Chronic pharyngitis
The content of the article:
- Causes and risk factors
- Forms of the disease
- Chronic pharyngitis symptoms
- Diagnostics
- Chronic pharyngitis treatment
- Possible complications and consequences
- Forecast
- Prevention of chronic pharyngitis
Chronic pharyngitis is a chronic inflammation of the mucous membrane of the pharyngeal cavity, a recurrent disease that occurs with periods of remission and exacerbation.
In the structure of ENT pathology, complaints of pain and sore throat are the second most common after diseases of the nasal cavity and its paranasal sinuses; at an outpatient appointment, they are presented every 4 out of 10 patients.
Types and signs of chronic pharyngitis
A characteristic feature of chronic pharyngitis is an isolated inflammation of one of the parts of the pharynx (nasopharynx, oropharynx or laryngopharynx) without the involvement of lymphoid formations, i.e. tonsils, in the pathological process.
Chronic pharyngitis usually acts as an independent pathology, however, in some cases it is only a symptom of other diseases, including acute infectious processes.
Untimely diagnosis and treatment of the disease can lead to the spread of inflammation to nearby ENT organs or cause the development of an inflammatory process in distant structures (heart, kidneys, joints, etc.), and also significantly reduce the patient's quality of life.
Causes and risk factors
The causes of chronic pharyngitis can be both pathogenic microorganisms and the aggressive effect of unfavorable environmental factors.
The overwhelming majority of pathogens that most often provoke the development of an acute disease, which is transformed into a chronic form with untimely diagnosis and incompetent treatment, is represented by the following viruses:
- rhinoviruses (more than 80% of all cases of morbidity);
- adenoviruses;
- coronaviruses;
- influenza and parainfluenza viruses;
- respiratory syncytial virus;
- herpes simplex viruses type I and II;
- enteroviruses;
- Coxsackie virus;
- Epstein-Barr virus;
- cytomegalovirus.
In some cases, viruses are a kind of "pioneers" that create optimal conditions for the activation of their own conditionally pathogenic microflora and the addition of a secondary bacterial infection. Most often, inflammation of the pharyngeal mucosa is caused by Neisseria, diphtheroids, greening (non-hemolytic) streptococci, β-hemolytic streptococci, epidermal staphylococcus, corynebacteria (with the exception of diphtheria), fungi of the genus Candida.
In 80% of cases, chronic pharyngitis is caused by rhinoviruses
In addition to viral and bacterial agents, chronic pharyngitis can be caused by systematic exposure to aggressive physical or chemical factors:
- ionizing radiation;
- dust;
- volatile chemicals (toluene, formaldehydes, paint and varnish compounds, products of hydrocarbon processing, etc.);
- hot vapors and liquids;
- mechanical injury to the mucous membrane;
- combustion products;
- allergens, etc.
The development of chronic pharyngitis is facilitated by the impact on the body of local and general risk factors, which include:
- structural features of the mucous membrane;
- work in hazardous industries (metallurgical and other types of industry, implying work in a hot shop, coal mines, oil refineries, factories for the production of paints and varnishes, pesticides, fertilizers, etc.);
- work in the rescue area;
- smoking, alcohol abuse;
- Difficulty nasal breathing (allergic rhinitis, curvature of the nasal septum, polypous growths);
- changes in the endocrine background (menopause, hypothyroidism, etc.);
- hypo- or avitaminosis;
- state of immunosuppression;
- diseases of the gastrointestinal tract;
- general hypothermia of the body;
- the presence of severe chronic diseases (diabetes mellitus, renal and heart failure, bronchial asthma, etc.);
- the presence of a focus of chronic infection in the oral cavity or nearby ENT organs;
- dry, hot climate;
- unfavorable ecological situation;
- old age (age-related involutional changes in the mucous membrane).
Forms of the disease
The following forms of chronic pharyngitis are distinguished:
- simple or catarrhal;
- hypertrophic (granular);
- atrophic;
- mixed.
Chronic pharyngitis symptoms
Chronic pharyngitis is not characterized by the presence of pronounced clinical manifestations: there is no increase in body temperature, signs of intoxication, deterioration of the general condition.
The main symptoms of chronic pharyngitis:
- perspiration, dry throat;
- coughing;
- discomfort when swallowing;
- with a chronic inflammatory process in the projection of the laryngopharynx, hoarseness of the voice is possible;
- feeling of a lump in the throat;
- a feeling of discomfort, an obsessive desire to cough up.
In the atrophic form of the disease, the mucous membrane of the posterior pharyngeal wall looks thinned, pale, shiny ("varnished"), blood-filled vessels, traces of dried mucus are visible on it.
Coughing, perspiration, dry throat are the main symptoms of chronic pharyngitis
Hypertrophic chronic pharyngitis is characterized by foci of hyperplasia, thickening of the mucous membrane with enlarged, chaotically located follicles. The lateral tubopharyngeal ridges are also enlarged and edematous. On the surface of the pharynx, traces of a viscous secretion are noted.
