What Is Chronic Pharyngitis?

Chronic pharyngitis is a chronic inflammation of the pharyngeal mucosa, submucosa, and lymphatic tissue. Diffuse pharyngeal inflammation is often part of chronic inflammation of the upper respiratory tract; localized pharyngeal inflammation is mostly inflammation of pharyngeal lymphoid tissue. The disease is common in the clinic, with a long course and easy to repeat symptoms.

Basic Information

English name: chronic pharyngitis
Visiting department: ENT
Multiple groups: Repeated upper respiratory infections
Common locations: Throat

Common causes: Repeated episodes of acute pharyngitis are the main cause of chronic pharyngitis
Common symptoms: Throat foreign body sensation, secretions are not easy to spit out, dryness or irritation, sore throat
Contagious: no

Classification of chronic pharyngitis

Pathologically, chronic pharyngitis can be divided into the following 5 categories:

Chronic simple pharyngitis

This type is more common and manifests as chronic congestion of the pharyngeal mucosa. The lesions were mainly concentrated in the pharyngeal mucosa, and there was more infiltration of lymphoid tissues around the blood vessels, as well as infiltration of leukocytes and plasma cells. Mucosa and submucosal connective tissue hyperplasia can be accompanied by hypertrophy of mucus glands, hypersecretory function of glands, increased mucus secretion and thicker.

2. Chronic hypertrophic pharyngitis

Also known as chronic granular pharyngitis and pharyngitis, chronic simple pharyngitis can form chronic hypertrophic pharyngitis without prolongation. This type is also common in clinical practice. The pharyngeal mucosal layer is hyperemic and thickened, and there is extensive connective tissue and lymphoid tissue hyperplasia in the mucous membranes and submucosa. The lymphoid tissues proliferate around the mucus glands, showing multiple granular lymphoid follicles in the posterior pharyngeal wall, which can be chronic congestion. Multiple lymphatic follicles can also be fused together. The inflammatory exudate in the mucus gland can be closed, and a cystic white spot is formed on the top of the lymph particle bulge. When it is broken, a yellow-white exudate can be seen. This type of chronic pharyngitis often involves the lymphatic tissue of the pharyngeal cord, making it hypertrophic and cord-like.

3. Atrophic and dry pharyngitis

Rarely clinically. At the beginning of the onset, the secretion of mucus glands is reduced, and the secretions are thick and dry. Subsequent to chronic inflammation of the submucosa, mechanization and contraction gradually occur, compressing the glands and blood vessels, reducing glandular secretion and nutritional disorders, causing the mucosa and submucosa to gradually shrink and become thinner. Dried or pus may be attached to the back of the pharynx, usually with an odor.

4. Chronic Allergic Pharyngitis

Also known as chronic allergic pharyngitis. It is a type I allergy that occurs in the pharyngeal mucosa and is mediated by IgE. Allergens stimulate the mucosa of the pharynx, so that IgM-synthesizing plasma cells are transformed into IgE-synthesizing plasma cells, and IgE is attached to the surface of mast cells and basophils, so that the pharynx is in an allergic state. When the same allergen contacts the body again, the allergen binds to IgE on the surface of the mediator cells, causing the mediator cells to degranulate and release a variety of inflammatory mediators, including histamine and synthetic prostaglandins, which can cause capillary dilatation and blood vessels. Increased permeability and increased glandular secretion cause allergic reactions. Food allergens cause allergic reactions mainly through complement C3 and C4 pathways. Chronic allergic pharyngitis is often associated with systemic allergic diseases or allergic rhinitis, and it can also occur on its own. Seasonal chronic allergic pharyngitis may have seasonal changes in its symptoms. If you are allergic to food, symptoms related to chronic pharyngitis may appear after eating allergenic food.

5. Chronic reflux pharyngitis

Related to gastroesophageal reflux. Gastric juice directly damages the pharyngeal mucosa due to gastroesophageal reflux or causes chronic inflammation of the pharyngeal mucosa and submucosa through nerve reflex. ^[1]

Causes of chronic pharyngitis

The recurrence of acute pharyngitis is the main cause of chronic pharyngitis.

