ACUTE AND CHRONIC PHARYNGITIS & ATROPHIC PHARYNGITIS

1. PHARYNGI
TIS
DR AARYA SERIN

2. ACUTE
PHARYNGITIS

3. AETIOLOGY
Occurs due to varied aetiological
factors like viral, bacterial, fungal or
others
Viral causes are more common
Acute streptococcal pharyngitis (due to
Group A beta haemolytic streptococci)
has received more importance because
of its aetiology in rheumatic fever and
post-streptococcal glomerulonephritis.

4. Viral Bacterial Fungal
Miscellaneou
s
•Rhinoviruses
•Influenza
•Parainfluenza
•Measles and
chickenpox
•Coxsackie
virus
•Herpes
simplex
•Infectious
mononucleosis
•Cytomegalovir
us
•Streptococcu
s (Group A,
beta-
haemolyticus
)
•Diphtheria
•Gonococcus
•Candida
albicans
•Chlamydia
trachomatis
•Toxoplasmo
sis (parasitic,
rare)

5. CLINICAL FEATURES
Milder infections present with discomfort in
the throat, some malaise and low grade
fever.
Pharynx in these cases is congested
No lymphadenopathy.
Moderate and severe infections present
with pain in throat, dysphagia, headache,
malaise and high fever.
Pharynx in these cases shows erythema, exudate
and enlargement of tonsils and lymphoid follicles
on the posterior pharyngeal wall.
Very severe cases show oedema of soft

6. DIAGNOSIS
Culture of throat swab is helpful in the
diagnosis of bacterial pharyngitis.
It can detect 90% of Group A Streptococci.
Diphtheria is cultured on special media.
Swab from a suspected case of gonococcal
pharyngitis should be cultured immediately
without delay.
Failure to get any bacterial growth
suggests a viral aetiology.

7. TREATMENT
General measures
Bed rest, plenty of fluids, warm saline
gargles or pharyngeal irrigations and
analgesics form the mainstay of
treatment.
Local discomfort in the throat in severe
cases can be relieved by lignocaine
viscous before meals to facilitate
swallowing.

8. Specific treatment
Streptococcal pharyngitis (Group A, beta-
haemolyticus) is treated with
Penicillin G, 200,000 to 250,000 units orally
four times a day for 10 days or
benzathine penicillin G, 600,000 units once
i.m. for patient <60 lb in weight and 1.2
million units once i.m. for patient >60 lb.
In penicillin-sensitive individuals,
erythromycin, 20 to 40 mg/kg body weight
daily, in divided oral doses for 10 days is
equally effective.
Diphtheria is treated by diphtheria
antitoxin and administration of penicillin
or erythromycin
Gonococcal pharyngitis responds to
conventional doses of penicillin or

9. VIRAL INFECTIONS
CAUSING PHARYNGITIS
Herpangina
It is caused by Group A coxsackie virus and
mostly affects children.
Characteristic features include fever, sore throat
and vesicular eruption on the soft palate and
pillars.
Vesicles are small and surrounded by a zone of
erythema.
Infectious mononucleosis
It is caused by Epstein-Barr virus.
It is characterised by fever, sore throat,
exudative pharyngitis, lymphadenopathy,
splenomegaly and hepatitis.

10. Cytomegalovirus
It mostly affects immunosuppressed transplant
patients.
It mimics infectious mononucleosis but
heterophil antibody test is negative.
Pharyngoconjunctival fever
It is caused by an adenovirus
It is characterised by sore throat, fever and
conjunctivitis. There may be pain in abdomen,
mimicking appendicitis.

11. Acute lymphonodular pharyngitis
It is usually caused by a coxsackie virus
It is characterised by fever, malaise and sore
throat.
White-yellow, solid nodules appear on the
posterior pharyngeal wall in this type of
pharyngitis.
Measles and chickenpox
also cause pharyngitis
Measles is characterised by the appearance of
Koplik's spots (white spots surrounded by red
areola) on the buccal mucosa opposite the
molar teeth.
The spots appear 3-4 days before the
appearance of rash.

12. FUNGAL
PHARYNGITIS
Candida infection of the oropharynx can
occur as an extension of oral thrush.
It is seen in patients who are
immunosuppressed, debilitated or taking
high doses of antimicrobials.
Nystatin is the drug of choice.

