Chronic pharyngitis
Chronic pharyngitis is an inflammatory process that occurs in the pharyngeal mucosa. Chronic pharyngitis is the result of inadequate treatment of acute inflammation, or the result of the negative effects of a number of other pathogenic factors.
Chronic pharyngitis is usually divided into catarrhal, hypertrophic (granular and lateral) and atrophic pharyngitis.
Content:
- The causes of chronic pharyngitis
- Chronic pharyngitis symptoms
- Diagnostics of the chronic pharyngitis
- Chronic pharyngitis treatment
The causes of chronic pharyngitis
The causes of chronic pharyngitis are varied, but there is almost always prolonged irritation of the pharyngeal mucosa.
Among the etiological factors leading to chronic inflammation, there are:
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Acute recurrent inflammation of the pharynx, tonsils, nose and paranasal sinuses caused by viruses or bacteria. This includes rhinitis, sinusitis, tonsillitis. In addition to the fact that there is a source of inflammation in the upper respiratory tract, vasoconstrictor drops used to reduce catarrhal phenomena have an additional irritating effect on the posterior pharyngeal wall.
- Prolonged violation of nasal breathing, contributing to the drying of the pharyngeal mucosa.
- Hypothermia, both local and the body as a whole.
- Smoking.
- Unfavorable environmental situation in the area of residence (gas pollution, high concentration of harmful emissions, smoke, etc.).
- Occupational hazards are dry and hot air, a high concentration of cement and clay (porcelain industry), flour (flour milling), etc. in the inhaled air.
- Constitutional features of the structure of the upper respiratory tract, contributing to the development of inflammatory processes in them.
- Hemodynamic disturbances in the upper respiratory tract due to diseases of the cardiovascular system.
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Diseases of the digestive tract, in which there is a constant reflux of the acidic contents of the stomach into the esophagus, which provides irritation of the pharyngeal mucosa. These can be diseases such as reflux esophagitis, gastritis, hiatal hernia, etc.
- Hormonal and endocrine disorders.
- Tooth decay. Stomatitis and gingivitis can also provoke the development of inflammation.
- Immune system failure.
- Allergic diseases.
- Alcohol abuse.
- The predominance of spicy, very hot or very cold foods in the diet.
- Chronic infections such as tuberculosis.
- Injuries sustained during surgery or when a foreign body enters the pharyngeal cavity.
Chronic pharyngitis symptoms
Symptoms of chronic pharyngitis are reduced to soreness, rawness, tickling and other discomfort in the throat, which intensify during swallowing. The clinical picture of pharyngitis will be influenced by the form of the disease, somewhat modifying the manifestations of inflammation.
Symptoms of catarrhal chronic pharyngitis
In the catarrhal form of the disease, diffuse venous hyperemia is found, the mucous membrane becomes pasty, as small veins expand and blood stagnates in them. As a rule, all parts of the pharynx are inflamed, often the auditory tubes, excretory ducts of the paranasal sinuses are involved in the pathological process.
Among the complaints that patients present:
- Sore throat, sore throat, worse when swallowing.
- Sensation of a foreign body in the throat, which is not an obstacle to the passage of food and liquid. But at the same time, this feeling of discomfort makes the patient swallow more often.
- A thick mucous phlegm accumulates in the throat, which makes the person cough all the time. The cough becomes more pronounced in the morning. During exacerbations of chronic catarrhal pharyngitis, coughing may be accompanied by nausea and even vomiting.
- The mucous membrane of the throat, uvula and soft palate are thickened. On the pharynx, areas covered with mucus or mucopurulent secretions are visible. Some groups of follicles are enlarged.
Symptoms of hypertrophic pharyngitis
As for the hypertrophic form of the disease, then with it all layers of the mucous membrane of the pharynx thicken, it itself becomes denser and thicker. The lymphatic and blood vessels dilate. Most often, the hypertrophic process proceeds as granulosa pharyngitis, when the mucous membrane of the posterior pharyngeal wall is affected. In some cases, the lateral walls of the pharynx (lateral hypertrophic pharyngitis) are involved in the pathological process. In this case, the follicles are combined with the infected lymphoid folds of the pharynx, which gives the impression of the presence of additional posterior arches.
As for the complaints presented by patients, they are as follows:
- Violent sore throat, like scratching.
- Pronounced sensation of the presence of a foreign body in the throat.
- Frequent swallowing of saliva with which a person tries to get rid of an obstacle.
- The mucopurulent discharge flowing down the back of the pharynx becomes very viscous, forms crusts, which are separated with great difficulty.
- A strong cough is also observed due to the fact that crusts of dried mucus irritate the nerve endings of the laryngeal nerve.
- The patient's voice is often hoarse.
Symptoms of atrophic pharyngitis
The mucous membrane of the pharynx in the atrophic form of the disease is very thinned and excessively dry. If the disease is acute, the pharynx looks shiny, varnished. The size of the mucous glands is reduced, the epithelial lining of the pharynx is exfoliated by small scales.
