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Acute and chronic pharyngitis
This document summarizes acute and chronic pharyngitis. It discusses the anatomy of the pharynx and describes acute pharyngitis as usually being viral or bacterial in origin. The clinical features, investigations, and treatment of acute pharyngitis are outlined. Complications are also discussed. Acute tonsillitis is described separately. Chronic pharyngitis and its causes, symptoms, signs, and treatment are briefly covered. Specific conditions like peritonsillar abscess, diphtheria, and retropharyngeal abscess are also summarized.
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Acute and chronic pharyngitis
- 3. Acute and chronicpharyngitis By Dr Saeed Ullah MBBS, FCPS Classified ENT, Head and Neck Surgeon
- 4. Pharynx • Nasopahrynx • Oropharynx •Hypopharynx
- 5. Oropharynx • Lateral wall –Ant faucial pillar – Tonsil – Post faucial pillar • Superior wall – Soft palate • Inferior wall – Post 1/3 tongue • Posterior wall
- 6. Acute pharyngitis Viral (42%) Adenovirus(most common 31%) Epstein –Barr virus(6%) Influenza virus(5%) Bacterial –Mixed infection common(48%) beta-hemolytic streptococci (GABHS-38%) H. influenza staphylococcus aureus Corynebacterium diphtheria gonococcus anaerobes remain uncertain. Fungal –Candida albicans
- 7. Pathophysiology • Invasion ofmucosa • Local inflammation • Irritation of mucosa by secretion • Release of local toxins, proteases • M-protein fragment of GABHS and sarcolemma antigens of myocardium • Antigen-antibodies complex deposition in glomeruli
- 8. Clinical features • Sorethroat, fever, chills, • Malaise, headaches, anorexia, abdominal pains • History of exposure to known carriers • Pain on swallowing • Redness, congestion of pharynx • Enlarged congested tonsils • Cervical lymphadenitis
- 9. Viral infections • Herpangina-coxsakievirus • Infectious mononucleosis-EBV • Cytomegalovirus • Pharyngoconjunctival fever-Adenovirus • Acute lymphonodular pharyngitis-coxsakie virus • Measles and chickenpox
- 10. Investigations • Throat swabfor C/S • Rapid antigen testing against GABHS • Kleb loafler’s bacillus (KLB) • Leukocytosis • Monospot test for EBV
- 11. Treatment • NSAIDS • Antibiotics •Oral penicillin V given six-hourly for ten days goldstandard • Cephalosporins (cefixime) • Augmented Amoxicillin • Macrolids
- 12. Recurrent sore throat •Benzathine penicillin • Clindamycins • Cefuroxime • Tonsillectomy
- 13. Complications • Routes ofspread – Hematogenous – Lymphatics – Direct spread
- 14. Complications • Peritonsillar abscess, •Septicaemia, • Toxic shock • Otitis media/mastoiditis, • Descending necrotizing mediastinitis, • Septic thrombophlebitis, internal jugular vein • Orbital myositis • Epiglottitis, • Rhinosinusitis • Pneumonia.
- 15. Acute tonsillitis • GABHS •Hemophilus influenzae • Viral
- 16. Types of acutetonsillitis • Acute catarrhal or superficial • Acute follicular • Acute parenchymatous • Acute membranous
- 21. Symptoms • Sore throat •Painfull swallowing • Fever • Earache • Constitutional – Headache – Body aches – Malaise
- 22. Signs • Coated tongue •Hyperemia of pillars • Enlarged, red, congested tonsils • Follicles • Membranes
- 23. Treatment • Bed rest •Analgesics • Antibiotics
- 24. Tonsillectomy • SIGN guidelines –sore throats are due to tonsillitis; – there are five or more episodes per year – there are symptoms for at least a year; – the episodes of sore throat are disabling and prevent normal functioning
- 25. Indications • OSA • Unilateralenlargement • 2nd attack of quinsy • As an oncological procedure • Large symptomatic tonsilolith
- 26. Peritonsillar abscess (Quinsy) •Streptococcus pyogenous • S. Aureus • Anaerobes
- 28. Clinical features • Highgrade fever with rigors • Severe throat pain (unilateral) • Odynophagia • Muffled and thick speech (hot potato voice) • Foul breath • Trismus • Earache (ipsilateral)
- 29. On examination • Swollentonsil, pillars, soft palate • Uvula swollen and pushed • Bulging of soft palate above the tonsil • Cervical lymphadenitis • Torticollis
- 30. Treatment • Needle drainageand antibiotics • Incision and drainage and antibiotics • Abscess tonsillectomy • Interval tonsillectomy
- 33. Diphtheria • Corynebecterium diphtherae •Droplet infection • Carrier state
- 34. Clinical features • Membraneover the tonsils, palate, uvula • Tenacious, difficult to remove • Bleeding on removal • Bull’s neck • Toxic looking • Breathing difficulty
- 37. Investigations • Culture forKLB • ECG
- 38. Complications • Exotoxins – Myocarditis –Cardiac arrhythmias – Circulatory failure – Paralysis of soft palate – Paralysis of diaphragm – Paralysis of ocular muscles
- 40. Treatment • Exotoxins inblood • Organisms in tonsil • Started on suspicion • Antitoxins as IV infusion – 20,000 to 40,000 – 40,000 to 80,000
- 41. Parapharyngeal abscess • Parapharyngealspace – Medial-constrictor muscles – Post-prevertebral fascia – Lateral-medial pterygoid muscle, – mandible – Communictes with other spaces • Retropharyngeal • Submandibular • Carotid space
- 42. Causes • Pharynx • Teeth •Ear • Other spaces • External trauma
- 43. Clinical features • Anteriorcompartment – Prolapse of tonsil – Trismus – Ext swelling • Post compartment – Bulge – Cranial nerve paralysis – 9, 10, 11, 12 – Swelling of parotid region
- 44. Treatment • Systemic antibiotics •Drainage of abscess – Tracheostomy for trismus – Horizontal incision below the angle – Blunt dissection
- 45. Retropharyngeal abscess • Acute –In children • Suppuration of lymph nodes – In adults • Penetrating trauma • Chronic – Tubercolous • Lymph nodes • Cervical spine
- 46. Clinical features • Dysphagia •Torticollis • Bulge in post wall • Stridor
- 47. Investigations • X-Ray necklateral view • C T scan
- 48. Treatment • I &D • Anti TB drugs
- 49. Chronic pharyngitis • Chronicinflammatory of the pharynx characterized by hypertrophy of mucosa, seromucinous glands and sub epithelial lymphoid tissues
- 50. Chronic pharyngitis • Chronicnon specific • Chronic specific
- 51. Non specific • Persistentinfection in neighborhood • Mouth breathing • Chronic irritants • Environmental pollution
- 52. Symptoms • Discomfort inthroat • Foreign body sensation • Cough
- 53. Signs • Congested postwall • Odema of the wall • Nodules on the wall • Lateral pharyngeal bands
- 55. Treatment • Predisposing factors •Saline gargles • Anti inflammatory drugs • Cautry of the nodules
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