Chronic Pharyngitis

Overview of Chronic Pharyngitis

A triad of sore throat, fever, and pharyngeal inflammation marked by erythema and edema are usually described as acute pharyngitis, although exudates, vesicles, or ulcerations may also be present.

The inflammation of the pharynx, which presents as a sore throat, is pharyngitis. It is a painful inflammation of the pharynx and is colloquially referred to as a sore throat.

Pharyngitis is a common medical problem in the outpatient medical setting, resulting in more than seven million pediatric visits each year.

Most types of pharyngitis are caused by infectious etiologies. The most common cause of pharyngitis is a viral infection.

However, some of the more serious types of pharyngitis are attributed to bacterial etiologies, such as group A-hemolytic Streptococcus pyogenes (GAS).

Complications from GAS pharyngitis include rheumatic fever, deep space abscesses, and toxic shock. Although most episodes of pharyngitis are acute in nature, a small percentage becomes recurrent or chronic. With regards to chronic pharyngitis, non-infectious etiologies, such as Laryngopharyngeal reflux disease and periodic fever, aphthous ulcers, pharyngitis, and adenitis syndrome also need to be considered.

Both medical and surgical therapies are effective in managing pharyngitis. Antibiotic treatment requires first-line medical therapy. Surgical management via adenotonsillectomy is recommended for certain indications. Adenotonsillectomy has been shown to be effective in reducing the burden of disease and improving the global quality of life and disease-specific.

Several procedures, including traditional and intracapsular tonsillectomies, exist for adenotonsillectomy. (3)

Indian epidemiology then other

Causes of Chronic Pharyngitis

A large number of factors are responsible:

1. Persistent infection in the neighborhood. In detail, In chronic rhinitis and sinusitis, purulent discharge constantly trickles down the pharynx and provides a constant source of infection. Furthermore, This causes hypertrophy of the lateral pharyngeal bands. Similarly, chronic tonsillitis and dental sepsis are also responsible for chronic pharyngitis and recurrent sore throats. [1]
2. Mouth breathing. Besides this, 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:

(a) Firstly, Obstruction in the nose, e.g. nasal polypi, allergic or vasomotor rhinitis, turbinal hypertrophy, deviated septum or tumors.

(b) Secondly, Obstruction in the nasopharynx, e.g. adenoids and tumors.

(c) Thirdly, Protruding teeth which prevent apposition of lips.

(d) Lastly, Habitual, without any organic cause.

3. Chronic irritants. For example, Excessive smoking, chewing of tobacco and pan, heavy drinking or highly spiced food can all lead to chronic pharyngitis.
4. Environmental pollution. In detail, Smoky or dusty environment or irritant industrial fumes may also be responsible for chronic pharyngitis.
5. Faulty voice production. Less often realized but an important cause of chronic pharyngitis is the 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, also that may cause chronic pharyngitis, especially of hypertrophic variety

Types of Chronic Pharyngitis

1. Chronic catarrhal Pharyngitis
2. Chronic hypertrophic Pharyngitis

Other types

KERATOSIS PHARYNGITIS

In general, It benign condition characterized by horny excrescences on the surface of tonsils, pharyngeal wall or lingual tonsils. Moreover, They appear as white or yellowish dots. These excrescences the result of hypertrophy also keratinization of epithelium. They are firmly adherent and cannot wipe off. There is no accompanying inflammation nor any constitutional symptoms and thus can easily differentiate from acute follicular tonsillitis. Besides this, The disease may show spontaneous regression and may not require any specific treatment except for reassurance to the patient.

ATROPHIC PHARYNGITIS

It a form of chronic pharyngitis often seen in patients of atrophic rhinitis. Pharyngeal mucosa along with its mucous glands shows atrophy. Additionally, Scanty mucus production by glands leads to formation of crusts, which later get infected giving rise to foul smell.

Dryness also discomfort in throat are the main complaints. Hawking and dry cough may present due to crust formation. Finally, Examination shows dry and glazed pharyngeal mucosa often covered with crusts.

Risk factors of Chronic Pharyngitis

• History of ill contact
• Over crowding
• Frequent sinus infections
• Smoking
• Attending day care
• Immunocompromised
• Cold season
• Allergic rhinitis
• Gastroesophageal reflux disease
• Use of corticosteroids
• Oral sex
• Multiple sexual partners
• Unprotected sex (3)

Pathophysiology of Chronic Pharyngitis

• Most viruses, such as adenovirus or coxsackie virus, can cause inflammation of the pharyngeal mucosa by direct invasion of the mucosa or by secondary to supra pharyngeal secretions. Other viruses, such as rhinoviral infections produce bradykinin and lysyl bradykinin, which are known inflammatory mediators that can excite nerve endings in the pharynx to cause pain.
• Pathogenesis of bacterial pharyngitis varies with etiology. In streptococcal pharyngitis (which is the most common bacterial pharyngitis), the bacteria release exotoxins and proteases. Erythrogenic exotoxins are responsible for the development of the scarlatiniform exanthem. Secondary antibody cross react against M2-protein of the myocardial tissue that may result in rheumatic fever and valvular heart diseasea(type II hypersensitivity reaction)nd the antigen-antibody complexes can lead to acute poststreptococcal glomerulonephritis (type 3 hypersensitivity reaction).(3)

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Sign & Symptoms of Chronic Pharyngitis

SIGNS

1. Chronic catarrhal pharyngitis. In this, there is a congestion of posterior pharyngeal wall with engorgement of vessels; facial pillars may thicken. Additionally, There increased mucus secretion which may cover pharyngeal mucosa.
2. Chronic hypertrophic (in other words, granular) pharyngitis

(a) Firstly, Pharyngeal wall appears thick and edematous with congested mucosa and dilated vessels.