1. Upper respiratory tract lesions adjacent to the pharynx

For example, chronic inflammation of the nasal cavity, sinuses, and nasopharynx can stimulate the mucous membrane of the pharynx due to inflammatory secretions flowing back through the nostril to the pharynx; chronic rhinitis, nasal septum deviation, chronic sinusitis, adenoid hypertrophy, snoring, or nasal cavity Sinus and nasopharyngeal mass occupying lesions affect chronic pharyngitis due to long-term mouth breathing caused by chronic pharyngeal mucosa due to affecting nasal ventilation. Chronic inflammation of chronic tonsillitis can spread directly to the posterior pharynx and cause chronic pharyngitis. ; If oral inflammation can not be controlled in time, chronic pharyngitis can also be caused as the inflammation spreads.

2. Climate and regional environmental changes

Changes in temperature and humidity, poor air quality, tobacco and alcohol irritation, spicy irritating food, dust, harmful gases, and radiation exposure are also the causes of chronic pharyngitis.

3. Occupational factors

Long-term use of a large number of speakers such as teachers, singers and susceptible physical factors can also cause the disease.

4. Systemic factors

Such as anemia, indigestion, gastroesophageal reflux, heart disease (pharyngeal congestion caused by pharyngeal venous reflux due to blood circulation disorders), chronic bronchitis, bronchial asthma, rheumatism, liver and kidney diseases, etc. can also cause chronic pharyngitis. Endocrine disorders, autonomic disorders, infections of Rhinobacillus and diphtheriae, vitamin deficiency and immune dysfunction are all associated with atrophic and xeropharyngitis.

5. Allergic factors

Allergic pharyngitis can be caused by inhaled allergens (including seasonal and perennial allergens), drugs, chemical irritants in the work environment, and food allergens. ^[2]

Clinical manifestations of chronic pharyngitis

Chronic pharyngitis is more common in adults and can also occur in children. Systemic symptoms were not obvious, mainly local symptoms. The symptoms of various types of chronic pharyngitis are roughly similar and varied, such as pharyngeal discomfort, foreign body sensation, pharyngeal secretions not easy to spit out, pharyngeal itch, burning, dryness or irritation, and there may be slight pain. Because the posterior pharyngeal wall is usually adhered to the viscous secretions due to chronic inflammation of the pharynx, and due to nasal, sinus, and nasopharyngeal disease caused by mouth breathing at night, irritating cough and nausea often occur in the morning. Due to pharyngeal foreign body sensation can appear as frequent swallowing. Pharyngeal secretions that are not easy to cough often show habitual dry cough and throat clearing and sputum action. If you cough or clear your throat, you may cause bleeding in the mucous membranes of the pharynx, causing blood in the secretions.

Chronic simple pharyngitis

Examination showed chronic congestion of the pharyngeal mucosa, small blood vessels varicose veins, dark red, and a small amount of sticky secretions on the surface.

2. Chronic hypertrophic pharyngitis

Examination of the pharynx shows multiple granular follicular bulges in the posterior pharyngeal wall, which are chronically congested, sometimes fused together. A cystic white spot can be formed on the top of the lymph granules, and yellow-white exudate can be seen when broken. Lymphoid tissue can be thickened in a cord-like shape.

3. Chronic atrophic pharyngitis or chronic dry pharyngitis

Dry throat attached to the throat with halitosis. Examination showed that the pharyngeal mucosa was dry and thin, and in severe cases it was scaly and shiny. Can cover purulent dryness, and the extension of the lesion to the eustachian tube can cause tinnitus and hearing loss. It can spread to the throat and cause hoarseness.

4. Reflux pharyngitis

Pharyngeal examination is the same as chronic simple and hypertrophic pharyngitis. Throat reflux may be accompanied by vocal nodules and vocal polyps.

The above symptoms are often exacerbated by excessive throat use, sudden weather changes, changes in ambient temperature and humidity, especially atrophic and dry pharyngitis.

