PHARYNGITIS DEPT OF OTORHINOLARYNGOLOGY JJM M C DAVANAGERE
PharyngitisACUTE:•very common condition encountered in medicine.•One of the poorly understood condition.•Many have no scientific basis.•Several questions remain unanswered Do viral infections predispose to bacterialinfection?Do viral infections involve pharyngeal lymphoidtissue without involving tonsils?
Pharyngitis Is there a condition like chronic tonsillitis? Is there a infective condition like chronic pharyngitis? Why are some patients susceptible to acute pharyngitis/tonsillitis? Does the tonsil become irreversibly diseased after many episodes of acute tonsillitis? Does removal of tonsils predispose for more frequent episodes of pharyngitis?
Pharyngitis There is poor co-relation between surface culture swabs from core culture. Presence of organisms in throat culture does not mean that it is pathogenic or vice versa is also true for streptococci, haemophilus influenza (aerobic) therefore suggested that may be caused by anaerobes. Size of the tonsil is not directly related to their infective state,infact sunken tonsils are immunologically incompetent. Parenchymatous tonsillitis, chronic tonsillitis, streptococcal pharyngitis and chronic hypertrophic pharyngitis are non proven category.
Pharyngitis-aetiology Viral (42%)- a) Adenovirus (most common 31%) b) Epstein –Barr virus(6%) c) Influenza virus(5%) Bacterial –Mixed infection common(48%) -beta-hemolytic streptococci(38%) -H. influenza -staphylococcus aureus -diphtheria -gonococcus -anaerobes remain uncertain. Fungal –Candida albicans.
Pharyngitis-clinical features Mild infection-discomfort ,malaise ,low grade fever ,congested ,no lymphadenopathy. Moderate-pain, dysphagia, headache, high fever. -congested, oedematous, exudates. -enlarged tonsils, lymphoid follicles of posterior pharyngeal wall. -lymph nodes palpable and tender. viral infection mild-associated with rhinorrhoea. Voice change-severe bacterial infection. Gonococcal pharyngitis-mild or even symptomless.
Atrophic pharyngitis All the layers become atrophied. Secondary to atrophic rhinitis. Clinical features: dryness, discomfort, hawking-dry cough. Signs: dry glazed pharygeal mucosa often covered with crusting. Treatment: treat the primary nasal cause, saline gargle. -potassium iodide(325mg orally) promote secretions.
Keratosis pharyngitis Benign condition characterized by horny white/yellow excrescences on the surface of the tonsils, pharyngeal wall, lingual tonsils- Result of hypertrophy & keratinisation of epithelium. Firmly adherent, cannot be wiped off. No accompanying inflammation. Spontaneous regression, does not require any treatment. Assurance.