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Pharyngitis

Pharyngitis, the most common throat disorder, is an acute or chronic inflammation of the pharynx. It's widespread among adults who live or work in dusty or dry environments, use their voices excessively, habitually use tobacco or alcohol, or suffer from chronic sinusitis, persistent coughs, or allergies. Uncomplicated pharyngitis usually subsides in 3 to to days.

Beta-hemolytic streptococci, which account for 15% to 20% of acute pharyngitis, may precede the common cold or other communicable diseases. Chronic pharyngitis commonly is an extension of nasopharyngeal obstruction or inflammation.

Viral pharyngitis accounts for approximately 70% of acute pharyngitis cases.

Causes

Many things can cause pharyngitis and tonsillopharyngitis. Causes include:

  • Infection with a virus, such as the viruses that cause influenza and the common cold
  • Infection with bacteria, such as the bacteria that cause strep throat
  • Mucus from your sinuses that drains into your throat
  • Smoking
  • Breathing polluted air
  • Drinking alcoholic beverages
  • Hay fever or other allergies
  • Acid reflux from the stomach
  • Allergies

Signs and Symptoms

Typically, the patient complains of a sore throat and slight difficulty swallowing; swallowing saliva hurts more than swallowing food. The patient also may complain of a sensation of a lump in the throat, a constant and aggravating urge to swallow, a headache, and muscle and joint pain (especially in bacteria: pharyngitis). Assessment of vital signs may reveal mild fever.

On inspection, the posterior pharyngeal wall appears fiery red, with swollen, exudate-flecked tonsils and lymphoid follicles. If the patient has bacterial pharyngitis, the throat is acutely inflamed, with patches of white and yellow follicles. The tongue may be strawberry red in color.

Neck palpation may reveal enlarged, tender cervical lymph nodes.

Diagnostic tests

Throat culture may be used to identify the bacterial organisms causing the inflammation but it may not detect other causative organisms. Rapid strep tests generally detect group A streptococcal infections, but they miss the fairly common streptococcal groups C and G.

Computed tomography scanning is helpful in identifying location of abscesses.

A white blood cell (WBC) count is used to determine atypical lymphocytes; an elevated total WBC count is present.

Treatment

Based on the patient's symptoms, treatment for acute viral pharyngitis consists mainly of rest, warm saline gargles, throat lozenges containing a mild anesthetic, plenty of fluids, and analgesics as needed. If the patient can't swallow fluids, he may need hospitalization for I.V. hydration.

Bacterial pharyngitis requires rigorous treatment with penicillin (or another broad-spectrum antibiotic if the patient is allergic to penicillin) because streptococcus is the chief infecting organism. Antibiotic therapy should continue for 48 hours after visible signs of infection have disappeared or for at least 7 to 10 days. Antifungal agents are used to treat fungal pharyngitis. Equine antitoxins are given for diphtheria pharyngitis.

Chronic pharyngitis necessitates the same supportive measures as acute pharyngitis but with greater emphasis on eliminating the underlying cause such as an allergen.

Preventive measures include adequate humidification and avoiding excessive exposure to air conditioning. In addition, patients who smoke should be urged to stop.

Prevention

To reduce your chances of getting a sore throat, take the following steps:

  • Wash your hands frequently, especially after blowing your nose or after caring for a child with a sore throat.
  • If someone in your home has a sore throat, keep his or her eating utensils and drinking glasses separate from those of other family members. Wash these objects in hot, soapy water.
  • If a toddler with a sore throat has been sucking on toys, wash the toys in soap and water.


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