This document provides information about acute and chronic pharyngitis. It discusses the anatomy of the pharynx and causes of acute pharyngitis such as viral and bacterial infections. Clinical features of acute pharyngitis are described along with investigations and treatment options. Complications are outlined. Acute tonsillitis is also discussed including types, symptoms, signs, and treatment. Chronic pharyngitis and conditions such as peritonsillar abscess, diphtheria, and retropharyngeal abscess are summarized as well.

1. Acute and chronic pharyngitis
By
Dr Saeed Ullah MBBS, FCPS
Classified ENT, Head and Neck Surgeon

2. Pharynx
• Nasopahrynx
• Oropharynx
• Hypopharynx

3. Oropharynx
• Lateral wall
– Ant faucial pillar
– Tonsil
– Post faucial pillar
• Superior wall
– Soft palate
• Inferior wall
– Post 1/3 tongue
• Posterior wall

4. 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

5. Pathophysiology
• Invasion of mucosa
• 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

6. Clinical features
• Sore throat, 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

7. Viral infections
• Herpangina-coxsakie virus
• Infectious mononucleosis-EBV
• Cytomegalovirus
• Pharyngoconjunctival fever-Adenovirus
• Acute lymphonodular pharyngitis-coxsakie
virus
• Measles and chickenpox

8. Investigations
• Throat swab for C/S
• Rapid antigen testing against GABHS
• Kleb loafler’s bacillus (KLB)
• Leukocytosis
• Monospot test for EBV

9. Treatment
• NSAIDS
• Antibiotics
• Oral penicillin V given six-hourly for ten days
goldstandard
• Cephalosporins (cefixime)
• Augmented Amoxicillin
• Macrolids

10. Recurrent sore throat
• Benzathine penicillin
• Clindamycins
• Cefuroxime
• Tonsillectomy

11. Complications
• Routes of spread
– Hematogenous
– Lymphatics
– Direct spread

12. Complications
• Peritonsillar abscess,
• Septicaemia,
• Toxic shock
• Otitis media/mastoiditis,
• Descending necrotizing mediastinitis,
• Septic thrombophlebitis, internal jugular vein
• Orbital myositis
• Epiglottitis,
• Rhinosinusitis
• Pneumonia.

13. Acute tonsillitis
• GABHS
• Hemophilus influenzae
• Viral

14. Types of acute tonsillitis
• Acute catarrhal or superficial
• Acute follicular
• Acute parenchymatous
• Acute membranous

19. Symptoms
• Sore throat
• Painfull swallowing
• Fever
• Earache
• Constitutional
– Headache
– Body aches
– Malaise

20. Signs
• Coated tongue
• Hyperemia of pillars
• Enlarged, red, congested tonsils
• Follicles
• Membranes

21. Treatment
• Bed rest
• Analgesics
• Antibiotics

22. 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

23. Indications
• OSA
• Unilateral enlargement
• 2nd attack of quinsy
• As an oncological procedure
• Large symptomatic tonsilolith

24. Peritonsillar abscess (Quinsy)
• Streptococcus pyogenous
• S. Aureus
• Anaerobes

26. Clinical features
• High grade fever with rigors
• Severe throat pain (unilateral)
• Odynophagia
• Muffled and thick speech (hot potato voice)
• Foul breath
• Trismus
• Earache (ipsilateral)

27. On examination
• Swollen tonsil, pillars, soft palate
• Uvula swollen and pushed
• Bulging of soft palate above the tonsil
• Cervical lymphadenitis
• Torticollis

28. Treatment
• Needle drainage and antibiotics
• Incision and drainage and antibiotics
• Abscess tonsillectomy
• Interval tonsillectomy

31. Diphtheria
• Corynebecterium diphtherae
• Droplet infection
• Carrier state

32. Clinical features
• Membrane over the tonsils, palate, uvula
• Tenacious, difficult to remove
• Bleeding on removal
• Bull’s neck
• Toxic looking
• Breathing difficulty

35. Investigations
• Culture for KLB
• ECG

36. Complications
• Exotoxins
– Myocarditis
– Cardiac arrhythmias
– Circulatory failure
– Paralysis of soft palate
– Paralysis of diaphragm
– Paralysis of ocular muscles

38. Treatment
• Exotoxins in blood
• Organisms in tonsil
• Started on suspicion
• Antitoxins as IV infusion
– 20,000 to 40,000
– 40,000 to 80,000

39. Parapharyngeal abscess
• Parapharyngeal space
– Medial-constrictor muscles
– Post-prevertebral fascia
– Lateral-medial pterygoid muscle,
– mandible
– Communictes with other spaces
• Retropharyngeal
• Submandibular
• Carotid space

40. Causes
• Pharynx
• Teeth
• Ear
• Other spaces
• External trauma

41. Clinical features
• Anterior compartment
– Prolapse of tonsil
– Trismus
– Ext swelling
• Post compartment
– Bulge
– Cranial nerve paralysis
– 9, 10, 11, 12
– Swelling of parotid region

42. Treatment
• Systemic antibiotics
• Drainage of abscess
– Tracheostomy for trismus
– Horizontal incision below the angle
– Blunt dissection

43. Retropharyngeal abscess
• Acute
– In children
• Suppuration of lymph nodes
– In adults
• Penetrating trauma
• Chronic
– Tubercolous
• Lymph nodes
• Cervical spine

44. Clinical features
• Dysphagia
• Torticollis
• Bulge in post wall
• Stridor

45. Investigations
• X-Ray neck lateral view
• C T scan

46. Treatment
• I & D
• Anti TB drugs

47. Chronic pharyngitis
• Chronic inflammatory of the pharynx
characterized by hypertrophy of mucosa,
seromucinous glands and sub epithelial
lymphoid tissues

48. Chronic pharyngitis
• Chronic non specific
• Chronic specific

49. Non specific
• Persistent infection in neighborhood
• Mouth breathing
• Chronic irritants
• Environmental pollution

50. Symptoms
• Discomfort in throat
• Foreign body sensation
• Cough

51. Signs
• Congested post wall
• Odema of the wall
• Nodules on the wall
• Lateral pharyngeal bands

53. Treatment
• Predisposing factors
• Saline gargles
• Anti inflammatory drugs
• Cautry of the nodules

54. Questions

55. Thank you