Diagnosis of chronic pharyngitis

According to the patient's continuous pharyngeal discomfort for more than 3 months, combined with chronic congestion of the pharyngeal mucosa, small varicose veins, dark red, a small amount of viscous secretions on the surface or multiple granular follicles on the posterior pharyngeal wall. Chronic congestion, thickened pharyngeal lymphoid tissue is strip-like, or pharyngeal mucosa is dry, thin, and covered with purulent dryness, which can diagnose chronic pharyngitis, but it should be noted that the early stages of many systemic diseases (especially tumors) may only be Has similar symptoms to chronic pharyngitis. Therefore, when the main complaint is inconsistent with the findings of the examination or there are other doubts, you should not rashly diagnose chronic pharyngitis. Instead, you must inquire about the medical history in detail and thoroughly check the concealment of the nose, throat, throat, trachea, esophagus, neck and even the whole body Disease to avoid missed diagnosis. In the diagnosis of chronic allergic pharyngitis, in addition to a corresponding history of allergen exposure, corresponding symptoms and signs, a skin allergen test should be performed, and total IgE and serum specific IgE tests should be performed to determine its allergens. Chronic reflux pharyngitis can be examined with gastroesophageal reflux.

Differential diagnosis of chronic pharyngitis

Chronic tonsillitis

It can also manifest as discomfort symptoms such as pharyngeal foreign body sensation, pharyngeal itching, dryness, pain, and irritating dry cough. It can be accompanied by intermittent pharyngeal pomace-like yellow bean dregs with millet grain size and odor. On examination of patients with chronic tonsillitis, tonsils may have hypertrophy, scars on the surface of the tonsils, unevenness, adhesion to surrounding tissues, or emboli in the tonsil crypts.

2. Benign and malignant mass of the pharynx or nearby

Benign tumors such as oropharyngeal and hypopharyngeal papilloma, fibroids, hemangiomas, lipomas, leiomyomas, schwannomas, etc., oropharyngeal and hypopharyngeal, nasopharyngeal, larynx, esophageal malignant tumors such as squamous Cell carcinoma, sarcoma, lymphoma, etc. Oropharyngeal and hypopharyngeal, nasopharyngeal, and laryngeal lesions can be detected by ENT examinations, nasal endoscopy, and fiber laryngoscopes; early esophageal cancer patients often have only pharyngeal discomfort or The sternal pressure is easily confused with chronic pharyngitis and should be diagnosed by esophageal angiography and esophagoscopy. For middle-aged patients, if there is no obvious symptoms of pharyngitis and pharyngeal discomfort, a detailed examination should be performed accordingly.

3. Styloid process syndrome, hyoid bone syndrome and pharyngeal susceptibility

May have the same pharyngeal symptoms. Chronic pharyngitis was identified by palpation, X-ray of styloid process and hyoid bone, X-ray of cervical spine and CT scan.

4. Tuberculosis

In addition to pharyngeal tuberculosis, patients with tuberculosis are often accompanied by chronic pharyngitis.

5. Gamma globulin deficiency

The disease is prevalent in children and young people, and has a history of recurrent acute or chronic respiratory inflammation. The pharynx changes to a significant reduction or disappearance of lymphoid tissue.

Chronic Pharyngitis Treatment

Remove the cause

Quit smoking and alcohol, and actively treat the primary causes of chronic pharyngitis (acute pharyngitis, chronic inflammation of the nose and nasopharynx, reflux gastroesophageal disease, and improve working and living conditions).

2. Lifestyle changes

Perform proper physical exercise, normal work and rest, light diet, and maintain a good psychological state to improve the local functional status of the pharyngeal mucosa by enhancing its overall immune function.

3. Local treatment

(1) Chronic simple pharyngitis is usually rinsed with compound borax, furacillin solution, etc., to keep the mouth and throat clean; or iodized laryngeal tablets, peppermint throat tablets, etc., which are used to treat chronic inflammation of the pharynx; Pharyngitis also has a certain effect; topically, compound iodine glycerol, 5% silver nitrate solution or 10% weak protein silver solution can be applied to the pharynx, which has astringent and anti-inflammatory effects; ultrasound atomization can relieve the symptoms of chronic pharyngitis; antibiotic treatment is generally not required .

