Jankikund Chikitsalaya

1. Pharyngitis
Presented By
Dr. Rajesh Pandey
20 Nov. 2019

2. 2
Pharyngitis
Definition
Pharyngitis is inflammation of the pharynx, which
is in the back of the throat.

3. Anatomy & Pharynx

4. • The pharynx is divided in to three part
• Nasopharynx
• Oropharynx
• Laryngopharynx
Nasopharynx
• The part of pharynx which lies above the soft palate &
Behind the nasal cavity.
Oropharynx
• This part extends from the level of the soft palate to the level of
laryngeal inlet.
Laryngopharynx
• This part lies behind the larynx & partially surrounds the larynx.
Cont..

5. Type of Pharyngitis
1- Acute
2- Chronic

6. Acute

7. Chronic

8. Chronic

9. Acute Pharyngitis
Definition
Acute inflammation of pharyngeal mucosa and
submucosa, mostly invovled in pharyngeal
lymphoid tissue.

10. Etiology
• 1. Virus*
• 2. Bacteria*
• 3. Environmental Factors*

11. Pathology
• Acute inflammation of the pharyngeal
mucosal tissue
• Blood vessels dilatation
• Inflammatory cells infiltration
• Mucosal swelling.

12. Sign
• Erythema
• Enlargement of tonsils
• Lymphoid follicles on the posterior pharyngeal wall
• Oedema of soft palate and uvula.
• Enlargement of cervical nodes.

13. Symptoms
• Sore throat
• Pain or difficulty when swallowing or talking
• Swollen, sore glands in the neck or throat
• Red throat and red, swollen tonsils
• A hoarse voice.

14. Treatment
• Gargle
• Bed rest
• More drink
• Antiviral
• Antibiotics

15. Chronic Pharyngitis
Definition*:
diffuse inflammation of pharyngeal
mucosa and submucosa, and pharyngeal
lymphoid tissue.

16. Chronic Pharyngitis- Etiology
Viral Adenovirus
• Influenza virus
Bacterial –beta-hemolytic streptococci
• H. influenza
• Staphylococcus aureus
• Diphtheria
• Gonococcus
Fungal – Candida albicans.

17. • Persistent infections- chronic rhino sinusitis with
post nasal drip, chronic tonsillitis, dental sepsis, Mouth
breathing-nasal polyp.
• Allergic/vasomotor rhinitis, nasopharyngeal adenoids,
tumors.
• Chronic irritants -smoking, tobacco chewing, alcohol,
highly spicy food.
• Environmental-smoke, dust, chemicals,
• occupational fumes.
Chronic Pharyngitis- Etiology

18. Chronic Pharyngitis- signs
• Catarrhal- congestion, increased secretions.
• Hypertrophic-pharyngeal wall thick, edematous,
congested mucosa and dilated vessels.
• Posterior pharyngeal wall studded with reddish nodules-
due to sub epithelial lymphoid follicle hypertrophy.
• Uvula congested and elongated.

19. Chronic Pharyngitis- signs
Chronic hypertrophic (granular) pharyngitis
• Pharyngeal wall appears thick
• Pharyngeal wall edematous
• Congested mucosa
• Dilated vessels.
• Posterior pharyngeal wall may be studded with reddish nodules.
• Lateral pharyngeal bands become hypertrophied.
• Uvula may be elongated and appear edematous.

20. Chronic catarrhal pharyngitis
• Congestion of posterior pharyngeal wall with engorgement
. of vessels.
• Faucial pillars may be thickened.
• Increased mucus secretion which may cover pharyngeal
. mucosa.
Cont..

21. Chronic Pharyngitis- symptoms
• Discomfort, pain-more during morning.
• Foreign body sensation-constant desire to
swallow or clear throat.
• Voice tiredness.
• cough

22. Factors
1. Local Factors：
• Repeat relapse of acute pharyngitis
• Affected by adjacent organs ：nose, tonsils.
• Bad irritants
2. General Factors：
• General chronic diseases: anemia, dyspepsia, lower
• Respiratory chronic diseases, cardiovascular diseases.
• Allergic factors

23. A large number of factors are responsible:
1. Persistent infection.
• Chronic rhinitis
• Sinusitis
• Purulent discharge
• Constantly trickles down the pharynx and
• Provides a constant source of infection.
• Causes hypertrophy of the lateral pharyngeal bands.
2. Chronic tonsillitis
3. Dental sepsis
4. Mouth breathing
Factors

24. 5. Breathing through the mouth
• Obstruction in the nose
• Nasal polypi
• Allergic rhinitis
• Vasomotor rhinitis
• Turbinate hypertrophy
• Deviated septum
• Tumours
6. Nsopharyngeal causes
• Adenoids
• Tumours
.
Cont..

25. 7. Chronic irritants.
• Excessive smoking
• Chewing of tobacco and pan
• Heavy drinking,
• Highly spiced food
8. Environmental pollution
• Smoky
• dusty environment
• Irritant industrial
9. Faulty voice production
• Excessive use of voice
• Throat clearing
• Hawking
• Snorting
Cont..

26. Transmission
• Both viral and bacterial forms of pharyngitis are contagious. The
germs that cause pharyngitis tend to live in the nose and throat.
• When a person with the condition coughs or sneezes, they release
tiny droplets that contain the virus or bacteria into the air. A person
can become infected by: breathing these tiny droplets in.
• Touching contaminated objects and then touching their face
consuming contaminated food and beverages.
• This is why it is essential for a person to wash their hands before
handling food or touching their face.
• People usually recover from viral infections, such as the common
cold, within 7 to 10 days.

27. Physical Examination
• Examination of the oropharynx reveals an
exudative pharyngitis with erythema and tonsillar
hypertrophy , diffuse lymphoid hyperplasia of
waldoyar`s ring, petechiae at the hard palate-
soft palate junction, and ulcers on the
pharyngeal and epiglottis mucosa.

28. Waldoyar`s Ring

29. Clinical Manifestation
Bacterial (Strep.)
• Rapid onset
• Headache
• GI Symptoms
• Sore throat
• Erythma
• Palatine petechiae
• Enlarged tonsils
• Anterior cervical adenopathy &Tender
• Red& swollen uvula

30. Cont..
Viral
• cough
• headache
• fever
• body aches
• sneezing
• congestion in the nasal passageways
• swollen lymph nodes
• mouth ulcers
• abdominal pain, especially on the upper left side
• rash

31. Pathology
• Chronic simple pharyngitis: chronic mucosal
congestion, gland hypertrophy, hypersecretion.
• Chronic hypertrophic pharyngitis: mucosal
congestion, pharyngeal lymphoid tissue hypertrophy.
• Atrophic pharyngitis and pharyngitis, hypo secretion,
mucosa is thin.

32. • ESR, Hb, TLC & DLC
• Total Serum Proteins
• Serum Electrolytes
• Throat swab
• Endoscopy
• X-ray
• CT-Scan
Investigation

33. Clinical Diagnosis
• high probability :empiric antibiotic
therapy,
• intermediate probability: further testing
( rapid antigen test) or (throat culture)
• low probability: symptomatic therapy and
appropriate follow-up

34. • Etiological factor sought and eradicated.
• (Oily & Spicy food, Tobacco, Alcohol)
• Voice rest.
• Bed rest
• Warm saline gargle
• Analgesics.
• Clindamycin
• Augmentin
Chronic Pharyngitis-treatment

35. Complications
• Otitis media
• Sinusitis
• Peritonsillar and retropharyngeal abscesses
• Suppurative cervical adenitis

36. Thanks for
your attention!