Acute pharyngitis is a sudden painful inflammation of the pharynx, the back portion of the throat that includes the posterior third of the tongue, soft palate, and tonsils. It is commonly referred as a sore throat. It is the most common infection and inflammation of the respiratory tract. The incidence of Pharyngitis peaks during winter and early spring in regions that have warm summers and cold winters because of environmental exposure to viral agents and poorly ventilated rooms. Viral pharyngitis spreads easily in the droplets of coughs and sneezes and unclean hands that have been exposed to the contaminated fluids.
Chronic pharyngitis is a persistent inflammation of the pharynx. It is common in adults who work in dusty surroundings, abuse of voice such as stage performer or singer, suffer from a chronic cough, or habitually use alcohol and tobacco. There are three types of chronic pharyngitis:
- Hypertrophic: It is characterized by general thickening and congestion of the pharyngeal mucous membrane.
- Atrophic: It is probably a late stage of the first type (the membrane is thin, whitish, glistening and at times wrinkled)
- Chronic granular (Clergyman’s sore throat): It is characterized by numerous swollen lymph follicles on the pharyngeal wall.
Pathophysiology of Pharyngitis
Pharyngitis is caused by viral or bacterial agents. The responsible viruses include the adenovirus, influenza virus, Epstein-Barr Virus and herpes simplex virus. The bacterial organisms implicated in pharyngitis include mycoplasma pneumonia, Neisseria gonorrhoeae and H. Influenzae type B. M. pneumoniae is one of the most common bacterial pathogens of the respiratory tract and is encountered frequently in the people with upper respiratory tract symptoms. 10% of the adults with pharyngitis have group A beta-hemolytic streptococcus or commonly referred as group A streptococcus (GAS). When GAS causes acute pharyngitis, the condition is known strep throat. The body responds by triggering an inflammatory response in the pharynx. This results in pain, fever, vasodilation, edema and tissue damage, manifested by redness and swelling in the tonsillar pillars, uvula and soft palate. A creamy exudate may be present in the tonsillar pillars. Uncomplicated viral infection usually subsides within 3 to 10 days after the onset. However, pharyngitis caused by virulent bacteria is a more severe condition.
Clinical features (Acute pharyngitis)
The signs and symptoms of acute pharyngitis include:
- A fiery-red pharyngeal membrane and tonsils.
- Lymphoid follicles that are swollen and flecked with white-purple exudate.
- enlarged and tender cervical nodes and no cough.
- High fever (with or without chills).
- Malaise and sore throat also may be present.
- Patients with GAS pharyngitis exhibit vomiting, anorexia, and a scarlatina-form rash with urticaria known as scarlet fever.
- Tonsils appear swollen and erythematous.
- Bad breath is common.
The patient with chronic pharyngitis complain of:
- Constant Sense of irritation or fullness in the throat.
- Mucus collects in the throat and can be expelled by coughing.
- Difficulty in swallowing.
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Diagnostic findings and Assessment of Pharyngitis
Accurate diagnosis of pharyngitis is essential to determine the cause (viral or bacterial) and to initiate treatment early.
- The diagnosis is made based on the presenting symptoms.
- Swab specimens obtained from posterior pharynx and tonsils (tongue not included).
- Rapid streptococcal antigen test (RSAT) used with professional clinical evaluation.
- A backup culture of negative rapid antigen tests.
Complications of Pharyngitis
- Otitis media
- Peritonsillar abscess
- Cervical adenitis
- If left untreated, it can be life-threating
Treatment of Pharyngitis
Viral pharyngitis is treated with supportive therapy measures, whereas antibiotic agents are used to treating pharyngitis caused by bacteria: penicillin (5 days) for a group A streptococci and cephalosporins and macrolides (from 3 to 10 days) for those patients with penicillin hypersensitivity or erythromycin resistance. In severe instances, Iv fluids are administered if the patient cannot swallow. Liquid or soft diet is recommended during the acute stage and he/she is encouraged to drink at least 2 to 3 liters of fluid daily. Analgesic medications or NSAIDs (Non-steroid anti-inflammatory drugs) for example aspirin, ibrufen or acetaminophen can be given at 4 to 6 hours interval.
Treatment of chronic pharyngitis is based on symptom relief; avoidance of exposure to irritants. Early treatment of any upper respiratory, pulmonary or cardiac condition that might be responsible for a chronic cough. Nasal spray or medications containing ephedrine sulphate or phenylephrine hydrochloride are used to relieve nasal congestion. Tonsillectomy may be an effective option for recurrent infection if consideration is given to morbidity, complications relating to the surgery.
Home Remedies of Pharyngitis
- A soft diet or liquid is recommended during the acute stage of the disease.
- Cool beverages, warm liquids and flavored frozen desserts such as popsicles are often soothing.
- Have plenty of water for drinking at least 2 to 3 liters per day.
- Stop smoking or chewing tobacco (most importantly).
- Avoid alcohol
- Oral care to prevent fissures of lips and inflammation in the mouth.
- Gargle with salt water every day before sleeping.
- Proper disposition of secretions to prevent the spread of infection.
- Have a ginger tea or warm water mixed with ginger, salt, and turmeric.
- Prevent exposure to the cold environment and dust/smoke.
- Wear a mask for protection.
- Rest follow up
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