Acute and Chronic Pharyngitis • Viruses causing pharyngitis…• Causes of Herpangina, Infectious Mononucleosis,

Pharyngoconjunctival fever, Acute lymphnodular pharyngitis….

• Types of chronic pharyngitis…• Aetiology of chronic pharyngitis…• Keratosis pharyngitis…

Acute pharyngitis • Etiology

– Viruses are the most common of all – Streptococcus has received imp. d/t RF and PSGN.

Viruses Bacteria Fungal Misce Rhinoviruses Streptococcus

(Group A beta-hemolytic)

Candida albicans

Toxoplasmosis

Influenza virus Diphtheria Chlamydia trachomatis

Parainfluenza Gonoccocus Measles and chickenpox Coxsakie virusHerpes simplexInfectious mononucleosisCytomegalovirus

• Clinical features – Milder form: discomfort in throat, some malaise and low

grade fever + congestion in pharynx w/o lymphadenopathy– Moderate and severeform:

• pain in throat, dysphasia, headache, malaise and high fever • Erythema, exudate and enlargement of tonsils & lymphoid follicles

– Very sever cases: edema of soft palate and uvula w/ enlargement of cervical nodes

• Dx. – Culture of throat swab – Diptheria is cultured on special media– Failure to get any bacterial growth indicates viral origin

Treatment • General measures – Bed rest, plenty of fluids, warm saline, gargles or pharyngeal

irrigations – Analgesics – Local discomfort can be relieved by lignocaine viscous before

meal

• Specific measures – Streptococcal pharyngitis:

• Penicillin G 2,00,000-2,50,000 units orally four times/day for 10 days

• Benzathine penicillin G 6 lac units once i.m (<60lb) or 1.2 million units for >60lb

– Diphtheria • Diphtheria antitoxin and penicillin/erythryomycin

Chronic pharyngitis • Chronic inflammation of pharynx c/b hypertrophy of

mucosa, seromucinous glands, subepithelial lymphoid follicles and also muscular coat of pharynx

• Types – Chronic catarrhal pharyngitis – Chronic granular pharyngitis

Etiology • Persistent infection in neighbourhood – Chronic sinusitis and rhinitis

• Mouth breathing – d/t unfiltered air

• Chronic irritants: excessive smoking, chewing of tobacco, heavy drinking, etc

• Environmental pollution • Faulty voice production

Clinical features • Symptoms – Discomfort or pain in the throat – F/b sensation in throat – Tiredness of voice – Cough

• Signs:– Chronic catarrhal pharyngitis: congestion of posterior pharyngeal wall

with engorgement of vessels; faucial pillars are thickened + increased mucous secretion

– Chronic granular pharyngitis • Wall appears thick and edematous with congested mucosa • Studded with reddish nodulesthese nodules are due to hypertrophy of

subepithelial lymphoid follicles • Lateral pharyngeal bands become hypertrophied • Uvula may be enlogated and edematous

Treatment 1. In every case of chronic pharyngitis, aetiological

factors should be sought and eradicated 2. Voice rest and speech therapy 3. Warm saline gargles, especially in the morning4. Mandl’s paint 5. Cautery of lymphoid granules. Throat is sprayed

with local anesthesic and granules are touched with 10-25% sliver nitrates under general anesthesia

Atrophic pharyngitis • Form of chronic pharyngitis often seen in patients of atrophic

rhinits • Pharyngeal mucosa along with mucous glands shows atrophy • Scanty mucous formation and crusting • Clinical features:

– Dryness and discomfort in throat – Hawking and dry cough d/t crust formation – O/e: dry and glazed mucos

• Tx– Crust are removed by spraying alkaline solution– mandl’s paint apllied locally provide relief – Potassium iodide, 325mg administered orally for few days promote

secretion and prevent crusting

Keratosus pharyngitis • Benign condition c/b horny excrescences on the surface of

tonsils, pharyngeal wall or lingual tonsil • Appear as white or yellowish dots; d/t hypertrophy and

keratinization of epithelium; firmly adhered and cannot be wiped of

• No accompanying inflammation nor any constitutional symptoms

• Shows spontaneous regression and may not require any specific tx