Describe acute and chronic pharyngitis.

Acute and Chronic Pharyngitis

• Pharyngitis is inflammation of the pharyngeal mucosa, most often as part of a generalised upper respiratory infection.
• It is extremely common, viral and self-limiting — and is the commonest reason antibiotics are prescribed unnecessarily.
• Acute pharyngitis — the great majority is viral (rhinovirus, adenovirus, influenza, parainfluenza, coronavirus, Epstein-Barr); the important bacterial cause is group A streptococcus
• The features favouring a virus — cough, coryza, hoarseness, conjunctivitis, oral ulcers and diarrhoea. Each of these points away from streptococcus, and their presence is as informative as the Centor criteria are in the other direction
• Management is symptomatic — analgesia, fluids, rest, salt-water gargles and lozenges; with antibiotics reserved for likely streptococcal infection
• Specific forms worth recognising — gonococcal pharyngitis, frequently asymptomatic, in those with orogenital contact; acute HIV SERO-conversion, presenting as a glandular-fever-like illness with pharyngitis, rash, mouth ulcers and lymphadenopathy.
• Chronic pharyngitis is a persistent, low-grade inflammation causing a dry, irritable, tickling throat, a sensation of a lump, an irritating cough, and frequent throat-clearing
• Its causes are mostly environmental and behavioural rather than infective.
• Smoking and passive smoke; alcohol; dust, chemical fumes and occupational exposure; mouth breathing from nasal obstruction.
• Postnasal drip from chronic rhinosinusitis or allergic rhinitis.
• Laryngopharyngeal reflux, which is probably the commonest cause of a chronic sore or irritable throat in adults and is frequently unrecognised because heartburn is often absent
• Voice abuse and habitual throat-clearing, which becomes self-perpetuating — clearing irritates, which prompts more clearing
• Dry environments, air conditioning and dehydration; drugs, particularly ACE inhibitors (cough) and inhaled steroids; and mouth-breathing during sleep in OSA
• Chronic granular pharyngitis shows hypertrophied lymphoid granules on the posterior wall; and atrophic pharyngitis (pharyngitis sicca) shows a dry, glazed, crusted pharynx, frequently accompanying atrophic rhinitis
• Management is to find and remove the cause — stop smoking; treat nasal obstruction and postnasal drip; treat reflux with lifestyle measures and a proton pump inhibitor for an adequate trial of 2 to 3 months; humidify and hydrate; voice care and breaking the throat-clearing habit, substituting a sip of water or a silent swallow; and review the drugs
• What must BE excluded — any persistent unilateral sore throat, referred otalgia, dysphagia, hoarseness beyond 3 weeks, a neck lump or weight loss is a malignancy until proved otherwise, and requires examination of the throat and larynx, endoscopy and urgent referral
• Cough and coryza point away from streptococcus, and are as informative as the Centor criteria in the other direction