3. Pharyngitis
⢠Inflammation of the pharynx
secondary to an infectious
agent
⢠Most common infectious
agents are group A
streptococcus and various
viral agents
⢠Often co-exists with tonsillitis
6. Acute pharyngitis
â˘Etiology
â˘Bacterial
⢠Group A beta-hemolytic streptococci (S. Pyogenes)*
⢠Most common bacterial cause of pharyngitis
⢠Accounts for 15-30% of cases in children and 5-10% in adults.
⢠Mycoplasma pneumoniae
⢠Arcanobacterium haemolyticum
⢠Neisseria gonorrhea
⢠Chlamydia pneumoniae
7. Pharyngitis
â˘History
â˘Classic symptoms â fever, throat pain, dysphagia
ďVIRAL â most likely concurrent URI symptoms of
rhinorrhea, cough, hoarseness, conjunctivitis & ulcerative
lesions
ďSTREP â look for associated headache, and/or abdominal
pain
ďFever and throat pain are usually acute in onset
8. Clinical features
⢠Different grades of severity.
⢠Milder infections (symptoms)
⢠Discomfort in the throat
⢠Malaise
⢠Low grade fever.
⢠Milder infections (signs)
⢠Congested
⢠No lymphadenopathy.
9. Clinical features
⢠Moderate and severe pharyngitis (symptoms)
⢠Pain in throat
⢠Dysphagia
⢠Headache
⢠Malaise
⢠High fever.
⢠Moderate and severe pharyngitis (signs)
⢠Erythema
⢠Exudate
⢠Enlargement of tonsils
⢠Lymphoid follicles on the posterior pharyngeal wall
⢠Oedema of soft palate and uvula
⢠Enlargement of cervical nodes.
10. Clinical features
⢠Not possible on clinical examination to differentiate
⢠Viral from bacterial infections
⢠Viral infections
⢠Generally mild and are accompanied by
⢠Rhinorrhea
⢠Hoarseness
⢠Bacterial - Severe.
⢠Gonococcal Pharyngitis
⢠Mild and may even be asymptomatic
11. Pharyngitis
⢠Viral
ďEBV â
ďwhite exudate covering erythematous pharynx and tonsils
ďcervical adenopathy,
ďSubacute/chronic symptoms (fatigue/myalgias)
ď Transmitted via infected saliva
ďAdenovirus/coxsackie â
ďVesicles/ulcerative lesions present on pharynx or posterior soft palate
ďAlso look for conjunctivitis
12. Epidemiology of streptococcal pharyngitis
⢠Spread by contact with respiratory secretions
⢠Peaks in winter and spring
⢠School age child (5-15 y)
⢠Communicability highest during acute infection
⢠Patient no longer contagious after 24 hours of
antibiotics
⢠If hospitalized, droplet precautions needed until no
longer contagious
13. Pharyngitis
⢠Physical exam
⢠Bacterial
ďGAS â look for whitish exudate covering pharynx and tonsils
⢠Tender anterior cervical adenopathy
⢠Palatal/uvular petechiae
ďSpread via respiratory particle droplets â NO school attendance
until 24 hours after initiation of appropriate antibiotic therapy
⢠Absence of viral symptoms (rhinorrhea, cough,
hoarseness)
14. Suppurative complications of group A
streptococcal pharyngitis
⢠Otitis media
⢠Sinusitis
⢠Peritonsillar and retropharyngeal abscesses
⢠Suppurative cervical adenitis
15. Nonsuppurative complications of group A
streptococcus
⢠Acute rheumatic fever
⢠Follows only streptococcal pharyngitis (not group A strep skin
infections)
⢠Acute glomerulonephritis
⢠May follow pharyngitis or skin infection (pyoderma)
⢠Nephritogenic strains
25. Pharyngitis
⢠Treatment
ďVIRAL â supportive care only â analgesics, antipyretics,
fluids
ďNo strong evidence supporting use of oral or
intramuscular corticosteroids for pain relief â few
studies show transient relief within first 12â24 hrs after
administration
ďEBV â infectious mononucleosis
ďActivity restrictions â mortality in these pts most commonly
associated with abdominal trauma and splenic rupture
26. Pharyngitis
â˘Treatment â do so to prevent ARF (acute rheumatic fever)
ďGas â
ďźOral penicillinâ treatment of choice
ďź10 day course of therapy
ďźIm benzathine penicillin â 1.2 million units x 1
ďźAzithromycin, clindamycin, or 1st generation cephalosporins -
allergy
31. Aetiology
⢠A large number of factors are responsible:
1. Persistent infection in the neighbourhood
⢠Ch ronic 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
32. Aetiology
5. Breathing through the mouth
⢠Neither filtered
⢠Nor humidified
⢠Obstruction in the nose
⢠Nasal polypi
⢠Allergic rhinitis
⢠Vasomotor rhinitis
⢠Turbinate hypertrophy
⢠Deviated septum
⢠Tumours
6. Nsopharyngeal causes
⢠Adenoids
⢠Tumours
7. Habitual
⢠Without any organic cause.