(b) Secondly, Posterior pharyngeal wall may studded with reddish nodules (hence the term granular pharyngitis). These nodules due to hypertrophy of subepithelial lymphoid follicles normally seen in pharynx. [1]

(c) Thirdly, Lateral pharyngeal bands become hypertrophied.

(d) Lastly, Uvula may be elongated also appear edematous.

SYMPTOMS

Severity of symptoms in chronic pharyngitis varies from person to person.

1. Discomfort or pain in the throat. Moreover, This is noticed in the mornings.
2. Foreign body sensation in throat. Generally, 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. Besides this, 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 either retching or gagging.

Clinical examination of Chronic Pharyngitis

Vital Signs

• High/ low-grade fever

Skin

• Scarlatiniform rash associated with GAS, Arcanobacterium haemolyticum.
• Pharynx shows erythema, hypertrophy, tonsilar exudates, masses, Soft-palate petechiae (“doughnut” lesions), and beefy red, swollen uvula associate with Streptococcal pharyngitis.
• Grayish brown diphtheritic pseudomembrane which may involve one or both tonsils or may extend widely to involve the nares, uvula, soft palate, pharynx, larynx, and tracheobronchial tree associate with Corynebacterium diphtheria.
• Conjunctivitis and periauricular lymphadenopathy associate with adenoviral infection.
• Blisters or ulcers in the anterior mouth or lips are seen in herpes simplex infection.

• Heart

  • Heart murmur associate with rheumatic fever due to streptococcal pharyngitis.

  Abdomen

  • Hepato spleenomegaly: associate with pharyngitis caused by group A streptococcus, infectious mononucleosis

  Neck

  • Cervical adenopathy (3)

Diagnosis of Chronic Pharyngitis

• Throat Examination
• CBC

Differential diagnosis of Chronic Pharyngitis

• Rhinovirus
• Coronavirus
• Adenovirus
• Herpes simplex virus (HSV),
• Parainfluenza virus
• Influenza virus
• Epstein—Barr Virus (EBV)
• Human immunodeficiency virus (HIV). (4)

Complications are what happen after you have a disease. They are the negative consequences of the disease process.

Investigation of Chronic Pharyngitis

Rapid antigen detection test

Throat culture

Anti–streptococcal antibody titers

Rapid influenza diagnostic tests

Immunoassays that can identify the presence of influenza A and B viral nucleoprotein antigens in respiratory specimens

Complete blood count with differential

An increased percentage of neutrophils may be due to acute bacterial infection

An increase in lymphocytes may be related to viral infection Increased total number of lymphocytes, with greater than 10% atypical lymphocytes (large with irregular nuclei) is present in Epston- Bar virus (EBV) infection

May be useful when presenting amononucleosis-type syndrome

Monospot test

A monospot test (heterophile antibody test) is a rapid test for infectiousmononucleosis due to EBV.

Epstein-Barr virus serologic profile

Serologic profile will include testing for immunoglobulin G (IgG) and M (IgM) antibodies

Acute HIV infection tests

ELISA test: Uses an enzyme immunoassay to detect specific antibodies (3)

Treatment of Chronic Pharyngitis

Firstly, In every case of chronic pharyngitis, etiological factor should be sought also eradicated.

1. Secondly, 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.
2. Thirdly, Warm saline gargles, especially in the morning, are soothing and relieve discomfort.
3. Besides this, Mandl’s paint may be applied to pharyngeal mucosa.
4. Lastly, Cautery of lymphoid granules is suggested. Additionally, throat is sprayed with local anesthetic and granules are touched with 10–25% silver nitrate. Either electrocautery or diathermy of nodules may require general anesthesia. [1]

Prevention of Chronic Pharyngitis

• Gargle with warm saline solutions
• Stay well-hydrated
• Avoid smoking
• Manage pain with over-the-counter medication such as acetaminophen/paracetamol (5)

Homeopathic Treatment of Chronic Pharyngitis

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

Which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. Now a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improve with homeopathic medicines.

Homeopathic Medicines for Chronic Pharyngitis

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy, potency and repetition of dose by Homeopathic doctor.

So, here we describe homeopathic medicine only for reference and education purpose. Do not take medicines without consulting registered homeopathic doctor (BHMS or M.D. Homeopath).

Medicines

  Kali Mur

Pharyngitis, GREAT DEAL OF FOETOR IN BREATH, hawks up cheesy lumps of the size of a split pea; throat swollen, either spots or pustules appear with gray or whitish exudation;   adherent crusts especially, in vault of pharynx; tongue coated grayish-white, slimy or dry;   biliousness, dyspepsia, fatty or rich food causes indigestion. [2]

Diet & Regiment of Chronic Pharyngitis

• Warm Water Gargle
• Rest
• Adequate Water
• Nutritious Diet

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Reference

[1] Diseases_of_Ear_Nose_and_Throat_6Edition

[2] Homoeopathic Therapeutics by Lilienthal

[3]https://www.wikidoc.org/index.php/Pharyngitis_overview

[4]https://www.google.com/search?q=differntial+diagnosis+of+chronic+pharyngitis

[5]ttps://www.google.com/search?q=prevention++of+chronic+pharyngitis