Diagnosis and treatment of chronic pharyngitis in children (Alexandrov)

Author:

• Ustinova Marina Ivanovna

  otorhinolaryngologist of the highest qualification category

5.00 (Votes: 1)

Pharyngitis is a replenishment of the mucous membrane and lymphoid tissue of the oropharynx. Pharyngitis can be caused by both viral and bacterial infections. As a rule, the share of viral infections of the pharynx in children accounts for about 70%.

Causes of pharyngitis in children

Pharyngitis occurs due to the ingress of various viruses and bacteria.

There are also a number of factors

that increase the likelihood
of developing the disease:

• hypothermia;
• decreased immunity;
• throat irritation from smoke, dust and chemicals;
• lack of vitamins and microelements;
• diseases of the stomach and intestines;
• disruption of the endocrine system;
• allergic reactions.

Acute pharyngitis can also be a manifestation of inflammatory pathology of the upper respiratory tract, intestinal and general infections, etc. Viruses have little effect on the development of the disease. Usually this is a herpes and influenza virus, enterovirus, adenovirus. Among the bacterial pathogens are Haemophilus influenzae, moraxella, diplococci, streptococci of groups C, A, G, etc.

Pharyngitis can develop against the background of a fungal infection. In general, pharyngitis of viral origin accounts for 70% of cases, bacterial and other – 30%. Pharyngitis can be accompanied by measles, ARVI, scarlet fever, etc. In some cases, the causes may be foreign bodies in the pharynx or burns in this area. The chronic form of the disease is usually associated with other diseases of the ENT organs of an inflammatory nature - adenoiditis, rhinitis, stomatitis, sinusitis, tonsillitis, etc.

Risk factors

Risk factors contributing to the development of pharyngitis include:

• the child eating food that is too cold (for example, ice cream);
• improper breathing (through the mouth), especially in winter;
• low level of immunity;
• lack of vitamins in the body;
• diseases of the gastrointestinal tract and endocrine system.

Allergic reactions can also provoke the occurrence of pharyngitis.

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Types of disease

According to the nature of the course, the disease is divided into:

• acute – lasts up to 1 month;
• protracted – lasts more than six months with frequent exacerbations;
• chronic - can occur in several forms - atrophic, catarrhal, hypertrophic.

according to the condition of the mucous membrane :

• catarrhal – characterized by swelling and redness of the mucous membranes;
• hypertrophic - with it the mucous membrane thickens because the epithelium grows;
• subatrophic - the mucous membrane becomes thinner and atrophies.

Classification

Based on the course, acute, subacute and chronic forms of pharyngitis are distinguished. There is also a classification based on the condition of the pharyngeal mucosa. With catarrhal pharyngitis, the pharynx looks swollen, hyperemic, with the mucous membrane gradually acquiring a characteristic gray-pink hue. With the hypertrophic form of pharyngitis, the mucous membranes of the larynx and pharynx become thicker, with hypertrophic growth of ridges on the side of the pharynx. The palatine arches also thicken, and granulosa and nodular formations are observed at the back of the pharynx.

The subatrophic type of pharyngitis leads to focal or diffuse thinning of tissue. In this case, the mucous membranes look pale, atrophied, with thinned blood vessels.

Symptoms and signs of pharyngitis in a child

The main signs of pharyngitis in children are:

• moderate pain;
• sore throat.

Hoarseness of voice and dry cough may also be observed. And with the reflux nature of the disease, there is a feeling of bitterness in the mouth.

In the acute form, the signs are as follows:

• dry throat, rawness, burning, soreness when swallowing;
• hoarseness of voice;
• shallow cough;
• high temperature if the disease develops against the background of a virus;
• headache;
• signs of general intoxication;
• enlargement of regional lymph nodes. Source: T.V. Kulichenko, A.M. Kabaloeva, Yu.S. Lashkova, M.A. Lazareva Diagnosis of acute pharyngitis in children // Pediatric pharmacology, 2014, v. 11, no. 4, pp. 59-66

In infants, the disease is more severe:

• sleep disturbance;
• fever;
• salivation;
• decreased appetite;
• swallowing disorder;
• conjunctivitis;
• runny nose;
• rashes on the body;
• discomfort and pain in the upper abdomen.

The chronic hyperplastic form is characterized by thickening of the mucous and submucosal layer, lymphoid tissues, dryness and sore throat, urge to vomit, painful swallowing, which radiates to the ear. Sometimes hearing loss develops because thickened tissue blocks the openings of the auditory tubes.