33. Aetiology
8. Chronic irritants.
⢠Excessive smoking
⢠Chewing oftobacco and pan
⢠Heavy drinking,
⢠Highly spiced food
9. Environmental pollution
⢠Smoky
⢠dusty environment
⢠Irritant industrial
10. Faulty voice production
⢠Excessive use of voice
⢠Faulty voice production seen in certain professionals or in
⢠"Pharyngeal neurosisâ
⢠Throat clearing
⢠Hawking
⢠Snorting
34. Symptoms
⢠1. Discomfort or pain in the throat.
⢠2. Foreign body sensation in throat.
⢠3. Tiredness of voice.
⢠4. Cough.
⢠Throat is irritable
⢠Tendency to cough
⢠5. Retching or gagging.
35. Signs
⢠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.
36. Signs
⢠Chronic hypertrophic (granular) pharyngitis
⢠Pharyngeal wall appears thick
⢠Pharyngeal wall oedematous
⢠Congested mucosa
⢠Dilated vessels.
⢠Posterior pharyngeal wall may be studded with reddish nodules (hence the
term granular pharyngitis).
⢠These nodules are due to hypertrophy of subepithelial lymphoid foll icles
normally seen in pharynx
⢠Lateral pharyngeal bands become hypertrophied.
⢠Uvula may be elongated and appear oedematous.
37. Treatment
⢠Aetiological factor should be sought and eradicated
⢠Voice rest
⢠Speech therapy is essential for those with
⢠Faulty voice production. Hawking, clearing the throat
⢠Frequently or any other such habit should be stopped.
⢠3warm saline gargles.
⢠4. Mandl's paint
⢠5. Cautery of lymphoid granules
⢠10-25% silver nitrate.
⢠Electrocautery or
38. Atrophic pharyngitis
⢠It is a form of chronic pharyngitis often seen in patients of atrophic
rhinitis.
⢠Pharyngeal mucosa along with its mucous glands shows atropl1y.
⢠Scanty mucus production by glands leads to formation of crusts
which later get infected giving rise to foul smell.
⢠Clinical features
⢠Dryness and discomfort in throat are the main complaints.
⢠Hawki ng and dry cough may be present due to crust formation.
⢠Examination shows dry and glazed pharyngeal mucosa often
covered with crusts.
39. Atrophic pharyngitis
Treatment
⢠This is the same as for co-existent atrophic rhinitis.
⢠Aim is to remove the crusts and promote secretion.
⢠The crusts can be removed by spraying the throat with alkaline
solution ,pharyngeal irrigation.
⢠Mandl's paint applied locally has a soothing effect.
⢠Potassium iodide, 325 mg
40. Keratosis Pharyngitis
⢠Benign condition characterized by horny excrescences on the
⢠Surface of tonsils
⢠Pharyngeal wall
⢠Lingual tonsils
⢠Appearing as white or yellowish dots.
⢠These excrescences are the result of
⢠Hypertrophy
⢠Keratinisation of epithelium.
⢠They are firmly adherent and cannot be wiped off.
41. Keratosis pharyngitis
⢠No accompanying inflammation
⢠Constitutiona l symptoms thus
⢠Differential diagnosis
⢠Acute follicular tonsillitis.
⢠Spontaneous regression
⢠Does not require any specific treatment
⢠Reassurance to the patient.