Pharyngitis

PHARYNGITIS (pharyngitis), inflammation of the mucous membrane of the pharynx, occurs in acute and chronic forms. Acute inflammations of the pharyngeal mucous membrane are rarely isolated; more often they develop as a descending acute catarrh of the nose and nasopharynx, and in these cases the same factors that caused acute rhinitis are responsible for it; however, if the effect of these factors is directed primarily at the pharyngeal mucosa, isolated lesions of it occur. Acute P. can produce various subjective symptoms, expressed as a feeling of dryness, slight pain or tension in the throat. Objectively, the mucosa is red, covered in places with mucopurulent secretions. Individual follicles appear on the surface of the mucosa of the posterior pharyngeal wall in the form of red grains. The uvula is red, swollen or slightly edematous. Sometimes the inflammatory process extends to the larynx, and then the clinical picture will correspond to laryngopharyngitis. Temperature is usually normal or subfebrile, and general condition is little affected. Acute P. often precedes or is accompanied by acute catarrhal angina. Treatment coincides with the treatment of catarrhal angina. Chronic P. (pharyngitis chronica). Chronic diseases of the pharyngeal mucosa are divided into catarrhal, hypertrophic, and atrophic forms. Causes of pharyngitis can be local and general. Local causes include chronic rhinitis, purulent diseases of the accessory sinuses, chronic tonsillitis, etc. General causes include diseases of metabolism, constitutional peculiarities, circulatory stagnation in the venous system in diseases of the heart, lungs, liver and kidneys. Clinical and professional harmful factors in the form of sharp temperature fluctuations, dryness of air, its dustiness in various industries: cement, porcelain, flour milling, etc., also have considerable significance. The effect of vapors and gases in chemical industries, as well as abuse of alcohol and smoking, do not remain without influence on the mucous membrane of the pharynx. Clinical symptoms, due to various patho-anatomical forms and localization of the process, can be very diverse. Patients complain of a feeling of rawness, scratching in the throat and dryness in the atrophic form of catarrh (pharyngitis sicca, s. atrophica). In cases of hypertrophic forms of catarrh (pharyngitis hypertrophica), patients' complaints come down to the accumulation of viscous mucus secretion, which accumulates in large quantities in the nasopharynx, causing irritation and the need to cough and expectorate. This coughing is especially pronounced in the morning and may be accompanied by nausea, and sometimes even vomiting. In the hypertrophic form, the mucosa is red, swelling of the posterior pharyngeal wall is visible (the latter has a felt-like character), it is covered with viscous, mucopurulent secretion flowing from the nasopharynx. In the atrophic form, on the contrary, the mucosa is dry, shiny, as if covered with a thin layer of lacquer. Sometimes it is covered with viscous, almost dried mucus or crusts, difficult to remove when lubricated. The lymphoid apparatus of the pharyngeal mucosa often reacts to the existing chronic irritation with strong hyperplasia of individual follicles, forming separate red grains scattered on the posterior pharyngeal wall (pharyngitis granulosa, s. follicularis). In some cases, hypertrophy of adenoid tissue located in the lateral folds occurs (pharyngitis lateralis), which in such cases protrude in the form of strongly red, thick strands located behind the palatal arches; these strands are especially well visible during vomiting movements, when they bulge forward. Treatment should be directed toward finding etiological causes and their possible elimination. Local causes in the form of chronic rhinitis, purulent diseases of the accessory sinuses of the nose, etc., should be eliminated. Treatment of the mucous membrane itself comes down to removing the accumulating secretion and calming the existing irritation. This is achieved by frequent gargling with warm alkaline solutions of sodium bicarbonate, borax, table salt, in weak concentrations approaching physiological. These same solutions can be sprayed into the nasopharynx and pharynx with appropriate atomizers. In order to reduce the loose hypertrophied mucosa and decrease excessive secretion of viscous mucus, the mucosa should be lubricated every 2-3 days with 1-10% solutions of silver nitrate. In atrophic forms, lubrications with iodine-glycerin or menthol in vaseline oil are used, simultaneously with alkaline gargles. Isolated hypertrophies of the mucosa and lymphoid tissue in lateral and granular pharyngitis are cauterized with galvanocautery or removed surgically with correspondingly curved long scissors. Pharyngomycosis benigna, s. leptothricia, synonyms: pharyngitis keratosa, algosis faucium, hyperkeratosis pharyngis, angina leptothricia, mycosis amygdalarum, mycosis pharyngis. This disease was first described by Frenkel and Hartmann (W. Frankel, Hartmann) in the form of white or yellowish-white plugs, occurring not only on the unchanged surface of the tonsils, but also on the lateral ridges and posterior pharyngeal wall. These plugs consist of keratinized epithelium, sharply protruding above the surface of the mucosa in the form of pointed or rounded, chalk-like fragments, firmly seated at their base. The plugs contain in large quantities the fungus Leptothrix buccalis, which some authors attribute a causal role to the disease. - Symptoms. Leptothrix plugs usually do not cause any complaints and are accidentally found during examination of the pharynx or cause a feeling of slight tingling. The disease is persistent, difficult to cure, but by itself does not lead to serious consequences. A. Likhachev.