Among the complaints that patients present:
- Severe dry throat, which comes to the fore, prevailing over other symptoms.
- Difficulty swallowing food and liquids is observed. An empty sip is especially painful.
- An unpleasant odor emanates from the mouth of patients.
- Often during a conversation, a person has a desire to take a sip of water.
It is worth noting that the symptomatology, even with minor lesions of the mucous membrane of the throat, can be quite pronounced, and when the processes are running, it can be very scarce.
Diagnostics of the chronic pharyngitis
Diagnosis of chronic pharyngitis is based on pharyngoscopy, which is carried out in the otolaryngologist's office.
The criteria for assessing the condition of the pharyngeal mucosa, which make it possible to diagnose, are as follows:
- The catarrhal form of the disease is indicated by a slight edema and thickening of the mucous membrane of the pharynx, the presence of cloudy mucus in some of its parts.
- The granular form of the disease is indicated by the presence of lymphoid granules, which look like semicircular elevations the size of a millet grain. These elevations are red. The pharyngeal mucosa itself is also red, the veins piercing it are visible. With lateral pharyngitis, the lymphoid folds are thickened and hyperemic.
- The atrophic form of the disease is indicated by a thin dry mucous membrane of a pale pink color. In some places, it is covered with crusts and viscous stretching mucus.
To clarify the cause of the inflammation, a smear is taken from the pharynx for bacterial and virological research. It is possible that the patient will need to be examined by a dentist, endocrinologist, gastroenterologist and other specialists.
Chronic pharyngitis treatment
Treatment of chronic pharyngitis is carried out on an outpatient basis. Its primary goal is to eliminate local and general causes that provoked the development of the disease. These can be infections of the nasal cavity and paranasal sinuses, tonsils, etc.
It is important to get rid of external irritants such as exposure to tobacco smoke, from dusty and gassed air. Food should be gentle, all spicy, spicy, pickled and fried foods should be excluded from the menu. If the patient has chronic diseases of the gastrointestinal tract that support inflammation in the pharyngeal mucosa, then they must be disposed of.
Proper sanitation of the oral cavity is important. The mucous membrane of the pharynx should be regularly cleaned of crusts and mucus.
Treatment of hypertrophic and catarrhal forms of pharyngitis
To gargle with a hypertrophic form of the disease, use a warm isotonic sodium chloride solution. It can also be used for inhalation using a nebulizer.
To reduce the swelling of the mucous membrane, application of a solution of Lugolle, Protargol or Collargol to the back wall of the pharynx. Irrigation of the throat with Hexoral, Miramistin, Octenisept are effective. Also for rinsing, you can use an infusion of sage and chamomile, Bikarmint.
The composition of the complex therapy can include tablets for resorption, which have an antiseptic and bacteriostatic effect - these are Lizobakt, Faringosept, Hexaliz.
If a patient has large granules on the pharyngeal mucosa, then they are removed using cryotherapy, or they are cauterized with a solution of silver nitrate.
Treatment of atrophic pharyngitis
To get rid of atrophic pharyngitis, it is important to thoroughly and regularly wash off the mucopurulent masses and crusts from the pharyngeal surface. The best remedy for this is a 1% solution of sodium chloride, to which 4 drops of iodine of 5% concentration should be added. Sodium chloride for such an amount of iodine will require 200 ml. Irrigating your throat regularly with this remedy will relieve throat discomfort and reduce symptoms of inflammation.
Periodic lubrication of the posterior pharyngeal wall with Lugol's solution is also effective. It is important that the formulations used for the treatment of atrophic pharyngitis do not dry out the mucous membrane, as this will lead to the suppression of the functioning of its glands. So, the use of sodium bicarbonate (baking soda), eucalyptus and sea buckthorn oil is prohibited.
Novocaine blockade of the posterior pharyngeal wall has proven to be good. They can be combined with such biological stimulants as Traumeel, Aloe, Vitreous humor. The course of novocaine blockade consists of 8 procedures, the interval between them should be at least 5 days.
As for antibacterial drugs, they are used for chronic pharyngitis only during an exacerbation of the disease, when laboratory use confirms the presence of pathogenic bacterial flora. It is possible to use drugs from the group of penicillins, cephalosporins and macrolides. Systemic administration of antibiotics for pharyngitis provoked by beta-hemolytic streptococcus is mandatory.
A wide selection of antibacterial and antiseptic agents for the treatment of pharyngitis is limited by the spectrum of their antimicrobial activity, the absence of allergic reactions in the patient. Also, the drug should not be toxic.
Prevention of recurrence of chronic pharyngitis is adherence to a healthy lifestyle, rejection of bad habits, normalization of nasal breathing, if it has been violated. Periodic use of drugs-immunomodulators is possible.
The author of the article: Lazarev Oleg Vladimirovich | ENT
Education: In 2009, he received a diploma in the specialty "General Medicine" at the Petrozavodsk State University. After completing an internship at the Murmansk Regional Clinical Hospital, he received a diploma in Otorhinolaryngology (2010)