Usually, with pharyngitis, the temperature rises slightly. Temperatures above 38-39 degrees can only be observed if the tonsils are involved in the process.

If your child has a high fever, you should immediately consult your doctor. Experts do not recommend treating tonsillitis in a child without supervision from a pediatrician, since if treated incorrectly, the disease can lead to complications.

If pharyngitis does not go away for a long time, then it is necessary to look for the true cause of the disease.

Chronic pharyngitis

Unlike acute pharyngitis, chronic pharyngitis is caused primarily by non-infectious factors. The disease is considered chronic if symptoms of inflammation of the pharynx are observed for more than 4 weeks a year3.

The cause of chronic pharyngitis can be 3:

• gastroesophageal reflux disease, in which the acidic contents of the stomach are thrown into the esophagus and pharynx, irritating the mucous membrane and causing inflammation;
• chronic diseases of the digestive system, for example, gastritis, cholecystitis, pancreatitis;
• diseases of the cardiovascular, urinary and endocrine systems;
• smoking, abuse of strong alcoholic drinks;
• frequently exacerbating allergic diseases;
• long-term inflammatory diseases of the nose and nasopharynx, when mucus containing microbes constantly flows down the back wall of the throat, and due to nasal congestion, patients have to breathe through the mouth;
• abuse of vasoconstrictor drops, which cause spasm of blood vessels in the mucous membrane, impair its blood circulation and reduce local immunity;
• occupational factors, such as inhalation of contaminated, excessively hot and cold air3.

The risk of chronic inflammation of the pharyngeal mucosa is higher during menopause, diabetes mellitus, thyroid dysfunction and other endocrine disorders1,2. In addition, the course of the disease is affected by chronic stress, unbalanced nutrition and lack of vitamins, leading to a general weakening of the immune system1,3.

Depending on the processes occurring in the mucous membrane of the pharynx, chronic pharyngitis can be:

• catarrhal - the wall of the pharynx looks red and swollen;
• hypertrophic - the mucous membrane of the pharynx and palatine arches becomes red, thickens, enlarged lymphoid follicles and a certain amount of mucus appear on its surface;
• atrophic - the pharyngeal mucosa is dry, thin, dilated blood vessels are visible through it.

Symptoms of chronic pharyngitis

The disease occurs with alternating periods of exacerbation and remission, when the symptoms of the disease disappear or become less pronounced2. An exacerbation is most often associated with viral or bacterial infections, and its symptoms resemble those of acute pharyngitis3.

During the period of remission the following may remain1,4:

• soreness and dryness in the throat, more pronounced in the atrophic form;
• discomfort associated with the need to swallow mucus that accumulates on the back wall of the throat;
• feeling of a “lump” of mucus in the throat and the desire to cough;
• some enlargement and tenderness of the upper cervical lymph nodes.

Chronic pharyngitis, unlike acute pharyngitis, is not characterized by an increase in body temperature4. There is no significant deterioration in general condition either. However, due to discomfort in the throat, irritability often occurs and sleep is disturbed4.

Symptoms of chronic pharyngitis can be a manifestation of various serious diseases, so you should consult a doctor in any case4.

to come back to the beginning

Diagnostic methods

The diagnosis and treatment of tonsillitis in a child is carried out by a pediatrician or otolaryngologist. This disease must be distinguished from other infectious pathologies, including diphtheria and catarrhal tonsillitis. Therefore, you should also contact a pediatric allergist-immunologist and infectious disease specialist. After the examination, the doctor will prescribe laboratory tests (smear for microflora and sensitivity to viruses, bacteria, general blood test. Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807738/ Thea Brennan-Krohn, Al Ozonoff and Thomas J. Sandora Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study // BMC Pediatr. 2018; 18: 43

For recurrent forms of the disease, endoscopy of the nose and nasopharynx, consultation with an allergist, examination by a gastroenterologist, and endoscopy of the larynx will be required. All this is necessary to identify the true nature of the pathology.

Complications

Pharyngitis is a safe disease that responds well to treatment, provided it is properly managed. If a chronic form develops, in which the symptoms become permanent, it poses a great danger and is difficult to treat. She often quotes:

• to chronic bronchitis;
• laryngitis;
• tracheitis.

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In severe cases, the development of peritonsillar abscess or acute rheumatism of the joints is possible (if pharyngitis was caused by group A beta-hemolytic streptococcus).

Treatment of pharyngitis in children

How to treat this pharyngitis depends on the root cause of this disease in children . It is also necessary to eliminate unpleasant symptoms and generally strengthen the body.

