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Diseases Of Pharynx

  1. Acute Pharyngitis
Table: Cause of acute pharyngitis      
Viral Bacterial Fungal Miscellaneous
Rhinoviruses Streptococcus                                                                              
 (Group beta-haemolyticus)
(parasitic, rare)
Influenza Diphtheria    
Measles and chickenpox
Coxsackie virus
Herpes simplex
Infectious mononucleosis
Gonococcus Chlamydia
  1. Chronic Pharyngitis
    1. It is a chronic inflammatory condition of the pharynx. Pathologically, it is characterised by hypertrophy of mucosa, sero mucinous glands, subepithelial lymphoid follicles and even the muscular coat of the pharynx.
      Chronic pharyngitis is of two types:
    2. Chronic catarrhal pharyngitis
    3. Chronic hypertrophic (granular) pharyngitis.
      1. Aetiology
        1. Persistent infection in the neighbourhooD. In chronic rhinitis and sinusitis
        2. Mouth breathing. It is due to:
          1. Obstruction in the nose, e.g. nasal polypi, allergic or vasomotor rhinitis, turbinal hyper­trophy, deviated septum or tumours,
          2. Obstruction in the nasopharynx, e.g. adenoids and tumours,
          3. Protruding teeth which prevent apposition of lips,
          4. Habitual, without any organic cause.
          5. Chronic irritants. Excessive smoking, chewing of tobacco and pan, heavy drinking, highly spiced food can all lead to chronic pharyngitis. Environmental pollution. Smoky or dusty environ­ment or irritant industrial fumes.
    4. Symptoms
      1. Discomfort or pain in the throat. This is especially noticed in the mornings.
      2. Foreign body sensation in throat. 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. 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 retching or gagging.
    5. Sign
      Chronic catarrhal pharyngitis. In this, there is a conges­tion of posterior pharyngeal wall with engorgement of ves­sels; faucial pillars may be thickeneD. There is increased mucus secretion which may cover pharyngeal mucosA.
    6. Chronic hypertrophic (granular) pharyngitis
      1. Pharyngeal wall appears thick and edematous with congested mucosa and dilated vessels.
      2. Posterior pharyngeal wall may be studded with red­dish nodules (hence the term granular pharyngitis). These nodules are due to hypertrophy of subepithe­lial lymphoid follicles normally seen in pharynx
      3. Lateral pharyngeal bands become hypertrophieD.
      4. Uvula may be elongated and appear oedematous.
    7. Treatment
      1. In every case of chronic pharyngitis, aetiological factor should be sought and eradicateD.
      2. Voice rest and speech therapy.
      3. Warm saline gargles, especially in the morning, are soothing and relieve discomfort.
      4. Mandel’s paint may be applied to pharyngeal mucosA.
      5. Cautery of lymphoid granules is suggesteD. Throat is sprayed with local anaesthetic and granules are touched with 10-25% silver nitrate. Electrocautery or diathermy of nodules may require general anaesthesiA.
  2. Atrophic Pharyngitis
    It is a form of chronic pharyngitis often seen in patients of atrophic rhinitis. Pharyngeal mucosa along with its mucous glands shows atrophy. Scanty mucus production’ by glands leads to formation of crusts which later get infected giving rise to foul smell.
    1. Clinical Features
      Dryness and discomfort in throat are the main com­plaints. Hawking and dry cough may be present due to crust formation. Examination shows dry and glazed pharyngeal mucosa often covered with crusts.
    2. Treatment
      This is the same as for co-existent atrophic rhinitis. Aim is to remove the crusts and promote secretion. The crusts can be removed by spraying the throat with alkaline solution, or pharyngeal irrigation. Mandl’s paint applied locally has a soothing effect.
      Potassium iodide, 325 mg, administered orally for a few days helps to promote secretion and prevents crusting.
  3. Keratosis Pharyngitis
    It is a benign condition characterised by horny excres­cences on the surface of tonsils, pharyngeal wall or lin­gual tonsils appearing as white or yellowish dots. These excrescences are the result of hypertrophy and keratins tion of epithelium. They are firmly adherent and can­not be wiped off. There is no accompanying inflammation nor any constitutional symptoms, thus it can be easily differentiated from acute follicular tonsillitis. The disease may show spontaneous regression and does not require any specific treatment except for reassurance to the patient.
  4. Palatine Tonsil
    Palatine tonsil is an oval mass of specialized subepithelial lymphoid tissue situated between the palatopharyngeal and palatoglossal folds.
Plica Triangularis                                                                             
Triangle fold of mucous Membrane                                  
covers the antero-inferior                                                  
part of the tonsil.
Plica Semilunaris
Is a semilunar fold of mucous membrane.
Covers the upper pole of the tonsil.
  1. Lining mucosa:- Non-keratinizing stratified squamous epithelium.
  2. Each tonsil has 15-20 crypts.
  3. Intratonsillar cleft represent persistence of the ventral portion of the second pharyngeal pouch.
  4. Tonsillar sinus: Is a triangular recess between the palatopharyngeus and palatoglossal muscle.
Nerve Supply
  1. By the tonsillar branch of the 9th nerve
  2. Upper part of the tonsil: Lesser palatine nerve
Blood Supply:
  • Tonsillar branch : Facial artery
  • Ascending palatine  :  Facial artery
  • Dorsal linguae  : Lingual artery
  • Descending palatine  : Maxillary artery
  • Tonsillar branch : Ascending pharyngeal artery
Fig: Arterial supply of tonsil

  1. Venous drainage
    Paratonsillar vein:
    1. Pharyngeal plexus or facial vein

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