1. 1. Acute pharynx diseases
Department of Ear, Nose and Throat
diseases
Sechenov University
Moscow, Russia
2. Department of Ear, Nose and Throat
diseases
Sechenov University
Moscow, Russia
Lecturer Kochetkov Petr Aleksandrovich,
PhD, associate professor
1.1. Part 1 Acute pharyngeal diseases
3. Causes of soat throat
• Infectious factors (viruses, bacteria, fungi)
• Impurities in the air, occupational hazards, smoking
• Hot or annoying food / drink
• Acute cough and chronic cough
• Post-nasal drip, gastroesophageal reflux disease
• Surgical treatment of diseases of the pharynx, thyroid gland,
larynx
• Osteochondrosis of the cervical spine
• Foreign bodies of the pharynx, esophagus, larynx
• Drags (anticholinergic drug)
• Diseases of the maxillofacial system
4. Infectious factors of soat throat
• In most cases, viruses are the cause of sore throat
• Only in 5-15% of adult patients the disease is
caused by bacterial agents (β-hemolytic group A
streptococcus)
5. Acute pharyngitis
• Acute inflammation of the mucous membrane of the
posterior pharyngeal wall
• Most often a manifestation of ARVI
• Combined with inflammation of the mucous membrane
of the nasal cavity and nasopharynx (rhinopharyngitis)
• Possible combination with acute tonsillitis (acute
tonsillopharyngitis)
• The incidence increases during the period of epidemic
viral infections.
6. Factors that contribute to pharyngitis
• Subcooling, talking in the cold
• Long mouth breathing
• Chronic diseases of the upper respiratory tract
(rhinosinusitis, adenoiditis, diseases of the teeth and
periodontal)
• Gastrointestinal pathology (GERD)
• Irritating Nutrition Factors
• Allergic conditions
9. Clinical pattern of acute pharyngitis
• General health unchanged, slight weakness, malaise
• Normal (low-grade) temperature
• Dry, sore, sore throat
• Pain when swallowing (more, with "empty" pharynx),
irradiation in the ear
• Foreign body sensation in the throat
• Possible regional lymphadenitis (maxillary lymph nodes)
10. Clinical pattern of acute pharyngitis
• Hyperemia, swelling of the
mucous membrane of the
pharynx, especially in the
posterior wall with a viscous
mucosa, mucopurulent plaque
• Possible increase in individual
granules of the posterior
pharyngeal wall in the form of
bright red rounded elevations
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11. Acute pharyngitis
Treatment:
• Home regimen and diet - exclusion of irritating (hot,
cold, acidic, spicy, salty) foods, exposure to nicotine,
alcohol, and observance of the voice regime
• antioxidants: vitamin C
• antiviral drugs, systemic NSAIDs - with signs of general
intoxication
• Systemic antibiotics - not used
• The basis of treatment is topical remedies
12. The prognosis for cute pharyngitis
• The course of acute pharyngitis in the vast majority of
cases is favorable
• If a concomitant pathology of the UD is detected, its
treatment is recommended for the prevention of
relapse of acute pharyngitis.
13. Department of Ear, Nose and Throat
diseases
Sechenov University
Moscow, Russia
Lecturer Kochetkov Petr Aleksandrovich,
PhD, associate professor
1.1. Part 2 Acute pharyngeal diseases
14. Acute tonsillitis (angina)
• A common acute infectious disease in which local
inflammation affects the lymphadenoid tissue of various
tonsils of the pharynx.
• Palatine tonsils are more commonly affected.