Treatment of pharyngitis in a child includes:

• gargling with herbal decoctions or antiseptics (for children over three years old);
• antiseptics - for rinsing and local - lozenges and lozenges;
• anti-inflammatory drugs;
• antibacterial therapy;
• a gentle diet (excluding foods that irritate the mucous membrane);
• inhalation with a nebulizer to moisturize the mucous membrane with solutions based on mineral waters. Source: T.A. Polunina, E.V. Vishneva Pharyngitis in children // Pediatric pharmacology, 2011, vol. 8, no. 5, pp. 106-108

Also for the treatment of pharyngitis, antihistamines are indicated to relieve swelling, humidify the air in the room to facilitate breathing, inhalation, and vocal rest. It is advisable that the child’s diet include food that does not irritate the throat - pureed, liquid, soft, non-spicy.

Conservative therapy

All foods that irritate the mucous membrane of the mouth and pharynx should be excluded from the diet (too hot, cold, sour or salty). If a child is already three years old, he should be taught to gargle. It is recommended to consume foods in liquid form to make it easier for children to swallow.

Antiseptics are prescribed as therapy, and if the disease is bacterial in nature, antibiotics are prescribed, especially if we are talking about group A beta-hemolytic streptococcus. As is known, it is particularly dangerous and can cause the maximum number of complications. At high temperatures, it is advisable to prescribe non-steroidal anti-inflammatory drugs.

Alkaline drinking and inhalations are also indicated (they can be compressor or ultrasonic). If there is a history of laryngospasm or false croup, parents should always have inhalations at hand in order to promptly introduce one of the hormones into the child’s body - before the ambulance team arrives. Antihistamines are used to relieve swelling.

It is important to ensure vocal rest with limited communication.

Clinical recommendations for prevention

It is necessary to strengthen the child’s immunity - carry out regular hardening exercises, adjust the diet so that healthy and vitamin-rich food predominates in it, and take walks in the fresh air more often. In addition, it is necessary to promptly and completely cure infections of the respiratory tract and oral cavity, not to cause caries, otitis media, sinusitis, and stomatitis. It is important to prevent and promptly treat gastrointestinal diseases. To prevent the disease from becoming chronic, you must consult a doctor in a timely manner.

The children's medical department has all the capabilities to treat various diseases, including pharyngitis. Doctors at the medical center will diagnose and prescribe treatment as soon as possible.

Sources:

1. T.V. Kulichenko, A.M. Kabaloeva, Yu.S. Lashkova, M.A. Lazarev. Diagnosis of acute pharyngitis in children // Pediatric pharmacology, 2014, vol. 11, no. 4, pp. 59-66.
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5807738/ Thea Brennan-Krohn, Al Ozonoff and Thomas J. Sandora. Adherence to guidelines for testing and treatment of children with pharyngitis: a retrospective study // BMC Pediatr. 2018; 18:43.
3. T.A. Polunina, E.V. Vishneva. Pharyngitis in children // Pediatric pharmacology, 2011, vol. 8, no. 5, pp. 106-108.

Zaichenko Vladislav Sergeevich Clinic

Author of the article

Zaichenko Vladislav Sergeevich

Specialty: otolaryngologist

Experience: 18 years

The information in this article is provided for reference purposes and does not replace advice from a qualified professional. Don't self-medicate! At the first signs of illness, you should consult a doctor.

Prevention of pharyngitis

Everyone knows that it is much easier to prevent a disease than to subsequently treat it. In order to avoid the development of pharyngitis, the following rules must be followed:

• Try not to overcool the body.
• Limit the consumption of cold and hot foods, as well as the intake of cold and hot drinks.
• Stop smoking in the presence of your child.
• Regularly carry out wet cleaning of rooms.
• Make sure that your breathing is correct (the child should breathe through his nose - this is how the air warms up and is neutralized).
• Visit a doctor promptly if there is any suspicion of pathology of the throat and nose.

By following these rules, you can reduce the risk of developing ENT diseases in your child to a minimum.
“SM-Doctor” is a specialized clinic for children and adolescents, staffed by qualified specialists who regularly improve their professionalism. We examine and treat children in accordance with world-class medical guidelines. “SM-Doctor” provides only reasonable diagnostics and proven effective treatment. Contact professionals so that your child has good health and strong immunity!

Causes

In the vast majority of cases, the disease is caused by viruses, sometimes by bacteria and fungi. A healthy person can independently cope with those infectious agents that enter the mucous membrane, and with any weakening of the immune system, inflammation begins. Changes in general and local immunity are important. Local immunity is a cellular response of the pharyngeal mucosa, the capture and destruction of harmful agents by lymphocytes.