(2) The treatment of chronic hypertrophic pharyngitis is difficult. You can refer to chronic simple pharyngitis. In addition to the above methods, it is also possible to treat the raised lymph follicles in the posterior pharyngeal wall. Chemical drugs or electrocoagulation, freezing or laser treatment can be used. For chemical drugs, 20% silver nitrate or chromic acid solution is mostly used to burn the enlarged lymph follicles. Electrocoagulation is rarely used because of its many side effects. Laser or radio frequency therapy is often used to treat lymphopharyngeal follicles. The above methods for treating lymphoid follicles may increase mucosal scars and may exacerbate symptoms. In addition, ultrasonic nebulization therapy, local ultraviolet irradiation, and diathermy therapy can also help hypertrophic pharyngitis.

(3) Atrophic and dry pharyngitis is generally treated the same as chronic simple pharyngitis, but cauterization cannot be used. Can take or topically apply a small dose of iodine to the throat to promote increased mucosal epithelium secretion; ultrasonic nebulization can also reduce the symptoms of dryness. Taking vitamins A, B2, C, and E can promote the growth of pharyngeal mucosal epithelium. For patients with dry pharyngitis, care should be taken when considering tonsillectomy to avoid exacerbation of the postoperative condition.

(4) Avoid chronic allergic pharyngitis, avoid contact with various possible allergens, apply antihistamines or mast cell stabilizers, apply glucocorticoids and immune modulators locally or in the short term.

(5) Chronic reflux pharyngitis Avoid eating foods that promote gastric acid secretion, such as chocolate, spicy foods, etc. to reduce throat reflux to reduce irritation of the pharyngeal mucosa; control water intake 3 to 4 hours before bed . On the basis of general treatment of chronic pharyngitis, gastric acid inhibitors and gastric mucosal protective agents can be used in combination with treatment, and at the same time, gastric diseases can be actively treated. ^[3]

Prognosis of chronic pharyngitis

Chronic simple pharyngitis can be relieved until cured after controlling various pathogenic factors, maintaining good living habits and applying various treatments, otherwise it may be prolonged into chronic hypertrophic pharyngitis; The treatment effect is not good, and the symptoms are easy to repeat. The symptoms of chronic allergic pharyngitis can be alleviated to disappear after detachment from the allergen. The symptoms of chronic reflux pharyngitis can be significantly relieved until cured.

Chronic pharyngitis prevention

1. Avoid repeated episodes of acute pharyngitis.

2. Perform proper physical exercise, maintain a healthy routine, light diet, keep your mouth clean, avoid tobacco and alcohol stimuli, and maintain a good attitude to improve your overall immunity.

3. Avoid contact with dust, harmful gases, irritating food, poor air quality environment and other irritating factors to the pharynx.

4. Actively treat local related diseases that may cause chronic pharyngitis: such as chronic inflammation of the nasal cavity, sinuses, and nasopharynx; chronic rhinitis, deviated nasal septum, chronic sinusitis, adenoidal hypertrophy, snoring, etc. Inflammation; oral inflammation; gastroesophageal reflux.

5. Actively treat systemic related diseases that may cause chronic pharyngitis: such as anemia, indigestion, gastroesophageal reflux, heart disease, chronic bronchitis, bronchial asthma, rheumatism, liver and kidney diseases, etc.

6. Avoid prolonged overuse.

7. Try to avoid contact with allergens that cause chronic allergic pharyngitis.

References:

[1] Li Xuepei. Otorhinolaryngology [M]. Beijing: Peking University Medical Press, 2003: 102-104.

[2] Huang Xuanzhao, Wang Jibao, Kong Weijia. Practical Otolaryngology Head and Neck Surgery [M]. Beijing: People's Medical Publishing House, 2008: 2008: 317-319.

[3] CummingsCW, FredericksonJM, HarkerLA. Otolaryngology-HeadAndNeckSurgery [M]: 3rdedition. USA: Mosby-YearBook, 1999: 1327-1524.