Acute and chronic pharyngitis
By Dr Saeed Ullah MBBS, FCPS
Classified ENT, Head and Neck Surgeon
Pharynx
• Nasopahrynx • Oropharynx • Hypopharynx
Oropharynx
• Lateral wall– Ant faucial pillar– Tonsil – Post faucial pillar
• Superior wall– Soft palate
• Inferior wall– Post 1/3 tongue
• Posterior wall
Acute pharyngitis Viral (42%)
Adenovirus (most common 31%)Epstein –Barr virus(6%)Influenza virus(5%)
Bacterial –Mixed infection common(48%) beta-hemolytic streptococci (GABHS-38%) H. influenza staphylococcus aureus Corynebacterium diphtheria gonococcus anaerobes remain uncertain.
Fungal –Candida albicans
Pathophysiology
• Invasion of mucosa• Local inflammation• Irritation of mucosa by secretion• Release of local toxins, proteases• M-protein fragment of GABHS and
sarcolemma antigens of myocardium• Antigen-antibodies complex deposition in
glomeruli
Clinical features
• Sore throat, fever, chills,• Malaise, headaches, anorexia, abdominal
pains • History of exposure to known carriers• Pain on swallowing• Redness, congestion of pharynx• Enlarged congested tonsils• Cervical lymphadenitis
Viral infections
• Herpangina-coxsakie virus• Infectious mononucleosis-EBV• Cytomegalovirus• Pharyngoconjunctival fever-Adenovirus• Acute lymphonodular pharyngitis-coxsakie
virus• Measles and chickenpox
Investigations
• Throat swab for C/S• Rapid antigen testing against GABHS• Kleb loafler’s bacillus (KLB)• Leukocytosis • Monospot test for EBV
Treatment
• NSAIDS• Antibiotics • Oral penicillin V given six-hourly for ten days
goldstandard• Cephalosporins (cefixime)• Augmented Amoxicillin• Macrolids
Recurrent sore throat
• Benzathine penicillin• Clindamycins• Cefuroxime • Tonsillectomy
Complications
• Routes of spread– Hematogenous– Lymphatics– Direct spread
Complications • Peritonsillar abscess, • Septicaemia, • Toxic shock • Otitis media/mastoiditis,• Descending necrotizing mediastinitis,• Septic thrombophlebitis, internal jugular vein • Orbital myositis • Epiglottitis, • Rhinosinusitis• Pneumonia.
Acute tonsillitis
• GABHS• Hemophilus influenzae• Viral
Types of acute tonsillitis
• Acute catarrhal or superficial • Acute follicular• Acute parenchymatous• Acute membranous
Symptoms
• Sore throat• Painfull swallowing• Fever• Earache• Constitutional – Headache– Body aches– Malaise
Signs
• Coated tongue• Hyperemia of pillars• Enlarged, red, congested tonsils• Follicles • Membranes
Treatment
• Bed rest • Analgesics• Antibiotics
Tonsillectomy
• SIGN guidelines– sore throats are due to tonsillitis;– there are five or more episodes per year– there are symptoms for at least a year;– the episodes of sore throat are disabling and
prevent normal functioning
Indications
• OSA• Unilateral enlargement• 2nd attack of quinsy• As an oncological procedure• Large symptomatic tonsilolith
Peritonsillar abscess (Quinsy)
• Streptococcus pyogenous• S. Aureus • Anaerobes
Clinical features
• High grade fever with rigors• Severe throat pain (unilateral)• Odynophagia • Muffled and thick speech (hot potato voice)• Foul breath• Trismus • Earache (ipsilateral)
On examination
• Swollen tonsil, pillars, soft palate• Uvula swollen and pushed• Bulging of soft palate above the tonsil• Cervical lymphadenitis• Torticollis
Treatment
• Needle drainage and antibiotics• Incision and drainage and antibiotics• Abscess tonsillectomy• Interval tonsillectomy
Diphtheria
• Corynebecterium diphtherae • Droplet infection• Carrier state
Clinical features
• Membrane over the tonsils, palate, uvula• Tenacious, difficult to remove• Bleeding on removal• Bull’s neck• Toxic looking• Breathing difficulty
Investigations
• Culture for KLB• ECG
Complications
• Exotoxins – Myocarditis– Cardiac arrhythmias– Circulatory failure– Paralysis of soft palate– Paralysis of diaphragm – Paralysis of ocular muscles
Treatment
• Exotoxins in blood• Organisms in tonsil• Started on suspicion• Antitoxins as IV infusion – 20,000 to 40,000– 40,000 to 80,000
Parapharyngeal abscess
• Parapharyngeal space– Medial-constrictor muscles– Post-prevertebral fascia– Lateral-medial pterygoid muscle, – mandible– Communictes with other spaces• Retropharyngeal• Submandibular• Carotid space
Causes
• Pharynx • Teeth• Ear• Other spaces• External trauma
Clinical features
• Anterior compartment– Prolapse of tonsil– Trismus– Ext swelling
• Post compartment– Bulge– Cranial nerve paralysis– 9, 10, 11, 12– Swelling of parotid region
Treatment
• Systemic antibiotics• Drainage of abscess– Tracheostomy for trismus– Horizontal incision below the angle– Blunt dissection
Retropharyngeal abscess
• Acute – In children• Suppuration of lymph nodes
– In adults• Penetrating trauma
• Chronic– Tubercolous• Lymph nodes• Cervical spine
Clinical features
• Dysphagia• Torticollis• Bulge in post wall• Stridor
Investigations
• X-Ray neck lateral view• C T scan
Treatment
• I & D• Anti TB drugs
Chronic pharyngitis
• Chronic inflammatory of the pharynx characterized by hypertrophy of mucosa,seromucinous glands and sub epithelial lymphoid tissues
Chronic pharyngitis
• Chronic non specific• Chronic specific
Non specific
• Persistent infection in neighborhood• Mouth breathing• Chronic irritants• Environmental pollution
Symptoms
• Discomfort in throat• Foreign body sensation• Cough
Signs
• Congested post wall• Odema of the wall• Nodules on the wall • Lateral pharyngeal bands
Treatment
• Predisposing factors• Saline gargles • Anti inflammatory drugs• Cautry of the nodules
Questions
Thank you
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