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Pharyngitis often occurs simultaneously with sore throat, measles, influenza, ARVI, and rubella. The main viruses that cause damage to the pharynx:

• rhinoviruses;
• adenoviruses;
• coronaviruses;
• influenza viruses;
• herpes simplex virus;
• cytomegalovirus;
• Epstein-Bar virus;
• Coxsackie virus.

The rapid spread of infection is facilitated by the anatomical structure of the pharynx, which consists of 3 parts: nasal, oral and hypopharynx. The division into these parts is conditional; the pharynx connects the nose, mouth, esophagus and larynx. The nasopharynx receives the choanae or internal nasal openings, the Eustachian tubes or canals from the middle ear, and the anastomosis from the paranasal sinuses.

Infectious agents that enter the mucous membrane of the upper respiratory tract find themselves in an excellent nutrient environment, where it is warm and humid, there is intense blood circulation, and there is the possibility of rapid reproduction.

The anatomical features of the pharynx and the high ability of viruses to quickly reproduce themselves lead to the fact that viral infections of the upper respiratory tract spread among people like wildfire. During seasonal surges, the infection is transmitted in 3 ways: airborne droplets, contact and household contact. The infection develops especially quickly in children attending children's groups.

What are the forms of pharyngitis?

Symptoms and treatment of pharyngitis in adults and children vary depending on the form of the pathology in the patient. Inflammation of the pharyngeal mucosa can be acute or chronic.

Acute pharyngitis often develops as a result of chemical and thermal burns, massive and infectious infections

Chronic pharyngitis is the result of untreated acute inflammation. As a separate pathology, it occurs during prolonged contact of the mucous membrane with slowly acting irritating factors. Among them, special mention should be made of smoking, the polluted and dusty atmosphere of industrial cities, as well as occupational hazards. According to statistics, chronic pharyngitis is detected in 7–8% of the adult population. This disease is the most common diagnosis when visiting otolaryngologists at SM-Clinic.

Complications of pharyngitis due to improper self-medication and lack of treatment

The spread of infection leads to complications of an inflammatory nature: sinusitis, otitis, bronchitis, etc. But the long-term consequences of streptococcal pharyngitis pose a much greater danger. This microorganism provokes immune aggression against the body's own tissues, which causes endocarditis - inflammation of the inner lining of the heart, glomerulonephritis - pathology of the kidneys and joints.

Long-term consequences can lead to disability and even death of the child.

Surgery

For some forms of pharyngitis, surgical treatment is sometimes used. We are talking about modern laser technologies that effectively stop inflammatory processes and eliminate circulatory disorders. Thanks to this treatment, you can quickly relieve all pathological symptoms - in the form of swelling, dry throat, pain and cough. If we compare laser surgical treatment with other methods, it is the most gentle of all, which helps to increase the effectiveness of the procedure and significantly reduces the rehabilitation period.

The fourth generation carbon dioxide laser is used for treatment. The manipulation itself is not invasive. It is non-contact, there is no direct intervention into the tissue. Thanks to built-in technologies, doctors completely visually control the entire process, so the procedure is absolutely safe.

Diagnosis of pharyngitis

Ignoring a sore throat is a mistake and extremely dangerous. Difficulty swallowing can occur with a sore throat, inflammation can spread to the middle ear or turn out to be a manifestation of diphtheria, a severe infection.

In a typical case of pharyngitis, diagnosis begins with an examination performed by an otolaryngologist using a headlight and instruments. Only a doctor can distinguish simple catarrhal inflammation from scarlet fever, measles or rubella, which require completely different medical measures.

To clarify the diagnosis, CELT specialists confirm the diagnosis with bacterial smears, laboratory and other necessary examinations. In case of concomitant diseases, related specialists are involved for consultation.

Manifestations of pharyngitis

It all starts with discomfort in the throat, when a sore throat appears and it becomes difficult to swallow due to pain. The pain is less acute than with sore throat or acute tonsillitis, but is constant. Body temperature rarely rises or reaches subfebrile levels. If pharyngitis occurs as part of an acute respiratory viral infection, the condition is accompanied by symptoms of general intoxication. With chronic pharyngitis, bad breath may appear.

Manifestations in children and adults also include ear congestion because the lining of the eustachian tube swells. Almost always, inflammation is accompanied by enlargement of the lymph nodes - submandibular and occipital, which are easy to feel under the skin. A dry cough may be bothersome, which is caused by irritation of the larynx, and not inflammation of the bronchial tree.

Symptoms of general intoxication are mild and include headache, some weakness, and weakness.