1. PHARYNGITIS
DEPT OF
OTORHINOLARYNGOLOGY
JJM M C
DAVANAGERE

2. Pharyngitis
ACUTE:
•very common condition encountered in medicine.
•One of the poorly understood condition.
•Many have no scientific basis.
•Several questions remain unanswered
 Do viral infections predispose to bacterial
infection?
Do viral infections involve pharyngeal lymphoid
tissue without involving tonsils?

3. Pharyngitis
 Is there a condition like chronic tonsillitis?
 Is there a infective condition like chronic
pharyngitis?
 Why are some patients susceptible to acute
pharyngitis/tonsillitis?
 Does the tonsil become irreversibly diseased
after many episodes of acute tonsillitis?
 Does removal of tonsils predispose for more
frequent episodes of pharyngitis?

4. Pharyngitis
 There is poor co-relation between surface culture swabs
from core culture.
 Presence of organisms in throat culture does not mean that it
is pathogenic or vice versa is also true for streptococci,
haemophilus influenza (aerobic) therefore suggested that
may be caused by anaerobes.
 Size of the tonsil is not directly related to their infective
state,infact sunken tonsils are immunologically
incompetent.
 Parenchymatous tonsillitis, chronic tonsillitis, streptococcal
pharyngitis and chronic hypertrophic pharyngitis are non
proven category.

5. Pharyngitis-aetiology
 Viral (42%)- a) Adenovirus (most common 31%)
b) Epstein –Barr virus(6%)
c) Influenza virus(5%)
 Bacterial –Mixed infection common(48%)
-beta-hemolytic streptococci(38%)
-H. influenza
-staphylococcus aureus
-diphtheria
-gonococcus
-anaerobes remain uncertain.
 Fungal –Candida albicans.

6. Pharyngitis-clinical features
 Mild infection-discomfort ,malaise ,low grade
fever ,congested ,no lymphadenopathy.
 Moderate-pain, dysphagia, headache, high fever.
-congested, oedematous, exudates.
-enlarged tonsils, lymphoid follicles of
posterior pharyngeal wall.
-lymph nodes palpable and tender.
 viral infection mild-associated with rhinorrhoea.
 Voice change-severe bacterial infection.
 Gonococcal pharyngitis-mild or even symptomless.

7. Pharyngitis-diagnosis &treatment
 Diagnosis-culture & sensitivity-may be helpful.
 Treatment –general measures-bed rest ,fluids ,warm
saline gargle, analgesics.
-specific-penicillin g-oral or injection.
-if sensitive- macrolides.

8. Chronic Pharyngitis
 Characterized by hypertrophy of mucosal
seromucinous glands, sub epithelial lymphoid
tissue, even muscular coat.
 Two types-a) catarrhal (mucosal)
-b) hypertrophic

9. Chronic Pharyngitis- aetiology
 Persistent infections- chronic rhinosinusitis with
post nasal drip, chronic tonsillitis, dental sepsis
 Mouth breathing-nasal polyp, DNS with Hit's,
allergic/vasomotor rhinitis, nasopharyngeal
adenoids, tumours.
-with mouth breathing air is not filtered,
humidified and temperature conditioned.
 Chronic irritants-smoking, tobacco chewing,
alcohol, highly spicy food.

10. Chronic Pharyngitis- aetiology
 Environmental-smoke, dust, chemicals,
occupational fumes.
 Faulty voice production- misuse/over use

11. Chronic Pharyngitis- symptoms
1) Discomfort, pain-more during morning.
2) Foreign body sensation-constant desire to
swallow or clear throat.
3) Voice tiredness.
4) cough

12. Chronic Pharyngitis- signs
 Catarrhal- congestion, vascular engogement,
increased secretions.
 Hypertrophic-pharyngeal wall thick,
edematous, congested mucosa and dilated
vessels.
-posterior pharyngeal wall studded with reddish
nodules-(granular pharyngitis) due to sub epithelial
lymphoid follicle hypertrophy.
-uvula congested and elongated.

13. Chronic Pharyngitis-treatment
 Etiological factor sought and eradicated.
 Voice rest –speech therapy.
 Warm saline gargle.
 Severe granular type-chemical or diathermy
cautery done.

14. GRANULAR PHARYNGITIS

15. Chronic Pharyngitis-treatment

16. Atrophic pharyngitis
 All the layers become atrophied.
 Secondary to atrophic rhinitis.
 Clinical features: dryness, discomfort,
hawking-dry cough.
 Signs: dry glazed pharygeal mucosa often
covered with crusting.
 Treatment: treat the primary nasal cause, saline
gargle.
-potassium iodide(325mg orally) promote
secretions.

17. Keratosis pharyngitis
 Benign condition characterized by horny
white/yellow excrescences on the surface of
the tonsils, pharyngeal wall, lingual tonsils-
Result of hypertrophy & keratinisation of
epithelium.
 Firmly adherent, cannot be wiped off.
 No accompanying inflammation.
 Spontaneous regression, does not require any
treatment.
 Assurance.

18. Keratosis pharyngitis

19. Chronic specific pharyngitis
 Syphilitic
 Tuberculosis
 Leprosy
 Toxoplasmosis
 Scleroma