During the period of exacerbation of the disease, the clinical picture becomes more pronounced:
- intense pain;
- symptom of the first sip (maximum severity of pain during the first sip, swallowing saliva, decreasing after drinking or several swallowing movements);
- increase and soreness of regional lymph nodes (submandibular, posterior cervical, parotid);
- deterioration in general well-being (headache, general weakness, increased fatigue, etc.);
- slight increase in body temperature;
- redness and swelling of the oropharyngeal mucosa;
- the presence of mucous or mucopurulent secretions on the back of the pharynx, hypertrophy of individual follicles.
Chronic pharyngitis often accompanies diseases of the gastrointestinal tract, in which the failure of the cardiac sphincter of the stomach is noted. In these cases, aggressive gastric contents are thrown into the lumen of the esophagus and into the pharynx, irritating the mucous membrane of the pharynx. At the same time, the typical symptoms of the disease are supplemented by heartburn, belching, burning sensation along the esophagus, which occur sporadically, often when moving to a horizontal position.
In some cases, chronic pharyngitis can be iatrogenic in nature, being a complication of improper treatment of diseases of the nasal cavity (usually uncontrolled intake of vasoconstrictor drops). Long-term use of local drugs that reduce swelling of the mucous membrane of the nasal cavity and the formation of mucus contributes to the disruption of local blood circulation in the nasopharynx area and the development of atrophic changes in its mucous membrane.
Diagnostics
The diagnosis of chronic pharyngitis in most cases is straightforward. It is based on a comprehensive assessment of the clinical picture, laboratory data:
- a general blood test (leukocytosis with a neutrophilic shift to the left, acceleration of ESR during an exacerbation, during remission there are no changes in the blood test);
- biochemical blood test (acute phase indicators during an exacerbation, during remission there are no changes in the blood test);
- sowing the material of the pharyngeal cavity on a nutrient medium in order to isolate group A β-hemolytic streptococcus;
- determination of streptococcal antigen in smears by agglutination;
- immunodiagnosis of increased titers of anti-streptococcal antibodies.
One of the stages in the diagnosis of chronic pharyngitis is the inoculation of the pharyngeal cavity material on a nutrient medium
Detection of β-hemolytic group A streptococcus in the materials of a smear from the pharyngeal cavity is carried out in order to determine the tactics of treatment, since in this case antibiotic therapy is necessary. This type of microorganism is the most pathogenic of the group of streptococci, capable of provoking a number of serious infectious and inflammatory diseases, therefore, its timely detection and eradication is necessary to prevent the development of secondary complications.
Chronic pharyngitis treatment
The uncomplicated course of chronic pharyngitis, as a rule, does not require systemic treatment. In most cases, episodes of exacerbations are stopped by local antiseptic and analgesic drugs, the imposition of warming compresses, copious alkaline drinks, and adherence to a fortified diet.
Antibiotic therapy for the treatment of chronic pharyngitis is rarely used, the most common are local antimicrobial drugs in the form of rinses, sprays, lozenges, lozenges, often in combination with an anesthetic:
- antiseptics (chlorhexidine, hexetidine, benzydamine, ambazone, thymol and its derivatives, alcohols, iodine derivatives, etc.);
- phytopreparations with an antiseptic effect;
- antimicrobial agents of natural origin (lysozyme);
- beekeeping products;
- bacterial lysates.
Antiseptic gargling is an effective treatment for chronic pharyngitis
The main limitation to the use of certain therapeutic agents is their local irritating effect (as, for example, in derivatives of iodine, propolis) and the ability to provoke allergic reactions (herbal remedies, bee products, preparations containing essential oils, etc.).
The appointment of antibacterial drugs for exacerbation of chronic pharyngitis is advisable in the case of a secondary infection. The duration of the course of treatment, recommended by the World Health Organization, should be in this case at least 10 days. Antibiotic therapy begins with semi-synthetic protected penicillins, 2nd and 3rd generation cephalosporins. If they are intolerant, macrolides (azalides) are recommended.
Possible complications and consequences
Complications of chronic pharyngitis can be:
- tonsillopharyngitis;
- eustachitis, labyrinthitis;
- laryngitis;
- paratonsillitis;
- paratonsillar, or retropharyngeal abscess;
- mediastinitis;
- malignant transformation of the atrophic form of the disease;
- secondary damage to the heart, kidneys, joints.
Forecast
With timely diagnosis and complex treatment, the prognosis is favorable.
Prevention of chronic pharyngitis
- Avoiding hypothermia.
- Compliance with safety measures when working in hazardous industries, the use of personal protective equipment.
- To give up smoking.
- Timely sanitation of the oral cavity and treatment of diseases of the ENT organs.
- Avoiding spicy, overly hot, or spicy foods, especially on an ongoing basis.
- Restoration of normal nasal breathing.
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
