphoid follicle hypertrophy.lymphoid follicle hypertrophy.

-uvula congested and elongated.-uvula congested and elongated.

Chronic Pharyngitis-treatmentChronic Pharyngitis-treatment

Etiological factor sought and eradicated.Etiological factor sought and eradicated.

Voice rest –speech therapy.Voice rest –speech therapy.

Warm saline gargle.Warm saline gargle.

Severe granular type-chemical or diathermy Severe granular type-chemical or diathermy cautery done.cautery done.

GRANULAR PHARYNGITISGRANULAR PHARYNGITIS

Chronic Pharyngitis-treatmentChronic Pharyngitis-treatment

Atrophic pharyngitisAtrophic pharyngitis

All the layers become atrophied.All the layers become atrophied. Secondary to atrophic rhinitis.Secondary to atrophic rhinitis. Clinical featuresClinical features: dryness, discomfort, : dryness, discomfort,

hawking-dry cough.hawking-dry cough. Signs:Signs: dry glazed pharygeal mucosa often dry glazed pharygeal mucosa often

covered with crusting.covered with crusting. Treatment:Treatment: treat the primary nasal cause, treat the primary nasal cause,

saline gargle.saline gargle. -potassium iodide(325mg orally) promote -potassium iodide(325mg orally) promote

secretions.secretions.

Keratosis pharyngitisKeratosis pharyngitis Benign condition characterized by horny Benign condition characterized by horny

white/yellow excrescences on the surface of white/yellow excrescences on the surface of the tonsils, pharyngeal wall, lingual tonsils- the tonsils, pharyngeal wall, lingual tonsils- Result of hypertrophy & keratinisation of Result of hypertrophy & keratinisation of epithelium.epithelium.

Firmly adherent, cannot be wiped off.Firmly adherent, cannot be wiped off. No accompanying inflammation.No accompanying inflammation. Spontaneous regression, does not require any Spontaneous regression, does not require any

treatment.treatment. Assurance.Assurance.

Keratosis pharyngitisKeratosis pharyngitis

Chronic specific pharyngitisChronic specific pharyngitis

SyphiliticSyphilitic TuberculosisTuberculosis LeprosyLeprosy ToxoplasmosisToxoplasmosis ScleromaScleroma