Chronic Pharyngitis

Definition

Chronic pharyngitis is defined as a persistent inflammatory condition of the pharynx that lasts for more than 10 days. Pathologically, it is characterized by hypertrophy of the mucosa, sero-mucinous glands, subepithelial lymphoid follicles, and sometimes the muscular coat of the pharynx. This condition is commonly diagnosed based on a history of long-standing throat discomfort of varying severity, often without identifiable specific aetiological factors. Clinical examination typically reveals prominent lymphoid tissue, particularly in the lateral pharyngeal bands.

Types of Chronic Pharyngitis. Chronic pharyngitis can be classified into two main types:

1. Chronic Catarrhal Pharyngitis: Characterized by inflammation and increased mucus production.
2. Chronic Hypertrophic (Granular) Pharyngitis: This is marked by the presence of hypertrophied lymphoid tissue, resulting in a granular appearance.

Aetiology. Several factors contribute to the development of chronic pharyngitis:

1. Persistent Infection: Chronic infections in nearby areas, such as chronic rhinitis or sinusitis with post-nasal drip, can continuously irritate the pharynx. Chronic tonsillitis is also a significant contributor.
2. Mouth Breathing: Breathing through the mouth exposes the pharynx to unfiltered air, increasing susceptibility to infections. Causes of mouth breathing include:
   • Nasal obstructions (e.g., nasal polyps, allergic rhinitis, turbinate hypertrophy, deviated septum, or tumours).
   • Obstructions in the nasopharynx (e.g., adenoids or tumours).
   • Protruding teeth that prevent lip closure.
   • Habitual mouth breathing without any organic cause.
3. Chronic Irritants: Factors such as excessive smoking, chewing tobacco or betel, heavy alcohol consumption, and the intake of highly spiced foods can lead to chronic pharyngitis.
4. Environmental Pollution: Exposure to smoky or dusty environments and irritant industrial fumes can contribute to the condition.
5. Voice Strain: Faulty voice production, often seen in certain professions, can lead to chronic pharyngitis. Excessive voice use or habits like constant throat clearing can exacerbate symptoms.
6. Other Factors: Conditions such as acid reflux, poor dental hygiene, and psychological stress may also play a role in the development of chronic pharyngitis.

Symptoms. The severity of symptoms in chronic pharyngitis can vary widely among individuals. Common symptoms include:

1. Throat Discomfort or Pain: Patients often report discomfort that is particularly noticeable in the mornings.
2. Foreign Body Sensation: A persistent feeling of something stuck in the throat leads to frequent swallowing or throat clearing.
3. Voice Fatigue: Patients may experience difficulty speaking for extended periods, leading to voice strain and hoarseness.
4. Cough: The throat may be irritable, resulting in a tendency to cough, with even minor stimuli causing retching or gagging.

Signs. Physical examination findings may include:

1. Chronic Catarrhal Pharyngitis:
   • Congestion of the posterior pharyngeal wall with engorged blood vessels.
   • Thickening of the faucial pillars.
   • Increased mucus secretion covering the pharyngeal mucosa.
2. Chronic Hypertrophic (Granular) Pharyngitis:

1. • Thickened and edematous pharyngeal wall with congested mucosa and dilated vessels.
   • Presence of reddish nodules on the posterior pharyngeal wall, resulting from hypertrophy of subepithelial lymphoid follicles.
   • Hypertrophy of lateral pharyngeal bands.
   • Elongation and edema of the uvula.

Treatment. Management of chronic pharyngitis involves several approaches:

1. Identify and Eradicate Aetiological Factors: It is essential to determine and address the underlying causes of chronic pharyngitis.
2. Hydration: Patients are encouraged to consume plenty of oral fluids.
3. Voice Rest and Speech Therapy: Essential for individuals with faulty voice production. Habits such as frequent throat-clearing should be discouraged.
4. Warm Saline Gargles: Gargling with warm saline, particularly in the morning, can provide soothing relief from discomfort.
5. Topical Treatments: Mandl’s throat paint may be applied to the pharyngeal mucosa to alleviate symptoms.
6. Cautery of Lymphoid Granules: In cases of significant hypertrophy, cautery may be performed using 10–25% silver nitrate. Electrocautery or diathermy may require general anaesthesia.
7. Avoidance of Irritants: Smoking and chewing tobacco should be avoided to prevent exacerbation of symptoms.

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Learning resources.

• Scott-Brown, Textbook of Otorhinolaryngology-Head and Neck Surgery.
• Susan Standring, Gray’s Anatomy.
• Frank H. Netter, Atlas of Human Anatomy.
• B.D. Chaurasiya, Human Anatomy.
• P L Dhingra, Textbook of Diseases of Ear, Nose and Throat.
   

  Author:

  

  Dr. Rahul Bagla
  MBBS (MAMC, Delhi) MS ENT (UCMS, Delhi)
  Fellow Rhinoplasty & Facial Plastic Surgery.
  Renowned Teaching Faculty
  Mail: msrahulbagla@gmail.com
  India

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