This document discusses several disorders of the pharynx, including acute and chronic pharyngitis, herpangina, keratosis pharyngitis, pharyngeal pouches, and Eagle's syndrome. Acute pharyngitis is usually viral but can be bacterial, while chronic pharyngitis can be catarrhal or hypertrophic. Pharyngeal pouches are herniations of hypopharyngeal mucosa through the cricopharyngeus muscle. Eagle's syndrome involves an elongated styloid process or calcified stylohyoid ligament that can cause pain on swallowing. Diagnosis and treatment options are provided for each condition.

1. Disorders of pharynx
pharyngeal pouch
eagle’s syndrome
Dr. Sithananda Kumar . R
Asst. Professor
Department of ENT
MGMC&RI

2. DISORDERDERS OF PHARYNX
• Acute pharyngitis
• Chronic pharyngitis
• Viral pharyngitis
• Keratosis pharynx

3. Acute pharyngitis
• viral, bacterial, fungal
• Viral more common than bacterial
• Acute streptococcal pharyngitis (Group A
beta-hemolytic streptococci) – associated
with rheumatic fever and post streptococcal
glomerulonephritis.

4. Clinical features
• Viral and bacterial pharyngitis cannot
be differentiated clinically
• Viral pharyngitis milder than bacterial
pharyngitis
• Acute pharyngitis- mild , moderate ,
severe

5. Management
• Throat swab
• Saline gargling
• Mild , moderate – oral penicillin's
• Severe - parenteral penicillin's ,
macrolides

7. Chronic pharyngitis
• chronic inflammatory condition of the pharynx
• Characterized by hypertrophy of mucosa,
seromucinous glands, sub epithelial lymphoid
follicles
• Chronic pharyngitis is of two types:
1. Chronic catarrhal pharyngitis.
2. Chronic hypertrophic (granular) pharyngitis

8. Etiology
• Focus of infection in nose, PNS, Tonsils
• Mouth breathing
• Gastro-esophageal reflux
• Chronic irritation
• Voice abuse
• Environmental pollution

9. Clinical features
• Discomfort or pain in the throat
• Foreign body sensation in throat
• Voice fatigue
• Cough

10. Signs
Chronic catarrhal pharyngitis
•congestion of posterior pharyngeal wall
•Mucous secretion in posterior pharyngeal wall
Chronic hypertrophic (granular) pharyngitis
•Pharyngeal wall appears thick and edematous with congested
mucosa and dilated vessels
•Posterior pharyngeal wall -studded with reddish nodules
(granular pharyngitis)
•Lateral pharyngeal bands hypertrophied
•Uvula elongated and edematous

11. Treatment
•Identifying and treating the cause
•Mandl’s paint
•Saline gargling

13. Herpangina
• Caused by Group A coxsackie virus
• mostly affects children
• Characteristic features include fever,
sore throat and vesicular eruption on
the soft pal- ate and pillars
• Vesicles are small and surrounded by
a zone of erythema.

14. KERATOSIS PHARYNGITIS
• Benign condition
• Horny excrescences on the surface of tonsils,
pharyngeal wall or lingual tonsils
• Appear as white or yellowish dots
• These excrescences are the result of hypertrophy and
keratinization of epithelium.
• Firmly adherent and cannot be peeled off
• No accompanying inflammation nor any constitutional
symptoms

15. Pharyngeal pouch
• Pulsion hypopharyngeal diverticulum
• Hypopharyngeal mucosa herniates through
the Killian’s dehiscence
• Weak area between the thyropharyngeal
and cricopharyngeal parts of the inferior
constrictor muscle

16. • spasm of cricopharyngeal sphincter
• In coordinated contractions during deglutition
• Patients are usually old adults
• Herniation of pouch starts in the midline and
then comes to lie on the left
• Mouth of the sac is wider than the opening of
esophagus and food preferentially enters the sac

17. • Halitosis
• Dysphagia and regurgitation of food days after
ingestion
• Dysphagia may increase after a few swallows(the
pouch gets filled with the food and then presses on
the esophagus.
• Gurgling sound during swallowing
• Regurgitation of undigested food at night (due to
recumbent position) results in coughing and choking
• Loss of weight and malnourishment
• Aspiration pneumonia

18. • Patients with pharyngeal pouch can be associated
hiatus hernia
• Rarely carcinoma can develop in long-standing
cases of pharyngeal pouch(squamous cell
carcinoma)
• Diagnosis by barium swallow
• Treatment -excision of pouch and cricopharyngeal
myotomy
• Dohlman’s procedure
• Endoscopic laser treatment

19. Eagles syndrome
• Due to elongated styloid process or calcification of stylohyoid
ligament
• Pain in the tonsillar fossa and upper neck which radiates to the
ipsilateral ear
• Aggravated on swallowing
• Diagnosis –transoral palpation of the styloid process in the
tonsillar fossa
• Radiograph anteroposterior view with open mouth or lateral view
of skull
• Asymptomatic – No treatment
• Symptomatic styloid process can be excised by transoral or
cervical approach.