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Infection of the pharynx can involve any part of the pharynx, but the oropharynx is commonly involved.
It could be;
- Acute
- Non-specific pharyngitis
- Specific infection e.g., diphtheria
- Chronic
- Non-specific infection
- Specific infection e.g., TB, Syphilis, Leprosy, Scleroma
It may involve any part or all parts of the upper respiratory tract.
Affects children between 2 and 5 years.
Incidence has reduced because of vaccination (EPI).
It is caused by gram-positive bacilli Corynebacterium diphtheriae organisms which may be:
- Gravis
- Intermedius
- Mitis
Pathology
- Infection mainly involves the mucosa of the pharynx, tonsil, nose, and larynx.
- Epithelial necrosis occurs with excessive serous exudate.
- There is formation of fibrin and phagocytes leading to firmly adherent membrane which is greyish white in color.
- The bacteria produce an exotoxin which can cause myocarditis and neuritis.
Clinical Features
- Incubation period is 1 – 7 days.
- It is insidious, starts with sore throat, headache, mild fever, and malaise.
- Tachycardia out of proportion to the disease.
- Nose: Nasal discharge.
- Larynx: Hoarseness, stridor.
- Death: Due to toxemia which affects the myocardium, severe thrombocytopenia, and airway obstruction.
Examination
- Greyish green false membrane on the tonsils, soft palate, and pharynx.
- Membrane may also appear greyish brown.
- The membrane is difficult to detach and if detached, it leaves behind a bleeding surface.
- It could spread from the pharynx to the larynx causing rapidly increasing airway obstruction which may require emergency tracheostomy.
- Bilateral tender cervical lymphadenopathy in jugulodiagastric (bull neck) node.
Complications
- Peripheral neuritis
- Myocarditis
Diagnosis
Until proved otherwise, every membranous condition in the oral cavity should be suspected as diphtheria.
Culture: Throat swab cultured in Loeffler’s medium.
Microscopic examination: Show Chinese letter pattern with Albert’s stain.
Differential Diagnosis
- Acute streptococcal tonsillitis
- Infectious mononucleosis
- Acute leukemia
- Agranulocytosis
- Moniliasis
- Vincent angina
Prevention
Immunization is very important (triple antigen).
Treatment
- Isolation
- Bed rest to prevent diphtheric carditis
- Penicillin or erythromycin is bactericidal
- Tracheostomy may be necessary if there is stridor
- Neutralization of toxin with equine antitoxin 20,000 I.U or more depends on severity
Also known as acute necrotizing ulcerative gingivitis.
It is an ulcerative disease of the oral cavity and pharynx caused by spirochete borrelia vincenti (sp. denticola) and gram-negative fusiform bacilli.
Common in young adults.
Predisposing Factors
- Inadequate rest, overwork
- Extreme emotional stress
- Dental carries
- Marginal gingivitis
- Bad oral hygiene
- Poor nutrition
Symptoms
- Sore throat
- Fever
- Odynophagia
- Halitosis
- Painful gums
- Bleeding gums
- Drooling saliva
- Bad metallic taste
- Malaise
- Loss of appetite
Examination
- Greyish white patches on tonsils, soft palate
- Membrane easily removed leaving a red area
Diagnosis
- Throat swab for MCS
- Severe leukocytosis
Treatment
- Bed rest
- Systemic penicillin, erythromycin, metronidazole
- Antiseptic mouthwash
- Sodium bicarbonate mouthwash to remove secretions
Caused by:
- Chickenpox
- Measles
- Infectious mononucleosis
Clinical Features
- Sore throat
- Fever
- Congestion of the throat
- Viral pharyngitis is common in the catarrhal stage of fever
Aetiology
- Rhinosinusitis: post-nasal drip from the nose, sinuses and may cause pharyngitis
- Tonsillitis: recurrent attacks of tonsillitis
- Dental caries
- Gingivitis
- Allergy
- Mouth breathing
- Smoking
- Alcoholism causes vasodilation and pharyngitis
- Fumes from dust may be occupational predisposition
- GERD
Symptoms
- Sore throat
- Chronic throat irritation with throat clearing
- Foreign body sensation in the throat
- Hawking, humming, and gagging
- Change in voice if associated with laryngitis
Examination
Catarrhal: congestion of the pharynx and engorgement of blood vessels on the posterior pharyngeal wall and smooth
Treatment
- Treat the primary cause
- Stop smoking
- Mouthwash
- If lymphocytic follicles are enlarged, you can cauterize with 10% silver nitrate
- Give antibiotics if infective
Foreign Body in the Pharynx
Types
- Fish bone
- Denture
- Pin
Usual Sites
- Crypts of tonsils
- Base of the tongue
- Vallecula
- Pyriform sinus
- Posterior pharyngeal wall
- Level of cricopharyngeal sphincter
Symptoms
- Pain in the throat
- Pricking sensation on swallowing
- Dysphagia
- Odynophagia
- Blood in sputum
Retropharyngeal Abscess
Examination
- Indirect laryngoscopy may show foreign body
- Fiberoptic flexible endoscopy
- Videolaryngopharyngoscopy
Investigation
- Neck x-ray
- AP
- Lateral
- May demonstrate radio-opaque foreign body
- CT Scan: in a long-standing FB
Treatment
- Removal by indirect laryngoscopy under local anesthesia
- Or
- Direct pharyngoscopy under general anesthesia
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