15. Types of tonsillitis
Anatomically
• Angina of the tonsils (in the vast majority of cases)
• Pharyngeal tonsillitis (retronasal tonsillitis, acute
adenoiditis)
• Laryngeal tonsillitis
• Angina tonsillae lingualis
16. Types of tonsillitis
Occurrence
• Occasional sore throat (auto-infection as a result of a
decrease in body resistance)
• Epidemic tonsillitis (infection from a sick person, by
airborne droplets or alimentary)
• Angina as an exacerbation of chronic tonsillitis
17. Clinical classification of tonsillitis
• Primary - catarrhal, follicular, lacunar, mixed,
phlegmonous
• Secondary, for infectious diseases (measles, scarlet
fever, infectious mononucleosis, diphtheria, HIV,
syphilis, herpes)
• Secondary in blood diseases - leukemia,
agranulocytosis
• Specific – Angina of Simanovsky-Vincent-Plaut, fungal
18. Etiology of primary tonsillitis
Causative agent
Incidence(%)
Childrens Adults
Bacteria 30-40 5-10
Streptococcus group А 28-40 5-9
Streptococcus (groups C,
G)
0-3 0-18
M. pneumoniae 0-3 0-10
C. pneumoniae 0-3 0-9
Viruses 15-40 30-60
Idiopathic 22-55 30-65
19. Clinic of tonsillitis (acute streptococcal
tonsillopharyngitis)
Typical symptoms:
• Febrile temperature (up to 39 and higher)
• sharp sore throat with every swallowing movement
• Lack of cough
• Plaques on the tonsils of a mucopurulent nature,
hyperemia and swelling of the palatine arches and
tonsils, exudate in the gaps regional lymphadenitis
(maxillary lymph nodes)
20. Primary sore throats. Catarrhal sore
throat
• Viral or bacterial flora
• Mild signs of intoxication
• Mostly local hyperemia of
tonsils, palatine arches
• No raids
• minor to moderate signs
of inflammation in the
blood
Архив кафедры
21. Primary sore throats. Follicular tonsillitis
• Mostly Bacterial Flora (BHSA)
• Severe intoxication
• Hyperemia, infiltration, swelling of
tonsils, arches
• The presence of white-yellow dots
(vesicles) up to 1-2 mm in size,
towering above the surface of the
tonsils - suppurative follicles
• Severe inflammatory changes in
the blood
Архив кафедры
22. Primary sore throats. Lacunar angina
• Mostly Bacterial Flora (BHSA)
• The clinical picture resembles
follicular tonsillitis
• Severe intoxication
• Hyperemia, infiltration, swelling of
tonsils, arches
• Mucopurulent plaque in the area of
tonsil lacunae, loose, easily
removable
• Severe inflammatory changes in the
blood
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23. Pharyngeal tonsillitis (Acute
adenoiditis)
• The pharyngeal
tonsil is edematous,
hyperemic, purulent
discharge is traced
on the surface.
• Moderate
intoxication, difficulty
in nasal breathing is
expressed.
Архив кафедры
24. Diagnostic methods for streptococcal
tonsillitis
• Microbiological diagnosis
• Rapid diagnosis of streptococcal antigen
________________________________________________
• Microbiological examination
• High sensitivity (up to 90%), but a long wait for results is necessary
• Express diagnostics - steptotests
• Fast, economical, highly specific method, but a large sensitivity range
(50-95%)
25. Department of Ear, Nose and Throat diseases
Sechenov University
Moscow, Russia
Lecturer Kochetkov Petr Aleksandrovich,
PhD, associate professor
1.1. Part 3 Acute pharyngeal diseases
26. Angina with infectious mononucleosis
(Filatov’s disease, Pfeifer’s disease, glandular
fever, monocytic angina)
• Angina occurs in 80%, develops on day 3-5 of
the disease against the background of already
existing common lymphadenitis (cervical
(bovine neck), occipital, axillary, abdominal,
inguinal, etc.)
• Characterized by a white coating on the tonsils
• Blood test: a significant increase in the number
of lymphocytes and monocytes (a total of more
than 60%), atypical mononuclear cells
• Etiology: Epstein-Barr virus
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27. Angina with diphtheria
• Localized Form:
• dense deposits on tonsils, are
removed with difficulty, do not
rub on a glass slide, settle in
water without dissolution, leave
behind a bleeding surface -
“blood dew”
• Common form:
• The raids go beyond the tonsils to
the palatine arches, soft palate
Архив кафедры
28. Angina of Simanovsky-Plaut-Vincent
(ulcerative-filmy angina)
Pathogens: symbiosis of spindle bacillus
(B. fusiformis) and spirochetes of the
oral cavity (spirochaeta buccalis)
• General well-being suffers little
• One-way process
• No or slight pain
• Foreign body sensation
• Unilateral lymphadenitis
• Hypersalivation
• An ulcer covered with friable plaque. Perhaps
spread to the arches and other parts of the
oropharynx
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29. Angina with scarlet fever
• Reminds catarrhal and lacunar
tonsillitis
• Rashes on the skin of a generalized
nature - roseola, excluding the
nasolabial triangle
• Spilled hyperemia of the mucous
membrane of the oral cavity and
pharynx is a “flaming pharynx”,
which is replaced by plaques or
necrosis
• Language Changes - “Raspberry
Tongue”
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30. Sore throat with measles
• Reminds sore throat with scarlet
fever
• Enanthema - red spots of 1-2 mm on
the mucosa of the palate, cheeks,
back wall of the pharynx.