13. MISCELLANEOUS
CAUSES OF
PHARYNGITIS
Chlamydia trachomatis infection causes
acute pharyngitis and can be treated by
erythromycin or sulphonamides.
Toxoplasmosis is caused by Toxoplasma
gondii, an obligate intracellular parasite.

14. CHRONIC
PHARYNGITIS

15. It is a chronic inflammatory condition of the
pharynx.
Pathologically, it is characterised by
hypertrophy of mucosa, seromucinous
glands, subepithelial lymphoid follicles and
even the muscular coat of the pharynx.
Chronic pharyngitis is of two types:
1. Chronic catarrhal pharyngitis
2. Chronic hypertrophic (granular)
pharyngitis.

16. AETIOLOGY
1. Persistent infection in the neighbourhood
In chronic rhinitis and sinusitis, purulent discharge
constantly trickles down the pharynx and provides a
constant source of infection. This causes hypertrophy of
the lateral pharyngeal bands.
2. Mouth breathing
Breathing through the mouth exposes the pharynx to
air which has not been filtered, humidified and adjusted
to body temperature thus making it more susceptible to
infections.
Mouth breathing is due to:
 (i) Obstruction in the nose
 (ii) Obstruction in the nasopharynx

17. 3. Chronic irritants
Excessive smoking, chewing of tobacco and
pan, heavy drinking, highly spiced food
4. Environmental pollution
Smoky or dusty environment or irritant
industrial fumes
5. Faulty voice production
Excessive use of voice or faulty voice
production seen in certain professionals or in
"pharyngeal neurosis" where person resorts to
constant throat clearing, hawking or snorting,
and that may cause chronic pharyngitis,
especially of hypertrophic variety.

18. SYMPTOMS
1. Discomfort or pain in the throat This is especially
noticed in the mornings.
2. Foreign body sensation in throat Patient has a
constant desire to swallow or clear his throat to get
rid of this "foreign body".
3. Tiredness of voice Patient cannot speak for long
and has to make undue effort to speak as throat
starts aching. The voice may also lose its quality
and may even crack.
4. Cough Throat is irritable and there is tendency to
cough. Mere opening of the mouth may induce
retching or gagging.

19. SIGNS
Chronic catarrhal pharyngitis
•congestion of posterior pharyngeal wall with
engorgement of vessels; faucial pillars may be thickened
•increased mucus secretion which may cover pharyngeal
mucosa.
Chronic hypertrophic (granular) pharyngitis
•Pharyngeal wall appears thick and oedematous with
congested mucosa and dilated vessels.
•Posterior pharyngeal wall may be studded with reddish
nodules. These nodules are due to hypertrophy of
subepithelial lymphoid follicles normally seen in pharynx
•Lateral pharyngeal bands become hypertrophied.

20. GRANULAR PHARYNGITIS.
NOTE: REDDISH NODULES ON THE
POSTERIOR PHARYNGEAL WALL

21. TREATMENT
1. In every case of chronic pharyngitis,
aetiological factor should be sought and
eradicated.
2. Voice rest and speech therapy is essential for
those with faulty voice production. Hawking,
clearing the throat frequently or any other such
habit should be stopped.
3. Warm saline gargles, especially in the
morning, are soothing and relieve discomfort.
4. Mandl's paint may be applied to pharyngeal
mucosa.

22. ATROPHIC
PHARYNGITIS

23. It is a form of chronic pharyngitis often seen
in patients of atrophic rhinitis.
Pharyngeal mucosa along with its mucous
glands shows atrophy.
Scanty mucus production by glands leads to
formation of crusts which later get infected
giving rise to foul smell.
Clinical Features
Dryness and discomfort in throat are the
main complaints.
Hawking and dry cough may be present due
to crust formation.
Examination shows dry and glazed
pharyngeal mucosa often covered with
crusts.

24. TREATMENT
Aim is to remove the crusts and promote
secretion.
The crusts can be removed by spraying the
throat with alkaline solution, or pharyngeal
irrigation.
Mandl's paint applied locally has a
soothing effect.
Potassium iodide, 325 mg, administered
orally for a few days helps to promote
secretion and prevents crusting.

25. KERATOSIS
PHARYNGITISIt is a benign condition characterised by horny
excrescences on the surface of tonsils,
pharyngeal wall or lingual tonsils appearing as
white or yellowish dots.
These excrescences are the result of
hypertrophy and keratinisation of epithelium.
They are firmly adherent and cannot be wiped
off.
The disease may show spontaneous regression
and does not require any specific treatment
except for reassurance to the patient.