Acute-diseases-of-pharynx_Acute-diseases-of-pharynx

1. Acute pharynx diseases
Department of Ear, Nose and Throat
diseases
Sechenov University
Moscow, Russia

diseases
Sechenov University
Moscow, Russia
Lecturer Kochetkov Petr Aleksandrovich,
PhD, associate professor
1.1. Part 1 Acute pharyngeal diseases

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

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)

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.

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

Viruses - causative agents of acute
pharyngitis
Basic:
• Rhinoviruses
• Coronaviruses
• Adenoviruses
• Flu virus
• Parainfluenza virus
• New viruses
(metapneumo-,
bocavirus)
Rare:
• Respiratory Synthial Virus
• Herpes simplex viruses
Enteroviruses
• Coxsackie virus
• Epstein-Barr virus
• Cytomegalovirus
• HIV

Bacterial pathogens of acute pharyngitis

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)

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
https://pixabay.com/ru/photos/?q=%D0%B0%D0%BD%D0%B3%D0%B8%D0%BD%D0%B0&hp=&image_type=all&order=&cat=&min_width=&min_height=

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

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.

diseases
Sechenov University
Moscow, Russia

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.

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

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

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

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

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)

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

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

Primary sore throats. Lacunar angina
• Mostly Bacterial Flora (BHSA)
• The clinical picture resembles
follicular tonsillitis
• Hyperemia, infiltration, swelling of
tonsils, arches
• Mucopurulent plaque in the area of
tonsil lacunae, loose, easily
removable
• Severe inflammatory changes in the
blood
https://pixabay.com/ru/photos/?q=%D0%B0%D0%BD%D0%B3%D0%B8%D0%BD%D0%B0&hp=&image_type=all&order=&cat=&min_width=&min_height

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.

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%)

Department of Ear, Nose and Throat diseases
Sechenov University
Moscow, Russia

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

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

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

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”
https://pixabay.com/ru/photos/?q=%D0%B0%D0%BD%D0%B3%D0%B8%D0%BD%D0%B0&hp=&image_type=all&order=&cat=&min_

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

• 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

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)

• 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

Antibacterial therapy of streptococcal
tonsillitis
• Sore throat without risk factors: β-lactam antibiotics
(protected and unprotected penicillins, cephalosporins)
• Intolerance to β-lactam antibiotics - macrolides

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

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)

Typical localizations:
• Front-upper (more than
70%)
• Rear (16%)
• Lower (7%)
• Lateral (4%)

• The condition of the patient of
moderate severity is severe
• Refusal of food and fluid
• Extremely pronounced unilateral
pain
• Trismus chewing muscles
• Soft sky asymmetry
• Unilateral lymphadenitis

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)

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

Drugs:
• Parenteral antibiotics (protected penicillins,
cephalosporins, metronidazole
• Gargling with solutions of antiseptics, washing the
cavity of the abscess.
• Symptomatic treatment

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

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