What Is Acute Pharyngitis?

Acute pharyngitis is an acute inflammation of the mucosa and submucosa of the pharynx, and the lymphatic tissue of the pharynx is often involved. Inflammation can spread to the entire pharynx, or it can be limited to the nasopharynx, oropharynx, or a portion of the pharyngeal. The disease can be primary or secondary to acute sinusitis or acute tonsillitis.

Basic Information

English name: acute pharyngitis
Visiting department: ENT
Common locations: throat

Common causes: Decreased systemic resistance, nasal disease, tonsil inflammation, allergies, etc.
Common symptoms: Dry, burning, rough, slightly painful throat
Contagious: no

Causes of Acute Pharyngitis

1. Decreased body resistance, such as fatigue or excessive drinking.

2. Nasal diseases are involved.

3. Involvement of tonsil inflammation.

4. Poor living environment; there are irritating substances in the working environment, such as tannery, cigarette factory, etc .; toxic chemical agents, including chlorine, ammonia and other stimuli.

5. Pre-symptoms of upper respiratory tract infection.

6. Chronic disease throughout the body causes decreased respiratory resistance.

7. Caused by allergic factors.

8. Gastroesophageal reflux.

Classification of Acute Pharyngitis

Acute pharyngitis can be divided into three types: acute simple pharyngitis, acute necrotizing pharyngitis and acute edema pharyngitis. ^[1]

Clinical manifestations of acute pharyngitis

The disease is easily transmitted by droplets, and food or direct contact can cause infection. In autumn and winter seasons are more common. Generally, the onset is relatively rapid, and the patient can feel the throat dry, burning, rough, and slightly painful. The symptoms of sore throat gradually increase, and then swallowing pain appears. Sore throat can radiate to both ears and neck. If inflammation affects the throat, symptoms such as coughing and hoarseness can occur. After severe swelling of the soft palate and uvula, resonance cavity changes can occur. In addition, patients may experience general discomfort, headache, loss of appetite, dry mouth, thirst, chills, and sore limbs. It can be accompanied by an increase in body temperature, generally around 38 ° C, and can even reach 40 ° C with high fever.

On examination, the congestion and swelling of the mucous membrane of the pharynx showed dark red, and the secretion increased significantly. The oropharyngeal arch is swollen by the lateral wall of the oropharynx. Lymphoid follicles in the posterior pharyngeal wall are enlarged and hyperemic. Soft palate and tonsils were also congested. Sometimes uvulla drooping and soft palate swelling. Patients with severe infections may develop pharyngeal lymphadenopathy. At the same time, patients can have acute inflammatory changes in the nasal mucosa. Swollen lymph nodes can be touched when the neck is painful, and there is tenderness.

If multiple bacteria such as Streptococcus, Clostridium, Escherichia coli, Pseudomonas aeruginosa, and anaerobic bacteria are mixed infections, or if the patient himself has a systemic underlying disease such as granulocytosis, leukemia, diabetes, and scurvy Necrotic inflammation of the throat mucosa may occur. Lesions often begin in the palatine tonsil and its adjacent tissues, and then progress to the oral cavity, soft palate, nasopharynx, oropharynx, laryngo-pharynx, or parapharyngeal space. Initially, the pathological changes were limited to the mucosa and submucosa, and then deep into the muscle layer. Necrotic tissue was dark black or tan, and the surface was covered with a pseudo-membrane. Cervical lymph nodes are often affected. In severe cases, it can cause perforation of the soft palate, and hoarseness and difficulty in breathing can occur if it enters the throat. Invasion of large pharyngeal blood vessels can cause major bleeding. Bacteria can spread through the neck space and cause neck cellulitis or parapharyngeal space abscess, followed by systemic sepsis. If the infection is not controlled, it can further exacerbate the formation of mediastinal infections. Myocarditis can occur in a small number of patients.