• Rashes on the inner surface of the
cheeks - Filatov-Koplik spots
• Skin rash - a bright, spotty-papulose
rash on the background of
unchanged skin.
http://hdimagelib.com/koplik+spots?image=23566483
31. • Antiviral drugs
• Home mode and diet (it is necessary to exclude annoying
food, exposure to nicotine, alcohol), observe the voice
mode
• NSAIDs (if necessary)
• The use of topical preparations (tablets, lozenges,
aerosols)
Treatment of patients with viral
tonsillitis
32. Etiotropic treatment of viral tonsillitis
• Drugs that directly affect respiratory viruses that inhibit the
replication of the virus and its components (umifenovir,
oseltamivir, pentanedioic imidazolylethanamide)
33. • Systemic antibiotic therapy
• Bed mode (at home or in an infectious hospital)
• A sparing diet, with a restriction of spicy, annoying food,
heavy drinking
• NSAIDs
• The use of topical antibacterial drugs, oral antiseptics
(tablets, lozenges, aerosols)
Treatment of bacterial (streptococcal)
tonsillitis
34. Antibacterial therapy of streptococcal
tonsillitis
• Sore throat without risk factors: β-lactam antibiotics
(protected and unprotected penicillins, cephalosporins)
• Intolerance to β-lactam antibiotics - macrolides
35. Complications of streptococcal tonsillitis
• early (purulent) complications developing 4-6 days after
the onset of the disease - otitis media, sinusitis, abscesses
(paratonsillar, parapharyngeal, pharyngeal)
• late (non-purulent) complications developing:
• a) in the stage of convalescence (8-10th day from the
onset of the disease) - post-streptococcal
glomerulonephritis, toxic shock;
• b) 2-3 weeks after the relief of symptoms of tonsillitis -
rheumatic fever
36. Paratonsillar abscess
• nflammation of paratonsillar tissue between the capsule of the
tonsil and the muscles that compress the pharynx
STAGES:
Infiltrative (paratonsillitis)
Abscessing (paratonsillar abscess)
38. Paratonsillar abscess
• The condition of the patient of
moderate severity is severe
• Refusal of food and fluid
• Severe intoxication
• Extremely pronounced unilateral
pain
• Trismus chewing muscles
• Soft sky asymmetry
• Unilateral lymphadenitis
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39. Treatment of paratonsillar abscess
• At the stage of infiltration (paratonsillitis) - hospitalization,
dynamic observation, systemic antibiotic therapy. If suspected
maturation of the abscess, diagnostic puncture
• When forming an abscess, 2 options for therapeutic
tactics:
• lancing of paratonsillar
abscess. In the cold period
(after a month) -
tonsillectomy
• Absconstonsillectomy
(simultaneous opening of an
abscess and removal of
tonsils)
40. Lancing of paratonsillar abscess
• The incision at the site of
greatest bulging of the
mucous membrane
• Breeding the
edges of the cut;
washing his
cavity with
antiseptic
solutions
Архив кафедры
41. Drugs:
• Parenteral antibiotics (protected penicillins,
cephalosporins, metronidazole
• Gargling with solutions of antiseptics, washing the
cavity of the abscess.
• Symptomatic treatment
42. References
• Clinical recommendations of the Ministry of Health of
the Russian Federation
• Ovchinnikov Yu.M., Lopatin A.S., Gamov V.P. Diseases
of the nose, pharynx, larynx and ear. Textbook. MIA
2008