In addition, some acute pharyngitis shows edema changes or secondary to laryngeal vascular neuroedema; it can also occur alone, but it is rare, and it is easy to develop to the throat, causing suffocation. Patients had a history of intake of eggs, milk, peanuts, or fruit before the onset of illness. Acute edema pharyngitis mainly affects the soft palate, the tonsil area, and the throat entrance. Pharyngeal mucosal edema occurs quickly, is grayish white, translucent, and there is no inflammation. At the beginning of the onset, the patient felt a foreign body sensation in the pharynx, and then quickly had difficulty swallowing and breathing. In severe cases, the throat entrance was blocked and choking occurred.

Diagnosis of Acute Pharyngitis

A clear diagnosis can be made based on typical symptoms, as well as physical and auxiliary examinations.

Differential diagnosis of acute pharyngitis

Measles

Mouth and buccal mucosa can be examined for measles spots, accompanied by ocular conjunctival inflammation.

2. Scarlet fever

It is more common in children, with chills and high fever in the early stages, and typical bayberry tongue and scarlet fever-like rash can appear.

3. influenza

Congestion of the nasal mucosa with systemic aches, weakness, and headaches.

4. Infectious mononucleosis

Fever and sore throat symptoms can occur. The tonsils are swollen, and gray-white discharge can be seen on the surface, which is easy to wipe off. With cervical lymphadenopathy, the white blood cell count decreases early, increases later, and mononuclear cells increase, generally more than 10% as the positive standard. Heterophilic agglutination test was positive.

5. Granulocytopenic angina

Systemic symptoms are severe, tonsils and ulcers in surrounding tissues, brown necrosis, decreased white blood cell count, disappeared neutrophils, decreased platelets, and accelerated erythrocyte sedimentation.

6. Lymphocytic leukemia

Routine blood tests can be distinguished, and bone marrow smears can confirm the diagnosis.

7. Acute myocardial infarction

Patients with unilateral tooth pain or pharyngeal pain on one side and insignificant pharyngeal performance need to be alert for cardiovascular events.

8. Thyroid disease

Pharyngeal discomfort can be the main symptom, and pharyngitis is often misdiagnosed in the early stage. Neck ultrasound is used to confirm the diagnosis.

9. Fenson's angina

It is an ulcerative inflammation, mainly caused by Anaerobic Clostridium and Borrelia infection. Clinical manifestations are mostly sore throat on one side, accompanied by headache and difficulty in opening mouth, and general discomfort. Pharyngeal swab smear examination confirmed Clostridium and Treponema pallidum could be confirmed.

Acute Pharyngitis Treatment

Patients are generally advised to take more rest, drink more water and eat easily digested food, pay attention to smooth stool. Patients with severe throat pain can be given orally with acetylsalicylic acid.

The pharyngeal area can be rinsed with compound borax or warm saline. Alkaline gargle can dilute the viscous secretions. You can use iodine glycerol or silver nitrate to rub the throat wall at the beginning of the disease to help the inflammation subsided. If inflammation affects the throat, a drug aerosol inhalation therapy can be used. The use of hormonal acute aerosol inhalation therapy can improve patients' symptoms and quality of life.

Patients can be treated with antibiotics. Penicillin is generally preferred because it is more effective against hemolytic streptococci.

For throat mucosal necrotic inflammation, it is best to do bacterial culture in time and choose appropriate antibiotics. Penicillin is preferred, and high-dose intravenous infusion. Or choose the appropriate antibiotic according to the drug sensitivity test. For acute necrotizing pharyngitis, a potassium permanganate solution can be used for irrigation in the oropharynx, but it is forbidden to scrape or remove necrotic tissue locally, avoid major bleeding, and disable drug burning.

For acute edema pharyngitis caused by allergies, dexamethasone and antihistamine should be given intravenously after diagnosis. Relief can be achieved and respiratory conditions need to be closely observed. Give oxygen if necessary. If the larynx is involved, treat it as a laryngeal angioedema. A tracheotomy is required if necessary.

Prognosis of acute pharyngitis

After proactive treatment of acute pharyngitis, the prognosis is generally good. Acute necrotizing pharyngitis can cause sepsis, acute laryngitis, pneumonia, neck cellulitis, parapharyngeal abscess, and toxic myocarditis if improperly treated. Among them, toxic myocarditis is fatal and should be highly vigilant.